**6. Discussion**

In 2007 the National Ministry of Public Health published the clinical guide for humanized care during delivery with the main objective of providing access to all pregnant women for appropriate professional assistance during labor and delivery. This assistance guideline draw attention to intra-partum fetal monitoring and other medical interventions such as episiotomy practice. In spite of the recommendation regarding this practice, few other aspects are addressed namely the competencies needed to perform this intervention in order to avoid tears and other adverse events.

Our study demonstrates that near 30% of professionals lack specific episiotomy technique training. This aspect is thoroughly relevant in light of the international evidence assuring that a correct execution of the episiotomy may have significant implications in OASIS. This is the reason why many authors endorse supervised episiotomy practice when training midwives and doctors, with a minimum number of ten before they are permitted to practice [29].

Individual interpretation of whatever particular situation for practicing episiotomies varied among participants of our study. This aspect was also observed in the study published by Gonzalez-Diaz et-al (2015) [30] therefore it is pertinent to regulate this practice and secure a uniform standard technique, also to establish a common and precise criteria with regard to specific clinical situations that need to be approached by this intervention [30].

Although there are post graduate episiotomy training opportunities, still we have professionals that do not perform this technique in a correct fashion.

Considering the international recommendations, when the third stage of labour is completed, a rectal examination should be carried out in order to correctly assess

rectal sphincter injuries [30]. We point out that 46,7% of our participants did not perform this recommendation in every delivery, of these, 5.4% revealed they never practiced the examination and 1.6% performed rectal examination solely under rectal bleeding, also 1.6% respondents when assisting an instrumental delivery.

Following data analysis, it becomes evident that there is a need of a particular guideline for health professionals addressing the correct management of perineal injury prevention and a precise practice of episiotomy. Also, there is the need to promote more training at midwifery and medical schools so to secure the precise abilities and practical skills to correctly perform this technique. At the same time, we should broaden the capacity of continuous training courses for these professionals.
