A common practice during childbirth is episiotomy — a small incision in the perineum — the area between the vaginal and anus — to make it easier for the baby to pass through the birth canal. An episiotomy helps to avoid vaginal rupture, which is harder to suture after childbirth. Often an episiotomy is necessary at the birth of a large child, and it is very important to know how to care for the area of the episiotomy in order to avoid complications and speed up the recovery process.
Childbirth is not always a simple process, very often after it there are any injuries - gaps and sections of the genital tract, on which the external and internal sutures are superimposed. Injuries can be internal - tears on the cervix or vagina, as well as external - tears and incisions of the perineum itself.
After the end of the birth, which took place in a natural way, the obstetrician himself checks for gaps and, upon detection, sutures them. If suturing is not performed, then the postpartum period can end with a hospital ward due to bleeding that has opened or infection develops in them, and in the future this can provoke omission internal organs and urinary and fecal incontinence.
- The process of applying external and internal sutures lasts more than one minute and requires a highly qualified specialist and preparedness from the treating specialist, and if there is a rupture on the cervix, the surgeon must be a real virtuoso because of the inaccessibility and risk of damage adjacent to the bladder or ureters.
- The internal sutures after the birth process on the cervix, vagina and on the uterus itself must be applied using absorbable sutures from biological or semi-synthetic material. If deformed only the cervix, then in this case, anesthesia is not required - after childbirth it does not have increased sensitivity. In all other situations, general or local anesthesia is used.
- The muscle layers during rupture and incision of the perineum should also be sutured with special absorbable threads, and the skin is very often sutured with non-absorbable suture materials. They are removed even in the hospital or in the antenatal clinic after 3-7 days after the birth of the child, when the seam is completely healed. This procedure is quite painful, for this reason anesthesia is mandatory.
Reasons for the gap
The reasons for the gap are numerous. This may be a failure to follow the recommendations of the obstetrician during the period of attempts, and the presence of scars on the sutures imposed in the previous childbirth (the scar includes inelastic connective tissue), rapid or too long birth, anatomical structure of the pelvis, large baby’s head, gluteal presentation, low rate tissue elasticity mothers.
- The attitude to episiotomy - dissection of the perineum - varies among obstetricians. For some, this work is not complicated and unusual; it is used massively to avoid rupture of the perineum. The rest of the doctors are trying to make this process as natural as possible, so they intervene only when it is already clear that the gap cannot be avoided. If instrumental labor is performed using forceps or a vacuum extractor, it is best to first dissect the perineum.
At the same time, surgery has several advantages over rupture. Dissected tissue is technically much easier to suture than torn. The wound has even edges, so the healing and healing process is faster, and more aesthetic scar.
Suture healing process
If the seams are internal type, and the procedure for suturing is performed correctly, then pain will be experienced for only a few days. In this case, special care is not required at all, and you will not have to remove the seams, since they are made absorbable thread.
Self-absorbable sutures after birth from natural threads (catgut) are completely absorbed after one month, and from synthetic material after two to three months. Internal seams heal much faster and can diverge in extreme and very rare cases.
A completely different thing happens if external seams are placed on the perineum. With such a postpartum injury, it will be very difficult and unpleasant to move, often there are problems with going to the toilet, while it is completely forbidden to sit down, since the seams can quickly disperse. The ban on sitting will be valid for 14 days, after which you can try to sit on hard surfaces.
If catgut stitches are placed on the perineum, then you don’t have to worry too much if in a week you notice pieces of thread falling off - in such a short time the material completely loses its strength and begins to tear into pieces. The seams will definitely not part, unless, of course, you move too actively. How long the process of resorption of the material will take will directly depend on the speed metabolism in the body of a woman. In some cases, catgut is poorly absorbed or does not resolve even after 6 months after suturing.
Sutures made of non-absorbable threads from the perineum will be allowed to be removed after 3-7 days after the birth of the baby. If this is not done in the hospital, then the removal of the sutures should be carried out by the gynecologist himself in the antenatal clinic. With this procedure, a woman can feel pain. But in most cases, such pain is quite tolerable, in extreme cases, you can insist on local anesthesia.
What is an episiotomy?
Episiotomy is a small obstetric operation, performed at a time when the child is already close to the exit, but cannot exit for a number of reasons. The doctor prepares for surgery while the woman in labor is resting from contractions. One blade of scissors is carefully inserted into the crotch, at an angle of 45 degrees. It is necessary that it touches the skin, which is already stretched from the attempts and resembles parchment paper
As soon as the course of labor resumes, the doctor performs an incision. The woman in labor does not feel pain, her attention focuses on childbirth, so surgical intervention does without general anesthesia.
An injection of lidocaine or novocaine is given, but sometimes the situation becomes critical, and there is not enough time to make an injection. The cut is instantaneous. After the baby is born, surgical sutures are placed on the perineum.
Types of Epiotiotomy
Episiotomy is performed during childbirth so that spontaneous tissue rupture does not occur, because the direction of the lacerated wound will be uncontrollable. Loss of pelvic organs may occur, severe bleeding may open.
