The process of giving birth to a child is a real miracle, which is accompanied by unusual processes in the body of a woman. The preparation of a woman for pregnancy is quite popular, but the preparation for childbirth is no less important. It is more complex and significant, because it is impossible to predict the possible risks and the necessary measures that will have to be done during childbirth. Today we will analyze the incision during childbirth, as it is called, when, under what conditions, why it is done, and whether it is harmful to the baby.
Anatomical characteristics of the incision
In science, this procedure is called episiotomy. It is allowed to make an incision during childbirth only in the second stage of labor. This stage is characterized by finding the child in the exit from the pelvis. In this place is the head of the child, even if there is no effort, it does not go back, but remains in the small pelvis. This period is called teething, that is, the baby is already visible.
Currently, in 95% of cases, an incision is used along the oblique line, in the direction of the ischial tubercles. If you look at the child’s head directly, you need to make incisions obliquely in the lower left corner. The cut length is approximately 2 cm.
The remaining cases are characterized by a notch in a straight line to the anus. This method is more complex and is not applied unnecessarily in practice. This type of incision is already called perineotomy. The size and direction of the incision during childbirth depends on the individual characteristics of the woman and the birth process. Note that due to the fact that the muscles are tight and the skin is thin, a woman does not have painkillers. She does not feel pain from the cut.
Benefits of Surgical Incision
An incision during childbirth made by a doctor with surgical instruments heals faster than natural tissue rupture. This is due to the following:
- The edges of the wound are even, they are easier to connect and suture.
- Under natural conditions, ruptures are deep and slowly heal.
- An incision is made by a specialist, he will not allow deep tissue discrepancies and will create all the conditions for further healing.
Indications for the procedure
Despite the fact that a surgical incision during childbirth is a better option than natural tissue rupture, special indications are necessary for the procedure:
- Creating an immediate threat of tissue rupture, when the skin around the perineum becomes very thin, begins to shine.
- The large size of the fetus, which is installed before childbirth, so an incision during childbirth is not an emergency event, it is planned in advance.
- Premature birth, when the risk of injury to the child increases.
- The distance of the shoulders when the child’s head has already come out, and the shoulders cannot crawl due to the large size.
- If any obstetric surgery is prescribed during childbirth, you also need to carry out the procedure.
- An incision during childbirth is vital to reduce the second period of labor. This is necessary if arterial pressure is increased, a baby’s heart defect is diagnosed, the second period has been going on for too long.
- Hypoxia of the fetus begins and actively develops when the child does not have enough oxygen.
- The child is improperly located, he is in the pelvic area, this is called "pelvic presentation."
- Muscle stiffness is a phenomenon in which the muscles are so weak that they cannot create a full-fledged push for the child to exit.
- With the inability of a woman to push on her own.
Cut technology
The first and prerequisite for an incision during childbirth is time - it can only be done during the second phase of labor at the time of maximum effort. Before the cut, you need to treat the tissue with an antiseptic. If the tissues are not stretched enough and the procedure can cause pain, an injection of "Lidocaine" is done:
- The incision is carried out with surgical scissors. During the period of rest of the woman in labor between the attempts, one part of the scissors (blade), called the brush, is inserted into the gap between the head of the child and the tissues. The direction must be maintained in which an incision will be made.
- The length of the cut should not exceed 3 cm, a very short cut can be ineffective, and a long one will harm, leading to a gap.
- Suture at this stage does not occur, after the placenta leaves, the doctor examines the patient and the uterus, after which she already sutures. Anesthesia is done before suturing. After giving birth, the incision is no longer made; it is only sutured. The stitched place is treated with an antiseptic, this is the end of the procedure.
There are two main methods of suturing the resulting incision. Let's consider each of them.
Suturing in layers
Suturing of the incision occurs, starting with the mucous membrane of the vaginal wall, after they have been stitched, go on. Submersible seams connect all cut muscle tissue. In this case, synthetic threads are used, which are able to absorb. Catgut is a thread from the fibers of the intestines of an animal, which is sometimes used for suturing, in this case it is prohibited. It can cause allergies. The second layer is already applied cosmetic seams, they are small and continuous.
Puteoraphy according to the Shut
The second method of suturing is perineoraphy according to the Shut. There is no division into fabrics, all layers are connected at once. Eight-shaped seams are imposed, but synthetic threads are needed here, which do not absorb. After the wound has healed, the threads are simply pulled out. This method is more dangerous: inflammation and the appearance of infections often occur.
Postoperative Recovery
Recovery in this area is very inconvenient, especially considering that the woman has a newborn who requires constant care and protection. The inconvenience is that microorganisms are constantly present in the genital tract, which can enter the wound and cause inflammation. Dressing and continuous processing are not possible. If an incision is made during childbirth, you need to abandon the sitting position, otherwise the seams will open. As a general rule, it is forbidden to sit for 2 weeks, but all individually, depending on the level of regeneration and the depth of the cut. The term can last up to 4 weeks. It turns out that only lying and standing positions are allowed.
Suture healing
Sutures after childbirth after an incision heal in about 5-7 days, if the area is properly processed and the recommendations given by the doctor are not violated, there are no infections. After the first week after the suturing, the doctor removes superficial sutures and checks the condition of the scar. During the healing period, you must adhere to the following rules:
- Daily treatment of sutures - midwives in the hospital, as a rule, process them with brilliant green, while assessing the condition of the young mother.
- After a shower, you need to lie naked for some time, so that a woman naturally dries up, otherwise you can bring an infection. You can only wipe the seams with blotting movements with clean material.
- After each trip to the toilet, it is necessary to flush the place with a weak solution of potassium permanganate.
- Apply sanitary pads and change them every 2 hours.
- You can’t lift anything heavy, the only exception is the child, you can’t touch anything harder than him.
- To drink a lot of water.
- Train your muscles with Kegel exercises.
Full recovery occurs after 2 months from the date of the procedure. Pay attention to the photo of the incision during childbirth, it shows how it should look. You need to be careful about your health and consult a doctor if you have any ailments. It is about the complications that will be discussed further.
Effects
Not everything goes as smoothly as we would like, and if an incision was made during childbirth and mistakes were made during the recovery period, there may be complications:
- Swelling of the incision, which is treated with ice. It is superimposed on the incision site, anesthetic is additionally applied.
- Seam divergence can occur due to a sitting posture or heavy loads. In this case, new stitches are applied and the treatment process starts from scratch.
- Infection in the wound, treatment of which is possible only with the use of antibiotics. If the conditions are favorable, then the sutures are removed and the wound is drained, this is the removal of pus and fluid.
- The appearance of a hematoma - in this case, you need to immediately remove all sutures and clean the wound from pus, rinse with a disinfectant, prescribe a course of antibiotics and begin to be treated.
- Pain during intercourse. This is an unpleasant, but quite normal feeling, women experience pain during the first three months during an intimate relationship. About a year later, a full recovery begins.
Reviews of patients and opinions of doctors
As we understood, an episiotomy is a necessary measure, which should not be resorted to if the birth is normal. Let us turn to the opinion of experts.
Gynecologists indicate that up to 45% of all births are accompanied by this obstetric operation, it is the safest and best option for complications in labor. An episiotomy is necessary and useful only when there are indications for it; it is strictly forbidden to do it just like that.
Reviews of many women in childbirth show that you need to talk with the obstetrician before the time of birth, discussing with him all the nuances and expressing your opinion on the obstetric operation. Often there are cases when doctors are reinsured and make an episiotomy in cases where you can do without it. Be healthy and do not resort to surgical intervention once again!