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Anal sphincter rupture during delivery: philosophy of science and clinical practice.

Sometimes, the relationship between cause and effect is so logical or so obvious that it is barely debated. If a person is bleeding to death, logic dictates that the bleeding must be stopped. The effect of morphine on patients with severe pain is not doubted by those who have seen the effect a few times. But these are the exceptions. As a rule, the effects of what we do are by no means so obvious. One relevant example is the use of perineal support to prevent serious tearing during delivery (anal sphincter rupture) (1).