Art. II.???A Critical Inquiry into the Management of the Perineum during Labour

The unkindest cut?

“…Goodell disdainfully summarized the state of perineal care in 1871: “Wonderful, wonderful, and yet again wonderful diversities of opinion!” As an example, he cited obstetricians who advocated pushing the perineum backward and those“… who, for equally plausible reasons, push it forward.” Goodell concluded that applying direct support to the perineum did not substantially reduce lacerations . Instead, he advocated pulling the sphincter ani up and forward toward the pudendal area to imitate natural anal and perineal dilation.…”

Perineal injury associated with hands on/hands poised and directed/undirected pushing: A retrospective cross-sectional study of non-operative vaginal births, 2011–2016

“…Severe perineal injury involving the anal sphincter (3 rd degree) or anal epithelium (4 th degree), occurs in up to 6% of all vaginal births (Ampt et al, 2015, Ismail andPuyk, 2014) with approximately half resulting in medium to long term health implications such as bowel incontinence (Smith et al, 2013, Suto et al, 2015. Various strategies that can be used by clinicians to reduce the incidence of perineal trauma have been debated in the literature since the 19 th century (Goodell, 1871).…”