In medical practice, one of two types of gynecological operations:
- Standard dissection type (anatomical) implies that the doctor mentally draws a line that starts from the seat and ends at the back of the vagina, and performs an incision. Internal organs, nerve fibers, large muscles are not damaged. Bleeding may begin, but it is easy to stop. An operation of this type has one feature: if the incision is small, it can be extended.
- Second type - perineotomy - differs from the first direction of the incision - from the vagina to the anus. Several varieties of perineotomy are known - the mid-lateral, purely lateral episiotomy. Indications for carrying out is the special anatomical structure of a woman: a high or, conversely, low crotch. The height of the perineum is determined even before delivery. Pregnant women with such features should be prepared for a difficult birth. This type of operation is risky because it can damage the Bartolinieva iron.
How much the sutures will heal is affected by the individual healing rate of the lesions and their shape.
Most often, complete healing occurs after a month, the average time is 14 days.
Both before and after the stitch removal process, you need to regularly perform their processing. This is very important, since postpartum secretions and a constantly moist environment in the perineum affect the rapid multiplication of microbes. With improper care, the seams can simply fester, and the recovery process will be delayed at a later date.
It is important to know what means need to process the seams. As in the hospital, at home, the wound needs to be treated two to three times a day. Need to carry out processing antiseptic solutions or antibacterial ointments that suppress the rapid growth of bacteria that cause inflammatory processes. The most common tools that can be easily found in a home medicine cabinet are the well-known greenback, hydrogen peroxide, potassium permanganate and chlorhexidine. Of ointments, a drug called Levomekol is common. Processing should be carried out without being in a sitting position.
If you provide air access to the perineum, the healing process will go many times faster. To do this, wear breathable pads made of natural material, and do not wear too tight underwear. The best option would be to provide “ventilation” during sleep on a special absorbent diaper or oilcloth with a simple cloth diaper.
Of the folk remedies, the healing process speeds up the healing process of tea tree oil or sea buckthorn oil. It is also necessary to follow the rules of hygiene, which will help to quickly heal the inflamed area.
Who is indicated for an episiotomy?
Episiotomy performed during childbirth is a necessary measure carried out in the name of saving the baby or trouble for the woman in labor. The manipulation of dissection is performed only if a threat to life is created for the child or woman in childbirth.
It is known from medical journals that 50 out of 100 women in labor are given an episiotomy.
There is no predisposition to episiotomy, but the reasons for the operation may be as follows:
- premature birth, in which there may be a risk of damage to the fetal head,
- the child cannot come out: he is large or has a large head,
- the woman in labor rises, and the birth process is slow,
- medical forceps must be applied to increase entry into the vagina,
- childbirth is abnormal
- the child suffers (he has a gluteal previa, lack of oxygen), the rapid course of childbirth will help him to be born healthy,
- a pregnant woman has complex diseases of the heart, nervous system, inelastic tissue.
How to relieve pain
When the sutures heal, a quick tissue tightening occurs - the wound surfaces begin to contract, and the wound closes with an additional scar. Therefore, it is quite natural if the sutures hurt after they are applied, like any other muscle and epithelial injuries. The woman experiences pain and discomfort over the next six weeks after giving birth.
If the pain is too severe, which most often occurs in the first days after the birth of a child, then cold objects applied to the perineum, as well as other painkillers can help overcome it. In the maternity hospital, injections can be given, at home you can take the drug Ibuprofen (Nurofen), which is not contraindicated during breastfeeding. To feel less discomfort when urinating, you can try not to use the toilet, but to urinate while standing in the bath, while legs apart.
Advantages and disadvantages of episiotomy
Nowadays, a small surgical operation to speed up the birth process is often performed. A gynecologist is better to make an incision than to look for some new way of help. The decision is made when the doctor sees that the child is in danger.
And only some time after the birth of the baby, the young mother can realize the fidelity of the manipulation:
- this operation did not affect the child’s health: he was born without injuries,
- childbirth has passed - the pain is forgotten.
Gynecological manipulation has several disadvantages:
- there is a risk of injury to the rectum, a new operation is required,
- bleeding may open
- when suturing, a woman in labor experiences pain:
- a woman who has given birth cannot be seated for some time,
- the healing process is long, certain requirements must be observed,
- in case of violation of the doctor’s recommendations, the seams can be broken,
- poor-quality treatment of wounds causes inflammation of injured tissues.
Is there an alternative?
Episiotomy during childbirth does not exclude an alternative. What is it: a new type of surgical intervention or adherence to the advice of a gynecologist?
The thing is that a pregnant woman must consciously prepare for childbirth:
- For a woman preparing to become a mother, you can visit the pool or sports activities. You can do it at home. A set of exercises aimed at increasing the elasticity of the perineal tissues will help her avoid crushing the perineum during childbirth.
- An intimate massage is effective, which consists in massaging the perineum and vagina, because it is this area that stretches during childbirth. They familiarize themselves with the procedure at courses for pregnant women. You will need cosmetic oil on herbal extracts. Before the massage, you should take a shower to relax the body and grease your fingers with oil. Circular movements within the intimate zone should be carried out until a feeling of tension in the skin tissue appears.
