Episiotomy includes not only lateral incisions, but also central incisions (for convenience of description, hereafter collectively referred to as lateral incisions). Some mothers who have had a cesarean section choose surgical delivery for the simple reason of avoiding side incisions. Is side incision really that scary? Do all mothers who have natural births have to go through this level? In order to solve this problem, we collected relevant foreign information and compared it with the domestic situation:
Episiotomy has a limited scope of application abroad and in China. As a routine operation in natural childbirth, the proportion of vaginal births abroad is about 20%, and in China it is about 90%.
reason
It can reduce late perineal injuries and suture healing complications that occur within 7 days after delivery.
Prevention of perineal tears, protection of pelvic floor muscles, and the concept that surgical incisions are easier to repair and heal better.
Comment
The limited use of side incisions does not lead to further adverse consequences such as vaginal or perineal injury, pain, dyspareunia, or urinary incontinence. The only disadvantage is an increased risk of preperineal tears.
For some mothers who can give birth smoothly without side incision, it will increase some unnecessary pain. Moreover, side injuries may heal quickly physically, but the psychological impact on some mothers is lingering.
Why is lateral incision so widely used in China? Is there a risk of perineal tearing without a side incision? To answer these questions, I called a doctor who, for various reasons, was unwilling to appear in this article as an expert. However, she gave me a very objective answer based on many years of clinical experience and practice, that is: side incision should not be used as a routine operation in clinical practice, but limited side incision requires many prerequisites, one of which is very important. is the need for the current surgery. Excellent obstetrician nurses have a strong sense of responsibility, superb medical skills, rich clinical experience and judgment ability, as well as more meticulous care and attention to maternal care. However, the current medical level and diagnosis and treatment environment in most areas of our country cannot meet these conditions. She also stressed that it was too early to perform limited transverse incisions. If we blindly reduce the rate of side incisions, it will do more harm than good, such as increasing cases of perineal tears and even threatening the health and life of the fetus.
There’s not much we can do about the current medical situation, so what else can we do to reduce our chances of getting hit? If this stabbing is inevitable, how can I make myself less painful and recover faster?
1. Be prepared to avoid cutting edges
A large part of the reason why doctors decided to use a side incision was to avoid tearing the mother\’s perineum. At this point, some practices of foreign mothers are worth learning. They usually start perineal massage and daily exercise around 32 weeks into pregnancy to increase the flexibility and elasticity of their muscle tissue. The specific operations are as follows:
*Trim your nails, wash your hands, and sit in a warm and comfortable place with your legs straight in a semi-sitting birthing position.
*Place a mirror in front of the perineum, facing the perineum. This will allow you to clearly see the condition of the musculature surrounding the perineum.
*Choose some massage oil, such as pure canola oil, or a water-soluble lubricant, and use your thumb and fingers to apply the oil around the perineum.
*Insert your thumb into your vagina as far as possible and stretch your legs. Press the perineal tissue against the rectum. Gently continue stretching your vulva until you feel a slight burning or tingling sensation.
*Keep this stretch until the tingling subsides, then continue massaging your vagina gently back and forth.
*When massaging, hook your thumb around the vagina and slowly stretch the vaginal tissue forward, just like the baby\’s head coming out during childbirth.
*Finally, gently massage the muscle tissue between your thumb and index finger back and forth for about 1 minute.
Notice:
*Forcible pressure on the sensitive skin of the perineum causes bruising and stinging.
*Do not press hard on the urethra during massage, otherwise it will cause infection and inflammation.
Exercise the sphincter muscles to tighten the muscles of the vagina and anus. Do it about 200 times a day, for 8-10 seconds each time. You can also try contracting your muscles and pausing for a moment while you urinate.
Sphincter exercises have other benefits:
* It can help you stop leaking urine when you sneeze or cough.
* Tough muscles make labor easier and the perineum will remain intact (fewer tears, less chance of incision). It also helps to enjoy the sweetness of sex in the world of two people. Because it can prevent pelvic organ prolapse and aging.
2. Prepare to communicate with the doctor. The doctor on duty is likely to face several women at the same time, so she is unlikely to have the patience to explain to you why a lateral incision is required. According to data from our online survey, about 70% of mothers were not notified by the doctor when undergoing side incision, but were cut without knowing it. In order to prevent yourself from being cut and dazed, it is necessary to communicate with the doctor in advance. First of all, you need to understand that there are several situations where you must do it sideways:
* If 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 larger, the fetal head is not in the correct position, and the labor force is weak, so the fetal head is stuck in the perineum.
* Women over 35 years old, or those with high-risk pregnancies such as heart disease and pregnancy-induced hypertension syndrome, in order to reduce maternal physical exertion, shorten the labor process, and reduce the threat of childbirth to the mother and baby when the fetal head descends to the perineum. , a side cut is required.
*The cervix is fully dilated and the fetal head is low, but the fetus is obviously hypoxic and the heart rate changes abnormally, orIrregular heartbeat, turbid amniotic fluid or mixed with meconium.
*Delivery with forceps.
If the above situation occurs, do not hesitate to cooperate with the doctor and perform lateral incision as soon as possible.
