When is a side incision necessary? Will it hurt? How can I communicate with the doctor if I don’t want to have a side resection? Hear what senior midwives have to say about lateral incisions and your biggest concerns.
1. What is a side incision? A lateral incision is actually short for episiotomy. It means that when the fetal head is about to come out of the vagina during delivery, local anesthesia is performed near the perineum, and then special side scissors are used to cut the perineum to widen the birth canal to facilitate the delivery of the fetus.
The location of the lateral incision is generally on the left side of the vaginal opening, at an angle of 45°. Cut an opening about 4 to 5 cm long, but if the perineum is highly dilated, the cutting angle should be 60 to 70 degrees to avoid damaging the rectum.
2. Under what circumstances is a side incision necessary? Usually, if the mother\’s perineal elasticity is good, the fetus is small, the fetal heart rate is normal, and the labor process goes smoothly, the doctor will not perform a lateral incision.
However, lateral incisions may not be avoided if the following conditions exist: The perineum has poor elasticity, the vaginal opening is narrow, or the perineum is inflamed and edematous. It is estimated that severe perineal tearing will inevitably occur when the fetus is delivered.
The fetus is large, the fetal head is not in the correct position, the labor force is not strong, and the fetal head is stuck in the perineum.
For expectant mothers over 35 years old, or expectant mothers with high-risk pregnancies such as heart disease and pregnancy-induced hypertension, in order to reduce physical exertion, shorten the labor process, and reduce the threat of childbirth to mothers and pregnant women. Baby, when the fetal head descends to the perineum, a lateral incision is necessary.
The cervix is fully dilated and the fetal head is in a low position, but the fetus is obviously hypoxic, the fetal heart rate changes abnormally, or the heartbeat rhythm is uneven, and the amniotic fluid is turbid or mixed with meconium.
When using forceps to assist in delivery. If the above situation occurs, do not hesitate to cooperate with the doctor and perform lateral incision as soon as possible.
3. What can expectant mothers do to avoid side incisions?
First of all, you must control your weight through a reasonable diet and moderate exercise to avoid an oversized fetus; in addition, you can also strengthen the strength of related muscles through pelvic floor muscle exercises (for exercise methods, see the column \”Physical Fitness During Pregnancy\” in the ninth issue of 2009) and elasticity to help you have a smooth delivery.
4. Will it be painful during side incision? Won\’t. Because before side incision, anesthesia is usually given first (sometimes, if your perineum has been numb and has become very thin due to the pressure of the baby’s head, the doctor can also do it for you without taking painkillers) side cut, also sometimes called a pressure side cut).
After the baby is born, the doctor will give you another dose of local anesthetic to ensure that your perineum is completely numb and there is no pain when the side incision is sutured.
5. How can I communicate with the doctor if I don’t want to undergo side surgery?
Whether to trim edges during production has always been a controversial issue. Some doctors agree that because domestic women have small pelvic cavities and tight vulvaes, episiotomy can help end the disease earlier.During labor, prevent uneven wounds from natural tearing; some doctors who hold objections believe that natural childbirth should be done slowly, and as long as you wait patiently, the perineal extensibility will naturally appear.
In order to prevent yourself from being stabbed while in a daze, it is necessary to communicate with your doctor in advance. Usually, before you enter the delivery room, the doctor will tell you or your family about various problems that may arise, and ask you to sign a consent form for the surgery to save communication time in case of danger. You can take this opportunity to tell them your thoughts, such as: If the situation permits, can you not do lateral incision? Are you willing to take risks such as perineal tearing?
However, as a midwife, my advice is that expectant mothers make their decision based on the circumstances of their labor. If the fetal head still cannot be delivered naturally after many times of exertion, you really need to actively cooperate with the doctor to perform a lateral incision; but if your cervix is in good condition, you can see the fetal head after three or four times of exertion. If the doctor recommends a lateral incision at this time, you may as well be polite Please ask the doctor to give you a chance to try a few more times and express your cooperation if it fails. However, one thing must be grasped, that is, our aim is that the safety of the fetus and mother comes first.
6. How long does it take for a side incision wound to heal? Generally, wounds that are not serious will not hurt for 3-4 days. As long as there is no infection, the wound will heal in about 4 weeks.
7. What issues should be paid attention to in wound care? Mainly to prevent bacterial infection of wounds. New mothers should wash their perineum with warm water after defecation and gently dry it with a clean towel. Pat dry from front to back each time to avoid carrying bacteria from the anus to the vagina.
Keep the wound dry: After using the toilet or bathing, pat the perineum dry with a clean, soft towel to absorb moisture.
Do not strain: Do not strain when defecating to prevent the wound from opening after being sutured. It is best to sit in a sitting position when defecating and shorten the time as much as possible.
No lifting of heavy objects: Within 1 month after delivery, no lifting of heavy objects, no housework, and no physical exertion.
Betadine: can be used to reduce swelling and relieve pain. For those with severe lacerations and wound swelling and pain, you can add betadine to the water for a sitz bath, or use a baking lamp to speed up recovery (betadine can sterilize, and baking lamps use high temperature to promote blood circulation); if the swelling and pain are severe, 50% magnesium sulfate can also be used Wet compress. In addition, if the wound has the following conditions, you should ask a doctor for treatment in time.
*Wound hematoma: Severe pain occurred at the incision 12 hours after suturing, and it became more and more severe, and there was even a feeling of swelling in the anus.
*Wound infection: 23 days after delivery, local wounds appear red, swollen, hot, painful and other symptoms, sometimes accompanied by induration, and purulent secretions when squeezed.
*Wound dehiscence after suture removal: Some new mothers may experience wound dehiscence after suture removal. If you have been discharged from the hospital at this time, you should go to the hospital immediately for examination and treatment. 8. What should I pay attention to in my diet after side surgery?
Pay attention to eating high-fiber, easy-to-digest foodsPlease pay attention to add enough water (2000 ml per day) to avoid constipation and prevent external wound dehiscence.
9. Is there any relationship between postpartum urinary incontinence and side incision?
With a vaginal birth, the baby passes through the birth canal regardless of whether the perineum is cut or not. Whether postpartum urinary incontinence will occur after delivery is actually related to factors such as the size of the mother\’s pelvis, the size of the baby, and the speed of labor. If the labor process is too long, the baby stays in the birth canal for a long time, and the vagina is stretched for a long time, which is more likely to cause postpartum
The occurrence of urinary incontinence has nothing to do with whether episiotomy is performed or not.
New mothers can alleviate this situation by performing pelvic floor muscle training in time after delivery.