- Of no less importance is the ability to control your own breathing, because it is in the minutes of exhalation that you can relax. This will help to approach the physiological course of the birth process and avoid all sorts of complications.
- A pregnant woman should lead a healthy lifestyle, eat right.
A woman should understand that it depends on her whether a child can be born healthy.
How does an episiotomy go?
Episiotomy during childbirth: what is it, the technique of an incision is as follows:
- The estimated incision line is treated with an antiseptic.
- If a woman in labor is afraid of surgery, she is given local anesthesia.
- The doctor inserts medical scissors into the vagina of the woman in labor and, after waiting for a wave of effort, cuts the tissue. The maximum depth of dissection is 5 cm, the minimum is 3 cm. A midwife located nearby, obstructing the baby’s exit, holds his head by hand. What is it and how is an episiotomy done during childbirth
The operation is performed in the second stage of labor, when the skin and muscle tissue of the perineum does not stretch and prevent the appearance of the head of the child.
How long do the sutures heal?
The process and duration of healing depends on the application technique, the materials used for stitching and the condition of the woman in labor. The internal seams made by vicryl, catgut absorb independently.
External braces, if there is no infection, the gynecologist removes after 5-7 days. In the event of puffiness, physio-procedures are prescribed (ultrasound, laser), which enhance microcirculation.
Full healing occurs in a month, although a woman experiences discomfort within six months. To prevent the formation of a scar, after the wound is healed, it is recommended to use the Contractractex gel, which causes cell regeneration, within a month. After about a year, the seams will be practically invisible.
Suture care: how and what to handle?
In the maternity hospital, a simple procedure for processing sutures with diamond greens is performed by a midwife, who assesses the appearance of the wound. Sanitary pads, which must be changed very often, also save. We should not forget about the "female rule": change the gaskets "front - back".
After the woman was discharged from the hospital, the care of the child falls entirely on her, so she sometimes forgets about herself. And if you do not follow the doctor’s recommendations, the seams can become inflamed and disperse.
To do without unpleasant consequences, you need to independently take care of the seams:
- perform hygienic female procedures twice a day with warm water, in which a pale pink solution of potassium permanganate is added,
- apply only postpartum pads, as softer,
- the sutures should be dry constantly, so after water procedures you need to get wet the surface of the wound and wait until it dries.
Pharmacists recommend the use of disinfectants or ointments for suture treatment. They advise applying the ointment to the inflamed area through a napkin and do not remove until the composition is absorbed.
The following are considered effective:
- Levomekol. It is recommended not only by surgeons, but also by dentists. Indications for use are skin burns of various degrees, boils, tropical ulcers. Helps with festering wounds.
- Bepanten - a medicine that does not cause allergic reactions, so they can treat skin irritations anywhere in the body to prevent the spread of infectious microorganisms.
- Malavit – крем помогает при ожогах, обморожениях, способствует заживлению ран. Применяется для лечения гинекологических заболеваний.
- Solcoseryl improves metabolism in the skin, restores skin integrity. The cream is available in the form of jelly, ointment, in liquid composition.
- Chlorhexidine –Universal remedy with a wide range of applications. Surgeons disinfect their hands before surgery. Recommended for the treatment of burns, problem areas of female organs.
- Chlorophyllipt - possesses anti-infectious action. It is in demand for diseases of the female genital organs.
The treatment of joints with ointments should be done carefully. The room where the woman is being treated must be sterile clean, otherwise infection may be introduced.
Intimate life after an episiotomy
Episiotomy during childbirth went without complications. What is this - a signal that you can engage in an intimate life or abstain for a long time?
Doctors advise not to resume sexual relations after 1.5 - 2 months. After this period, go to the antenatal clinic to make sure that everything is in order. But, even if the seams were tightened without any complications, scars remained, the touch of which was painful.
In such cases, they make a massage of adhesions or lubricate the problem area with any ointment with an anesthetic effect. In addition, the uterus is still in an injured state.
It is possible that during sex she will be injured a second time. Intimate relationships are difficult due to vaginal dryness. This condition is possible due to the low amount of estrogen in the blood. The problem is solved by using gels and lubricants for intimate hygiene.
You need to choose those that contain anti-inflammatory elements to eliminate the risk of infection in the genitals. A suitable ointment is Contractubex, which relieves inflammation and smoothes scars after surgery. The strength of the woman in childbirth is restored within 2 months.
The uterus returns to normal, microcracks on the mucous membrane of the genitals heal, wounds are healed. From this moment, the full intimate life of the spouses returns to normal.
Does an episiotomy affect subsequent pregnancy and childbirth?
After an episiotomy, complications may occur:
- weakening of immunity,
- fabrics and sutures after surgery are not elastic,
- a new cut cannot be made in the same place.
However, there are many examples in gynecology when the second birth took place without surgery. Of great importance is the mood of a woman, her preparation for childbirth. So a mother who wants to give birth to a second baby needs to drop all fears and prepare her body for a new test.