Secondly, when labor pains begin, estimate who the doctor on duty will be. If you have the chance, try to talk to her and tell her your thoughts, such as: if the situation permits, can you not do side incision; perineal tear and other risks. Usually, the doctor will tell you or your family before you enter the delivery room. Various questions that may arise, and you will be asked to sign a consent form for surgery to save communication time in case of danger.
Time. At this time, you can also seize the opportunity and seek help from a doctor.
3. Recovery after surgery
Many mothers think that side incision is bearable, but the 1-2 weeks after surgery are the most difficult. Of course, taking painkillers is the most direct way to relieve pain, but you can also take some physical therapy to help the wound recover as quickly as possible:
*Sitz bath. Fill your tub with warm water. Use ice packs to create a special pad.
*Wound care. That is, when you clean, you can fill a sterile bottle with water, use the jet of water to rinse the wound, or pat the area around the perineum with water. This will feel much better than dry wiping.
*Use lubricant. After the intimacy between the couple has been restored, lubricants can be used to avoid further strain on the recovered muscle tissue.
During the wound recovery process, there are some precautions:
Before removing the sutures, the wound should be rinsed twice a day and once after defecation to avoid contamination with excrement. Wounds; after the sutures are removed, if the lochia is still not clean, you should still rinse the vulva with warm water twice a day. At the same time, keep the stool open to prevent the wound from opening. When defecating, it is best to sit down and shorten the time as much as possible. In addition, after the sutures are removed, the inside of the wound is not yet firm, so it is best not to exercise too much or make large movements.
In addition, if the following conditions occur in the wound, you should tell the doctor in time and ask her to deal with it:
*Wound hematoma: Serious hematoma appears at the incision site 1-2 hours after suturing. The pain is getting worse and worse, and there is even a feeling of swelling in the anus.
*Wound infection: 2-3 days after delivery, the wound will appear red, swollen, hot, painful and other symptoms, sometimes accompanied by induration, and purulent secretions will appear when squeezed.
*Wound dehiscence after suture removal: Some mothers will have wounds dehiscence after suture removal. If they have been discharged from the hospital at this time, they should go to the hospital immediately for examination and treatment.
On the Internet, many mothers have told their experiences about side incision surgery, which may help you who are about to give birth to know more about side incision and be more mentally prepared:
My baby was born The weight is only 6 pounds and 1 tael, and my condition is also good. I think it won’t be a big problem if I don’t do a side cut. But now the hospital seems to give you a surgery no matter what you do. It really should be \”\”Be merciful under the knife\”, I recovered well in other aspects, but the incision took a long time to heal, which caused a certain amount of pain. … He Fan
I was unlucky. My body had an allergic reaction to the thread, which resulted in wound infection, and it took a long time to recover. Although there were no sequelae, I was still worried… Liu Ying
I was very confused about whether a side incision was necessary. , I am also very confused about the so-called recovery time from side incision. For me, the physiological recovery time from side incision is not very long, but the psychological impact on me is very deep. By the time of suturing, the effect of anesthesia has passed and it is very painful. The biggest pain in my postpartum recovery is also from the side incision. The pulling pain really makes it difficult for me to have a good rest that day. As for the psychological shadow, I feel that it has not passed yet. Even now when I squat down to bathe the baby, I still feel that the wound is still there. The pain involved, I think it is psychological pain, maybe I am an overly sensitive person, but it was because of my fear of the scalpel that I chose to give birth naturally. I could bear the labor pain, but I did not expect that I would have no choice. I wanted to have a second baby, but I was timid when I thought about it… Wang Yue
From the day I was pregnant, I made up my mind that as long as the baby\’s fetal position was normal, I would have it myself. I gave birth to the baby. During the delivery process, I cooperated very well with the doctor and gave birth to the baby smoothly. The doctor said that I was in a standard labor process and the side incision was not large. After returning home, I paid attention to washing it every day to prevent infection and the wound recovered well… …Wei Hong
Pregnancy and childbirth are a series of smooth processes. After several months of pregnancy, the day of delivery finally arrived. The fetal membranes were prematurely ruptured and the cervix was not opened, which was a sign of dystocia. My husband called me aside and asked him whether to choose induction or caesarean section. He chose induction without hesitation. Anyway, the pain was not his. From the beginning of the oxytocin treatment, the baby\’s fetal heart rate slowed down. Four hours later, the cervix was dilated to seven centimeters and I was pushed into the delivery room. The doctor kept encouraging me to push harder, but at the last moment, the baby\’s fetal heart rate was only about 80 beats per minute, and it might be dangerous to wait for the baby to be delivered naturally. , so the friend who accompanied me into the delivery room was also a midwife. With her consent, I had an episiotomy and found a hematoma in the birth canal after the baby was delivered. It was very painful, especially during the anesthesia. It hurt even more. At that time, the baby was lying next to me, and I was staring at her to distract myself from the pain. I don’t know whether it was because the surgery itself was not successful enough or because I was more sensitive to pain. I always felt that the sutures were in the rain. There is a dull pain in the sky, and I have even lost interest in being intimate with my husband. If I really have the chance to have another child, I will choose natural delivery, but try not to have a side incision… Indiarose
Side incision. It seems to have become a routine. The doctor just gave me a knife without asking for advice. However, I didn\’t feel any pain at the time. It was not until the child was born that I gritted my teeth in pain… danma