Doctor’s thoughts on prevention of serious tears during labor:
 
1.     Create a common concept about the work, doctor and midwife should follow the same principles. We speak the same language, have the same routines, work in a similar way because we have the same goal.
2.     There is no prestige involved when it comes to protecting the perineum. An open environment between doctors and midwives regardless of age and experience. Everyone can improve and learn from each other!
3.     It takes time to change the way of working and everyone has their own learning curve in terms of grip and episiotomy.
4.     Be critical towards yourself. Look up your statistics and evaluate every single case objectively. Should I have done something differently? How can I get better? Do not be scared to ask a colleague who has better results!
5.     Learn how to do a vacuum delivery and how to protect the perineum, at the same time! It is a craftsmanship that requires a lot of practice and time.
6.     Be patient during a vacuum delivery. Is it really so important that the baby will be delivered during 1 or 2 tractions? Consider letting the head slide out during the last uterus contraction while the woman is breathing.
7.     Learn how to conduct a correct episiotomy and to suture in a secure way. Only a correct episiotomy on the right indication can prevent serious sphincter tears. You will have the courage to do an episiotomy if you feel that you master the technique.
8.     Learn different analgesic methods that helps you in your work. Local anesthesia, inner PDB, outer PDB.
9.     Share your experience with your colleagues.
10.  Accuracy in documentation regarding risk assessment, handling, different grips, and follow-up. This is a foundation for evaluation, open comparisons, and future improvements in work.
10+1 Your knowledge and experience create security around you. A delivering woman has the biggest need for you feeling secure.