Possible consequences and complications
Episiotomy during childbirth done. What is it: the beginning of rehabilitation or the long process of treatment? The first days after surgery are the most important, because wound healing is going on intensively. If this time has passed without complications, then the woman in labor is removed.
However, there are several uncomfortable moments that an episiotomy brings:
- The operation causes pain, which is not felt immediately, but after the delivery has ended. Painful sensations pass quickly, but if a woman in labor has high sensitivity, then they can last up to two months. In such cases, the doctor advises taking pills, such as paracetamol, ibuprofren, and putting painkillers.
- Scars can hurt, and when examined, the gynecologist does not see any pathology. In such cases, physiotherapy helps, which can be started two weeks after birth, help.
- Discomfort enhances and impaired bowel function. Subject to a certain liquid diet, as well as the use of lactic acid products, unpleasant moments pass.
- Sometimes there is swelling, which can be relieved by compresses or ice warmers.
- Bleeding may occur, microcracks or discrepancies in the edges of the stitched tissue are the cause. In this case, a new surgical intervention will be required. To speed up the healing process, the doctor prescribes a visit to physiotherapy, heating with a quartz or infrared lamp.
Within 2 weeks after the operation is done, the woman in labor should not sit in order to avoid pressure on the seams. An orthopedic pillow, with a round shape with a hole in the center, helps out in such situations.
Or you can use an ordinary rubber ring. When the wounds stop hurting, you can start to sit down. First, you can sit on one buttock, while the legs should be brought together. After some time, you can try to sit down in the usual way, but feeding the baby should be carried out lying down.
What to do if the seam is festering?
Sometimes there is a swelling of the perineum, which does not go away, then a seal appears, a brown-green discharge with an unpleasant odor. The process began a long time ago, but many young mothers do not attach this importance, in the hope that everything will pass.
When the temperature rises, weakness sets in, problems with urination begin, the woman understands that it is necessary to consult a gynecologist immediately. In the department, specialists open the wound and rinse. The mother is prescribed pills and antibiotic injections to suppress the infection.
You can disinfect the wound cavity with chlorhexidine or hydrogen peroxide. To speed up the healing process, the wound can be lubricated with Malavit gel, ointments Levomekol, Solcoseryl.
What to do if the seam has been split?
It happens that after returning from the hospital, the seams begin to bleed. This is a sign that the seam is diverging.
This can happen for several reasons:
- the woman in labor does not comply with the basic requirement: do not sit down for at least a week, because the skin is stretched and the wounds are exposed,
- the patient takes on hard housework,
- experiencing discomfort during bowel movements.
Secondary suturing is painful because the skin is inflamed and small sutures can lead to the formation of a rough scar, which will be inconvenient in the future.
It is better if healing goes naturally. To accelerate the healing process of wounds and restore the skin, it is necessary to apply a sterile bandage with Chlorofilipt, Traumeel ointment on the seam overnight, which have a healing effect.
How to relieve pain and speed healing?
Often, women in labor complain that the sutures after surgery hurt. Helps warming up with a red lamp, which can be carried out at home. Pain is relieved by ointments with an anesthetic effect, such as Bepanten, Malavit.
For quick healing of sutures, it is necessary to follow the advice given by the attending physician:
- you can’t lift weights for three months,
- do not wash in hot baths, do not visit the sauna,
- eat properly and rationally, follow a diet, eliminate flour products, drinking plenty of fluids helps restore bowel function,
- you should not start running in the first month, strive to get rid of the gained weight, but Kegel exercises should not be started, especially since it takes 10 seconds to complete them. The principle of implementation is as follows: tighten the muscles around the urethra, hold them in this position, and then relax the compression. The exercise should be repeated up to 20 times a day.
A woman needs to follow all the recommendations for daily care of sutures, in them - the hope for a quick healing of wounds. Those who went through such operations believe that nothing heals better than caring for a newborn. Doctors confirm that movement and an active life will contribute to faster healing.
Episiotomy during childbirth is sometimes a necessity, and every expectant mother should know what it will bring.
If you read the reviews of women who have experienced such an operation, the following can be noted:
- any pregnant woman needs to prepare her body for childbirth,
- You can find a lot of literature on the Internet to understand what the operation is,
- if you think that it will be easier for the child, then you can endure pain at the moment when the needle touched the skin, pain is not felt when the incision is made.
If you follow the seams, follow all the recommendations, then in a month there will be relief, and after 2 months - a full recovery. Returning to the delivery room, you need to believe that the birth will end safely, and that a beautiful baby will be born and the mother will be healthy.
Purpose and methods of the procedure
Artificial dissection of the perineum is called episiotomy. In such a small surgical operation, there is a need if during the natural birth there is a high risk of rupture of the perineum.
Doctors expand the exit of the vagina by an incision, so the risk of rupture is reduced, as is the likelihood of a baby getting a birth injury, because it becomes much easier and faster to be born into the world.
The procedure is done only in the second stage of childbirth, when a woman starts trying, at the time of birth of the head and shoulders. If the head exit is physiologically difficult, the problem is solved by an incision. There are four dissection methods, but in Russian obstetric practice, only two are usually used - the mid-lateral and perineotomy. In the first case, the incision is about 3 centimeters long, located from the center of the perineum to the right or left, and with perineotomy, down, in the direction of the anus, but not reaching it.
