> Più careful and less cuts (caesarean): the episiotomy

In this context, the woman plays a passive role and the operator, by acting on his body, attaches itself the exclusive jurisdiction of the place in the world.

Where are the ongoing projects of reduction in medical interference in the evolution of spontaneous labor, è the different arrangement of the actors on the scene of the birth, limiting the interventions provided on the body of the woman, reduces the use of episiotomy.

The review of the available studies in the literature confirmed that the use ofepisiotomy reduces any trauma to the perineum in the rear, and the needà of the sutures, solutions, continuityà (spontaneous or surgical) of the posterior perineum.

These studies, however, do not take into account the effect of the vertical positions in the period of expulsion on the integrityà perineal.

it Is assumed that the vertical positions can help to prevent lacerations, spontaneous, and to reduce the use of episiotomy), becauseé have resulted in lower stresses perineal area and allow a better effectiveness of the efforts end numbered.

The scientific review in this regard indicates that the vertical position allows a lower frequency of trauma pussy-perineum requiring suturing, without a simultaneous increase of the lacerations of the third degree, and no significant differences in neonatal outcomes.

The perineum is a very complex structure, è consisting of three layers of muscle fibres, smooth and striated; the three planes of the perineum, respond each to different functions and are complementary.

The più deep &is the main inductor of the deflection and rotation of the fetal head, help, così the progression of the child toward the median plane and, finally, towards the surface.

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the latter, with their total relaxation, induce the disengagement of the fetal head. The perineum surface is that on which the midwife intervenes for the practice of episiotomy; è formed by the muscle bulb cavernosum or constrictor of the vagina, and from the transverse surface.

These muscles, which are engraved in order to anticipate the disengagement of the fetal head, can not be considered as real obstacles to the birth of the child, who has già realized with the progress of the distension of the deepest layers.

During the expulsive phase of parturition these muscle fibres extend in the vertical direction and stretch by encouraging, through a kind of peristalsis, the progression toward the outside of the part submitted.

But becauseé the main function of the perineum is to protect and contain the internal organs, the baby, the emotions, the integrityà), this body is extremely sensitive to signs of danger, and at the slightest alarm puts you in a state of defence, and freeze and holding the contents and visceral.

The perineum, and is symbolically is the organ of self-preservation and integrityà; &is the seat of important neurovegetative functions and instincts related to survival; it is considered to be the seat of the unconscious and stimulates the production of hormones (oxytocin, endorphins, adrenaline). The dangers can come from within, from the relationship that women have with their body and with the sessualità.

But can also come from the outside: the function of involuntary perineum reflects all factors, braking, hostile to openness, are favourable to the stiffening.

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The perineum is contracted just warns of the danger or, in the case of childbirth, it reverses the peristalsis from the outside towards the inside, holding the child with the same force with which it was bringing the outside in.

If the goal is a perineum relaxed and yielding, that go with you and not in contrast with the release of the child, and of which it is possible to preserve the integrityà, you will haveà take part on three factors: the environment, support, give confidence and intimacyà; the woman who is aware of his needs and that can respond to them, with the position that his body spontaneously assumes and with the rhythm of his breathing; the perineum itself that should be able to receive a contact that is respectful and delicate.

The fourth factor is implicit and indispensable regard to the professionalismà of the midwife, responsible of the respect of the physiology of childbirth and of the effectiveness of the procedures of assistance.

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