A second child is easier to have and has less chance of trimming than a first child. However, it is still not ruled out that the second child will need a side cut. So what are the circumstances when giving birth to a second child require side surgery? Let’s listen to the answer from Dr. Xu Yimin, an expert in obstetrics and gynecology!
1. Three cases of normal delivery of second child requiring transection
The dilated vagina of a multiparous woman makes it easier to give birth to a first-time baby, and the chance of a side cut is reduced. However, if the following situations occur, in order to reduce the harm to the mother and newborn, the second child still needs to be lateral cut.
1. The fetal head is too large to avoid serious tearing of the perineum. If the fetus is relatively large and the delivery is fast, deep perineal lacerations may occur, which may even affect postpartum urination and defecation. The support of the pelvic floor and vagina will also be loose, affecting recovery. Lateral incision can reduce the expansion of the fetal head into the birth canal and protect the mother\’s pelvic floor and vagina to a certain extent.
2. Advanced maternal age, or combined with pregnancy-related diseases. For mothers who are over 35 years old and have a second child, or mothers with comorbidities such as heart disease and pregnancy-induced hypertension, side incisions are used to shorten the second stage of labor and reduce harm to the mother and baby in order to prevent the mother from exerting herself for a long time.
3. Prevent danger to the baby and complete the delivery process as soon as possible. If the fetal head is under huge pressure from the perineal tissue for a long time, it is likely to cause fetal asphyxia or intracranial hemorrhage. In order to shorten the time when the fetal head is squeezed at the vaginal opening and free the fetus from the risk of hypoxia as soon as possible, a lateral incision is required. In addition, if the fetal head is relatively large and the mother\’s pelvic condition is not good, she will need to use an aspirator or forceps to assist the delivery, and she will also need lateral incision to cooperate with the final delivery.
2. The position of trimming again depends on the production situation.
There are two methods of episiotomy, one is to incise along the direction of the vaginal cavity, which is called a straight incision, and the other is to make a side incision at a certain angle (about 40 degrees) to the above direction, which is called a lateral incision.
When the doctor sees that the fetal head is about to come out of the vaginal opening, he will immediately determine whether the baby is too big and whether it will cause severe tearing of the perineum, and then decide whether to perform an episiotomy. Multiparous women may have a side incision on the front side, and some mothers also have a side incision on the other side. The specific location of the side cut depends on the production situation at that time.
The time for episiotomy is generally chosen between two uterine contractions. The fetal head is exposed from the vaginal opening, with a diameter of about 34 cm. Under perineal block anesthesia, a 45 cm incision is made on the left side of the perineal body. 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 use buried sutures to suture the wounds, and some midwives use external silk threads to suture the skin, leaving the skin intact after suturing.
three, Key points of nursing care after lateral lateral dissection of the second fetus
For many moms, the first 1-2 weeks after side surgery is the most difficult time. Taking painkillers is the most direct way to relieve pain. At the same time, you can use some physical therapy to help the wound recover as quickly as possible:
1. Keep the wound clean and dry
Women who have had an episiotomy should clean their vulva with water or lotion every day after leaving the hospital. It’s best to wash twice a day if possible. At the same time, use safe sanitary products and replace them in time to keep the vulva dry and clean. Infrared rays can also be used to irradiate wounds to keep them dry, promote blood circulation, and accelerate wound healing.
2. Do not apply direct pressure to the wound
The mother may feel the wound is very painful when sitting or lying down, so she should choose a comfortable position when sitting or lying down, and try not to put direct pressure on the wound. Excessive compression may easily lead to suture dehiscence.
3. Do not strain when defecating
It is best to defecate in a sitting position to avoid wound dehiscence and prevent constipation. If you have constipation, you can eat laxative foods such as olive oil and honey. After defecation, rinse the perineum with clean water, just like wiping with toilet paper, from front to back to avoid bacterial infection.
4. Sexual life is prohibited during the recovery period
Women who have had an episiotomy should avoid having sex for 6 weeks after giving birth. Six weeks after delivery, if the doctor confirms that the uterus and birth canal are recovering well, you can have sex.
5. If the wound has the following conditions, you should tell the doctor in time:
Wound hematoma: 12 hours after suturing, I felt severe pain at the incision, which became more and more severe. Even the anus felt swollen.
Wound infection: 23 days after delivery, the wound appears red, swollen, hot, painful and other symptoms, sometimes accompanied by induration, and purulent secretions when squeezed. Wound dehiscence after suture removal: Some women may experience 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.