Everything is done simply - at the peak of the effort, when the head peeks out, the perineum pre-treated with an antiseptic is cut with surgical scissors. The wound is sutured at the end of labor, after the birth of the placenta.
Suturing is performed using pain relief, even if cut without it. How the technique will be, what kind of suture materials the medical worker chooses, depends on how the suture heals, how likely the complications are.
If there is damage to the genital tract, cervix, first internal sutures are applied. The threads use self-absorbable, which do not need to be processed and removed, after a certain period of time they are absorbed independently. Outer seams can be sewn with silk stitches in the shape of a figure eight (the so-called Shute technique). Threads pass through all layers simultaneously. The likelihood of complications and problems when healing such stitches is higher.
The optimal is considered to be layered and phased suturing of wound edges. First, internal sutures are applied to the posterior wall of the vagina, then muscle tissue is sewn, and then a continuous cosmetic suture is performed outside. Sutures after an episiotomy are treated with an antiseptic and the delivery is considered complete.
The presence of sutures in the perineum after childbirth aggravates recovery - a woman is limited in movement, she needs to constantly remember that the perineum cannot be strained. The main feature of surgical stitches applied after an episiotomy is that healing due to natural causes proceeds more slowly than scarring of sutures on open skin surfaces.
The crotch is a place that does not allow the sutured area to come into contact with open air, namely this could accelerate healing.
Treatment is also fraught with certain difficulties and is possible only with outside help; it is very, very difficult for a woman to treat a wound.
Sutures from episiotomy are often inflamed, since there is no way to apply a sterile dressing on them, as is done for a wound from a cesarean section. From the genitals in the first days after childbirth is very bleeding - lochia come out, the uterine cavity cleans itself, the uterus undergoes the process of involution - reverse development. Lochia surely needs a free exit, and it is impossible to impose a bandage also for this reason.
Lochia, which is a discharge of a blood character (a placental wound is bleeding on the inner wall of the uterus, where the placenta was located), are themselves dangerous for sutures, because blood is a favorable environment for the growth of bacteria. And even opportunistic microorganisms that live on the skin and in the intestines may well cause serious bacterial inflammation. Given the location of the stitches, it is easy to guess that contact with bacteria is very possible.
The anatomical location of the perineum cannot provide temporary rest to damaged and sutured tissues. When moving, defecating, urinating, with tension of the abdomen invariably tense and perineum. That is why, as well as because of the dissection of the nerve endings in the first days after the episiotomy, the sutures hurt, pulls in the perineal region. As the seam heals, pain decreases. After 5-7 days, the edges of the wound are completely joined.
On days 8–9, sutures are most often removed. Often in the healing process, they itch, ache. Gradually, after 3-4 weeks, the sutures will heal completely. Some seal at the place of suturing persists until six months. The cosmetic seam looks aesthetically pleasing, and you don’t have to worry about it. When the area of application of surgical sutures ceases to bother, it largely depends on how the woman will care for her, whether she will comply with all the recommendations of the doctor.
A woman who has had an episiotomy should not sit down after giving birth. Firstly, it hurts, and secondly, the tension of the skin in this position can lead to divergence of the seams. If the dissection was oblique (mid-lateral), then you can gently sit on one hip, opposite the direction of the seam.
If the incision was made to the left, then they sit on the right thigh, and vice versa. About three weeks will need to sit down in this way, and all the usual actions and care for the baby should be carried out while standing or lying on its side.
For safety reasons, it is better not to make sharp rises from a prone position and sitting, to move carefully, smoothly and carefully.
Proper treatment and care will help to avoid complications and infection and will contribute to tissue repair. Recommendations in this case are as follows:
change lining more often, use the sterile lining provided by the maternity hospital, and on the second day you can switch to sterile special pads for women in labor,
wash after each visit to the toilet, while doing the hand movements from the pubis to the anus, in no case not vice versa,
at home, you can be washed with a weak solution of potassium permanganate - this effectively dries the wound,
do not wipe the perineum, but blot it with a soft cloth or diaper,
seams must be treated every day - first apply a little hydrogen peroxide, and then smear the edges of the wound with green. At home, a spouse can help.
Once a day, it is advisable to leave the perineum open for 20-30 minutes so that healing progresses faster. You should not take a bath in the first 4 weeks, this will increase the likelihood of wound infection. Better to take a shower.
In a month, when the main restrictions will be lifted, a woman can begin to use tools that increase the elasticity of the scar - the “Contractubex” gel can be used if there are no complications.
A scar, moderately compacted along the entire length, is initially considered a variant of the norm. But the formation of a bump on or near the scar may indicate an uneven matching of the edges of the wound, as well as internal hematomas. The situation requires treatment. If hematomas are detected, surgical help is sometimes necessary to remove them.
