STUDIO OSSERVAZIONALE SULLE STRATEGIE DI ASSISTENZA OSTETRICA AL SECONDO STADIO DEL TRAVAGLIO PER LA SALVAGUARDIA DELL’INTEGRITÀ DEL PERINEO NEL PARTO A BASSO RISCHIO

Purpose: to identify the relationship between the integrity of the maternal perineum at the end of the second stage of labor and the technical and relational strategies that midwives applied to reduce perineal trauma aiming for his integrity. Materials and methods: the study consists of two phases; were collected in the first 600 normal chilbirths from the register of two Milanese Birth Centers (total of 1200 shares) that occurred between January and April-May 2014 and have identified six midwives (three to hospital) who had performed the lowest percentage of episiotomies and the highest percentage of intact genitals during the care of marked parts. In the second phase, were observed only those 16 births expulsive periods attended by midwives chose, in different shifts of the two hospitals between July and October 2014, scoring some aspects of an observation grid. Was subsequently administered a questionnaire to the same midwives for more information on the strategies they consider effective for protecting the integrity of the perineum. Results: the strategies most commonly used by the midwife were: • invite the woman to push spontaneously without closing the glottis (69%); • use of the 'oil to' outcrop and the crowning of the fetal presenting part (75%); • a mode is a service corridor of the presenting part of "hands poised " (attitude of watchful waiting with your hands away from the perineum but already in a position to intervene if served) in 38% or hands off (3 of 5 midwives interviewed) as is clear from the questionnaire; • the midwife expects the fetal head leftovers and retreats to further the progressive relaxation of the maternal tissues (element present in all deliveries observed); • invite the woman to keep the pressure immediately after the crowning of the fetal head at the time of the disengagement of the presenting part of the shoulder and back (element present in all parts observed); • create a peaceful environment, preserve the intimacy of a woman using a communication that includes the words of confirmation, knowing r rd, exchange of information, reassurance and encouragement ; • not encouraging women to actively push before the perception of the feeling of irrepressible push (88%); • perform episiotomy only if the perineum by clear signs of impending laceration (polished, tense, purplish-red or white) and in the presence of past wounds of 3rd or 4th grade; • provide a one assistance - to - one (all midwives interviewed consider it very important); The maternal positions considered most effective for the protection of the perineum is unclear as there is a discrepancy between the observational study and the questionnaire distributed to midwives. From the first it is clear that the position is the one used most maternal supine; the second shows that the supine position is the only one that is never mentioned among the maternal positions considered to be effective. Conclusion: protecting the integrity of the perineum is subject to many variables that are inseparable from the commitment that puts the operator in order to avoid an episiotomy or a spontaneous tear. The present study shows what are the strategies that the midwife put in place to increase the protection of the integrity of the maternal perineum.