Everyone should know the three major functions of the female vagina: First, it is the channel for menstruation, which is inevitable from adolescence to menopause; second, it is the channel for sexual life. Every mature woman obtains physical and mental pleasure through sexual life, and through sexual intercourse Life comes to completion. The important task of reproduction; finally, it is the passage for the birth of the fetus. Therefore, the growth of the human female pelvis, although various diameters vary during the period, is suitable for the fetus to be delivered from the mother\’s body through rotation and descent.
After we become pregnant, various organ systems in the body will undergo a series of changes due to pregnancy. These changes are for the healthy growth of the fetus and preparation for the delivery of the fetus, especially the changes in estrogen and progesterone in the endocrine system, which lead to huge changes in the female reproductive system. These hormones act on the uterus, cervix, pelvic ligaments, Pelvic floor tissue, vagina, perineum, breasts, etc. At the end of pregnancy, these hormones make the ligaments of the vulva, vagina, and pelvis soft and elastic, preparing for delivery. fetus.
There are generally three modes of delivery for the fetus: natural delivery, vaginal delivery and cesarean section.
Generally speaking, every woman has her own ability to give birth, which is the instinct of mammals. Near the end of pregnancy, when the fetus matures, the fetal adrenal gland and brain-hypothalamus-pituitary gland secrete hormones that act on the mother\’s body, causing the mother\’s body to produce oxytocin, which naturally starts uterine contractions, redness and swelling, the cervix naturally expands, and the water breaks naturally. The fetus\’s head droops naturally and the fetus is delivered naturally. No matter whether the contractions are severe or not, expectant mothers can endure it until they give birth naturally. The fetus is also well prepared for natural birth within the uterine cavity. Every time a contraction comes, the fetus is temporarily deprived of oxygen. Fetal death occurs in the womb; the bony birth canal is rugged and the fetus can rotate inside the body, constantly looking for the most suitable diameter in the pelvis and continuing to descend, eventually giving birth to the mother. This is the most basic ability for human beings to reproduce from generation to generation. Mothers who give birth naturally have less postpartum bleeding, can get off the ground soon after delivery, and recover faster. This is also the advantage of natural birth.
Perineal tears can occur as the larger fetal head passes through the narrow perineum. The common causes of perineal tears include: perineal edema and weak elasticity; the perineum is too narrow and elastic; the fetal head is delivered too quickly; the pubic arch is too low; the fetus is too large, etc. Some of these tears will be very deep, reaching the uterine fornix or even the lower part of the uterus, making suturing difficult; there are also large-scale tears, and the bottom of the perineum is the anus, and the tear can tear the vagina. The anal sphincter and even the rectum are completely torn, causing great harm to the mother; there are also irregular multiple lacerations that are difficult to suture.
In order to avoid this kind of perineal injury, episiotomy is used during delivery to form a neat wound on the perineum, which facilitates suturing and healing and minimizes the harm to the mother during delivery.
But not every pregnant woman needs a lateral incision during childbirth. When the child is of medium size; the mother\’s perineum is in good condition, with good elasticity and extensibility; there is no inflammation; no assisted delivery is required; the delivery process is assistedIt is done slowly under the guidance of doctors and others. In this case, no lateral incision is required. Careful guidance and careful protection of the perineum by experienced midwives and auxiliary personnel during labor can prevent or reduce perineal rupture and basically maintain the integrity of the perineum. After the delivery process, the midwife will carefully examine the unincised vulva, vagina, cervix, and vaginal vault, and sew any small tears in a timely manner. If there are no lacerations, the birthing process will be over.
As for whether there are indications for lateral incision, consultation is required, that is, the midwife, midwifery staff, and on-site doctors jointly diagnose whether lateral incision is necessary. Preliminary lateral incision will only be performed if there are indications. Indications for side cuts.
What are the indications for side resection?