It manifests itself in the fact that the seam swells, turns red, hurts when touched. Often he is bleeding or festering. The woman's temperature rises, discharge from the genitals may be yellowish with an unpleasant odor. The situation requires the appointment of local, and sometimes systemic antibiotics and anti-inflammatory drugs. When handling the wound is washed, if there is a lot of pus, then put a drain. If the seam becomes inflamed and fester in the late period, consider the likelihood of fistula formation.
To understand that the seam has been split, a woman can by the appearance of blood flow, by the increased soreness. Not all discrepancies require re-closure. Only extensive and deep. Minor ones do not require special treatment, except for topical application of Levomekol ointment to the area of application of the threads. Such discrepancies are usually fused by the secondary tension method.
Unpleasant sensations during intercourse
They are mechanical in nature. In this case, it is impossible to anesthetize the area of threading, you just need to wait a bit, choosing for intimate contacts poses in which the tension of the perineal tissues will be gentle. Usually, after six months, dyspareunia disappears and sexual positive feelings return in full.
With repeated birth, a well-healed elastic scar does not pose a great danger. But so that he heals properly and does not get sick either after six months or after 3 years, you need to follow the recommendations and treat the problems in a timely manner.
Many expectant mothers hear the word "episiotomy" from their girlfriends, acquaintances, and simply former women in labor. The stories of most of them boil down to the fact that this is a section of the perineum, bringing unbearable torment.
Sex after episiotymia is compared in feelings to deprivation of innocence. It is understandable why pregnant women have a fear of this manipulation, but few people know the benefits of it and how to prevent negative consequences.
Why is an episiotomy necessary?
Эпизиотомия – это родовспоможение, позволяющее избежать разрывов стенок влагалища и шейки матки. Показанием к проведению данной манипуляции является следующее:
- Ягодичное предлежание ребенка,
- Неэластичные стенки влагалища,
- Крупная головка плода,
- Узкий таз женщины,
- Риск гипоксии плода, снижение пульса, остановка сердца.
It is impossible to determine in advance whether an episiotomy is required. The decision is made by the doctor in the second stage of labor, when the baby begins to move along the birth canal and rests on the walls of the vagina. If the woman in labor does not succeed in pushing the fetus out, then the perineum is cut (episiotomy).
The incision is made in size from 1 to 3 cm sideways or towards the anus. Dissection is carried out at the height of the scrum, when pain receptors are less susceptible. If the doctor has done everything correctly, the woman in labor will not feel pain. After cutting the perineum, the child leaves almost immediately - on the first or second attempt.
Episiotomy, in spite of many negative consequences, is sometimes a necessity to preserve the life of the fetus and prevent vaginal ruptures. Spontaneous injuries heal much longer and more difficult than incisions made by an experienced specialist.
Unfortunately, it is impossible to avoid unpleasant consequences after an episiotomy. First of all, a woman is forbidden to sit for 1-3 weeks, depending on the depth of cut.
One and a half - two months you can not live sexually until the wound is completely healed. As for sex, the first time a woman can experience severe pain during penetration. This must be endured, after a few weeks the scars will cease to bring discomfort.
But when an episiotomy is performed, other, more unpleasant consequences are possible:
- Divergence of seams. In the first few days after birth, doctors categorically forbid sitting on the ass. If you neglect the instructions, then there may be a divergence of the seams. Contributes to this and improperly applied threads, too weakly tightened seams, attempts when visiting the toilet. Re-suturing is performed using anesthesia.
- Wound infection. Improper seam care often leads to infection. In this case, purulent sores appear on the wound, the woman feels severe pain. This condition requires qualified treatment to prevent blood poisoning.
- Urinary incontinence. If the incision is made incorrectly or the stitches are not tight enough, urinary incontinence is possible.
After an episiotomy, it is necessary to properly care for sutures and a wound. When you can sit, the attending physician will say, and you cannot do otherwise so that the seam does not open. In addition, other recommendations must be followed:
- Do not lift weights for the first 2 months after giving birth,
- Perform regular genital hygiene, including flushing the joints,
- Treat stitches with brilliant green until the wound is completely healed,
- Change gaskets every 2-3 hours to prevent the growth of pathogenic bacteria,
- You can wash yourself with chamomile broth for the speedy healing of sutures,
- Stop sex for the first 2 months,
- To eat fermented milk products to facilitate the act of defecation,
- Eat properly to improve skin regeneration and increase its elasticity.
The worst thing after an episiotomy for many mothers is the inability to sit. Feeding the baby in a prone position or reclining is inconvenient, so they rarely when they comply with the deadlines prescribed by the doctor and sit much earlier. In order to save seams in this case, it is necessary to sit only on the edge of a chair or on one buttock.
Episiotomy is not such a terrible phenomenon, as many women in labor describe it. Yes, you can’t sit and have sex for several weeks. But for the sake of preserving the life and health of the baby, you can tolerate this time. Moreover, the cut of the perineum also saves the woman herself from ugly, unaesthetic scars, which plastic surgery will only help get rid of.
Useful episiotomy video
Long process. A month is enough for someone, and for someone there are not enough three. If your mom has an episiotomy, recovery will be a little more difficult.
Usually, stitches after an episiotomy heal within a month. But only if there are no complications and the woman adheres to the doctor's recommendations. Accelerate recovery from episiotomy will help. But be sure to check with your doctor when you can start doing them after giving birth.
HOW TO CARE SEAMS AFTER EPISIOTOMY
The seams after the episiotomy are treated with hydrogen peroxide, a solution of potassium permanganate or brilliant green. This should be done once a day. Sometimes, in the first three days after birth, the doctor prescribes pain medication.
In addition to this, a woman needs to follow several recommendations.
- The first time after childbirth do not get up. Even eat in the room. Feed your baby lying down or reclining. You can sit sideways only 2-3 days after the seams are removed.
- Eat a diet. At first, give preference to broths, kefir, juices. This is necessary so that during stools, the stitches do not open after an episiotomy. Ask your doctor what kind of food will be beneficial for the child and will not harm mom.
- Stick to good hygiene practices. Change your postpartum pads often. Rinse the seam after each trip to the toilet, wipe well with a soft towel.
COMPLICATIONS AFTER EPISIOTOMY
The most common complications after an episiotomy are inflammation and suture discrepancies.
- Suture inflammation after an episiotomy, it is already noticeable a few days after the birth. It may appear due to poor quality care. The incision site is swollen, sore, pulsating. In such cases, the doctor prescribes ointments or ice.
- Seams after an episiotomy, it may occur due to bowel movements or if a woman began to sit earlier than the due date. In the first days after birth in such cases, the doctor again sutures. If the discrepancy occurred later, the edges of the wound are excised and sutured, or if the discrepancy is insignificant, they are left in this form.
In the power of women to give birth naturally and without episiotomy. But if an incision was nevertheless made, complications can be prevented by simply following the doctor's recommendations.
Episiotomy - an operation during childbirth performed by an obstetrician-gynecologist. Surgical intervention consists in cutting the perineum and deeper lying tissue with a scalpel. This event is forced and is carried out in two cases: when there is a risk of rupture of the perineum due to too large a head of the fetus, with poor extensibility of the vaginal walls of a woman.
Also, the operation is carried out if necessary to accelerate the birth process, when there is a threat to life for the child or mother.
How is the procedure carried out?
It is difficult to say before delivery how high the likelihood of this procedure. It is in the vast majority of cases carried out if there is evidence and in case of emergency.
The crotch is cut at the moment when the fetal head squeezes the tissues of the birth canal as much as possible. Usually it does without additional pain relief: the tissues are squeezed, that is, the blood does not reach the nerve endings, therefore, there will not be a pain impulse to the brain. That is why at the time of dissection nothing hurts.
The incision made by the specialist is sutured in layers: first, absorbable suture material is used on the muscles, mucous membranes and fascia located between the vagina and intestines. The skin is sewn with ordinary non-absorbable sutures, often medical silk. In some cases, the doctor can perform the so-called cosmetic suture: on the outside there is only the initial and final nodes, the rest of the thread is hidden under the skin.
Seams made by absorbable threads do not need to be removed. They dissolve on their own after 7-10 days after surgery. It is worth noting that the resorption time depends on the selected material. But the seams on the crotch itself will be removed by doctors in a maternity hospital or antenatal clinic.
Features of episiotomy sutures
The main feature that sutures made after an episiotomy have is that they are located in a place where it is difficult to maintain a sterile environment. Immediately after birth, lochia begin to stand out from the vagina, which will be observed from 1 to 1.5 months.
A sterile dressing cannot be fixed on the perineum due to the anatomical structure of this area. In addition, the patch is not glued to the damp surface of the skin. Based on the foregoing, special care is required behind the suture after the episiotomy.
What should be done so that the sutures are removed on time, that is, 5-7 days after surgery?
- Every 2 hours, change sanitary pads,
- After visiting the toilet, wash with warm water. You can use a disinfecting soap or a pale pink solution of potassium permanganate. Wipe the seam area with a towel or gauze with soaking movements. Such care should be both in the hospital, and for 1.5 months after childbirth,
- Every day, during the stay in the hospital, the midwife will process the stitches in the gynecological chair,
- You can not take a bath. The ban on such water treatments lasts at least 1 month. Hygienic procedures are carried out in the shower or use a bidet,
- Many women are interested in when to sit down after an episiotomy. This issue is very important, because if the regime is violated, complications are possible. Full sitting is not allowed 10 days - 2 weeks after the manipulation. Only a sitting pose on the toilet is allowed. You can eat or feed your baby while standing or lying down, but nothing else. After about 10 days, you are allowed to sit on a chair with a hard surface. After some time, rest is allowed on the couch, in an armchair, etc.,
- During the first 3 days, do not eat bread and other pastries. This also applies to cereals. Deprivation aims to delay defecation,
- After the woman is discharged from the maternity ward, she can go home in the back seat of the car in a reclining position,
- If there are signs of inflammation that will be noticeable during suture treatment, antibiotics are prescribed to the woman in labor, inside and in the form of injections.