1. Inflammation of the perineum. If vaginitis cannot be cured during pregnancy, the inflammation will cause congestion and edema in the perineum and vagina, causing the tissue to become brittle and lack elasticity, requiring side incision.
2. The perineal body is short, that is, the distance from the vaginal opening to the anus is too short. Once a laceration occurs, both the anal sphincter and rectum are affected. To prevent this from happening, prophylactic lateral incisions were made to avoid severe lacerations.
3. If the fetus is too large, it is difficult for the relatively large fetal head to pass through the vaginal opening, and a side incision is required.
4. When the fetal head is exposed, the fetal heart rate drops during uterine contractions, causing fetal distress. In order to get the fetus out of the danger of hypoxia as soon as possible, a lateral resection is required.
5. When the fetal head has reached the pelvic floor, forceps or fetal head aspirator must be used to assist delivery due to intrauterine distress or uterine atony. Therefore, side incision should be made to avoid laceration.
6. When the mother has complications such as pregnancy-induced hypertension, heart disease, etc., in order to prevent the mother from exerting force for a long time, a lateral incision is used to shorten the second stage of labor and reduce damage to the mother and baby during labor.
7. When the second stage of labor is prolonged, in order to deliver the fetus as soon as possible and avoid long-term pressure on the fetus in the vagina, a side incision is required.
The incision time for episiotomy is generally chosen between two uterine contractions. The fetal head is exposed at the vaginal opening, with a diameter of about 3-4 cm. The incision is made under the perineal block at a 45-degree angle on the left side of the perineal body, and the length is about 4-4 cm. 4 cm. 5 cm. It can prevent postpartum pelvic floor relaxation, avoid postpartum cystocele, anal prolapse and urinary incontinence. Generally, four layers are cut: vaginal mucosa, muscles (superficial transverse perineal muscle, part of levator ani muscle), perineal subcutaneous fat, and perineal skin. After the fetus is delivered and the placenta is delivered, the midwife carefully examines the cervix, vaginal wall and episiotomy wounds, and sutures them layer by layer to restore the original anatomical relationship. Some midwives sew the wound with buried sutures, and some midwives sew the skin with silk thread, leaving the skin intact after suturing.
How to care for postpartum side incision wounds?
1. Keep the perineum clean and pay attention to cleaning the perineum every day. Because the perineum is between the two thighs, it is airtight. In addition, postpartum lochia, urine, feces, and sweat are mixedTogether, infection is highly likely to occur. Therefore, on the second day after delivery, the hospital nurse will wash the perineum to clean the perineum that was contaminated during delivery. In the future, pay attention to flushing with clean water promptly after defecation and wiping to the opposite side of the side incision after defecation to avoid contaminating the wound. Keep the perineum clean through daily cleaning to promote wound healing.
2. Edema and congestion will occur in the side incision wound. When there is edema or congestion, wet compresses with magnesium sulfate gauze can be used, or cold compresses can be used with ice packs, but the time should not exceed half an hour before changing.
3. In the first few days after delivery, pay attention to whether there is anal protrusion and whether there is a desire to defecate. If there is anal swelling or defecation, the possibility of perineal hematoma or the possibility of sutures passing through the rectal wall should be considered. You should communicate with the doctor in time and ask the doctor for timely examination and treatment to avoid delaying the condition.
If the episiotomy has external sutures, the sutures need to be removed 4 days after delivery. Before the sutures are removed, the perineal wound will
There will be a tight feeling, but it will feel easier after the stitches are removed. Some people are not easy to absorb foreign bodies such as intestinal glands. After a week or two, intestinal glands will slowly push out pustules near the perineal opening and incision. Don\’t be afraid at this time. Go to the hospital and ask a doctor to cut it out and it will be fine.
4. Due to the thick tissue, perineal wounds may feel painful during the healing process. Therefore, when sitting flat, especially when breastfeeding, you can slightly lift the left side and put a soft pad under the buttocks to avoid wounds. pain.