Suture healing rate and sex after episiotomy
How many sutures made after an episiotomy heal? - Another issue disturbing newly moms. It is worth noting that this process is quite lengthy - it takes about a month and a half to heal. Skin restoration is influenced by the individual characteristics of the body, as well as compliance with the above measures.
When is sex after an episiotomy possible? Abstinence should also be long - at least 6 weeks. The first few sexual intercourse may be accompanied by pain and tension in the perineum. That is why the partner should be patient and not in a hurry. It is recommended to use a lubricant and give preference to that position, which allows the woman to control the depth of penetration.
How to care for sutures after childbirth and what to do if they bother?
In the hospital, midwives are involved in their processing. To do this, use zelenka or potassium permanganate. In the future, a woman will do this at home on her own. It is necessary to carry out the event after each water treatment.
Care must be taken to empty the bowel. It is impossible to overexert the fused tissues. The best option when using the toilet is an enema or a glycerin candle.
Sanitary pads can be replaced with disposable panties made of breathable materials. When preference is given first, the underwear must be made of natural material, such as cotton.
Also, do not dress immediately after a shower, because air baths have a good effect on the skin and dissections heal faster. In this case, you can not get the affected area wet, but just wait for it to dry completely.
Do not wear stretch underwear, as the blood circulation process is disrupted, which negatively affects wound healing.
Is Episiotomy Good or Bad?
Modern doctors often use surgical methods for delivery in order to facilitate and accelerate this process. But you need to know that after an episiotomy, careful care of the sutures is needed, because the discharge from the wound and vagina is initially plentiful. Therefore, it is worth washing the joints with warm water, and the doctor should say what to process them after the episiotomy, but usually they are simple antiseptics (iodine or green). Lubricate the sutures at least twice a day with a sterile swab so as not to infect and prevent the growth of pathogenic bacteria. It is impossible to say exactly how long the suture heals after an episiotomy, because in some women the wounds heal in one to two weeks, while in others this process can take several months. The same is with the question of how much the suture hurts after an episiotomy - usually soreness and numbness in the scar site remains for some time after the sutures are completely healed.
But in any case, an episiotomy leads to rather unpleasant consequences, such as pain and discomfort when walking, burning sensation during urination, pain during intercourse. In general, it is better to abstain from sex until the wounds heal completely, because it often happened that women had sutures after an episiotomy.
When re-suturing the incision, the pain will be much stronger, in addition, you will have to relive all these torments again. So before you “please” your husband, first think carefully about what will be better for you: to endure pain during intercourse and go to the doctor again so that he sutures you, or to be patient a bit more and recover faster.
When can I sit down after an episiotomy?
Recovery after an episiotomy does not come soon, the minimum term for wound healing is two weeks. During this period, it is better not to sit down, but when your doctor can sit after an episiotomy, your doctor will decide after examining the wounds. The ban on sitting does not exist just like that: it often happened that women who sat immediately after childbirth, upon returning to the ward, on the bed, the seams instantly burst. This is a very unpleasant sensation, so you need to be careful about yourself.
Do not think about what a seam looks like after an episiotomy. Modern doctors do everything neatly and, if you follow the rules for the care of sutures, then even a trace will not remain at the site of the incision. In most cases, to facilitate the life of newly occupied mothers already occupied, the sutures are applied with natural threads, which are absorbed after a month, so women do not need to remove sutures after an episiotomy. Many doctors, after an episiotomy, prescribe Kontraktubeks cream, which accelerates wound healing and contributes to the disappearance of scars.
Plastic surgery after episiotomy
In some women, it happens that the seam after an episiotomy has become inflamed and as a result has diverged. He begins to bleed - in this case, the incision needs to be changed, but not everyone agrees on this, so they immediately decide on the plastic of the external, and at the same time internal genital organs. Plastic surgery is also indicated for those women in whom the seam turned out to be uneven, protruding and greatly affects the appearance of the genitals and the quality of sexual life.
Most common complications
Most often, women continue to feel discomfort and pain for several weeks after giving birth. The intensification of the pain or its unremitting nature indicates that something interferes with normal healing, and this can lead to various complications - in this case, the intervention of a doctor, treatment and complex treatment of sutures with special means will be required. A young mother should be very attentive to her condition and listen to her feelings, carefully monitor the healing process and restore postpartum injuries.
- If the scars continue to hurt for a long time and do not heal, but no pathologies are detected during examination, the doctor may prescribe a course of physiotherapy - for example, warming up.
- Warming is carried out no earlier than a few weeks after birth to allow the uterus to fully contract.
- An infrared or quartz lamp is used for the procedure.
- Warming up lasts from 5 to 10 minutes from a distance of 50 centimeters.
Warming up can also be carried out independently at home after examination by a treating specialist
It is also possible to relieve pain by ointment for healing the joints of Kontraktubeks, you need to use it twice a day for two or three weeks.
Often, women after suturing the wound complain of itching, and it is very severe - usually this does not indicate any pathologies or complications. Pruritus is one of the symptoms of healing, and therefore should not cause a woman special anxieties.
To alleviate the discomfort, you need to wash yourself more often with water at room temperature (the main thing is that it is not hot).