Not every childbirth is complete without auxiliary obstetric techniques. Sometimes there is a need to make an incision in the perineum to facilitate the child's passage through the genital tract and prevent spontaneous perineal rupture. Stitches that are then applied in the postpartum period will be of particular concern. In this article we will tell you what are the features of the healing of such stitches and what problems a woman may face.
The purpose and methods of the procedure
Artificial dissection of the perineum is called episiotomy. Such a small surgical operation is required if there is a high risk of perineal rupture during natural childbirth.
Doctors expand the exit from the vagina with an incision, due to which the risk of rupture is reduced, as well as the likelihood of a baby getting a birth injury, because it becomes much easier and faster for him to be born.
The procedure is done only in the second stage of childbirth, when the woman starts trying, at the time of the birth of the head and shoulders. If the exit of the head is physiologically difficult, the problem is solved by an incision. There are four methods of dissection, but in Russian obstetric practice only two are usually used - median-lateral and perineotomy. In the first case, an incision about 3 centimeters long is located from the center of the perineum to the right or left, and with perineotomy - downward, in the direction of the anus, but not reaching it.
Technique
Everything is done simply - at the peak of the effort, when the head is visible, the perineum, which has been pretreated with an antiseptic, is cut with surgical scissors. The wound is sutured at the end of childbirth, after the birth of the placenta.
Suturing is carried out using anesthesia, even if cut without it. How the suture will heal, how high the likelihood of complications depends on what kind of technique, what suture materials the medical worker chooses.
If there is damage to the genital tract, cervix, first apply internal sutures. The threads are self-absorbing, which do not need to be processed and removed, after a certain period of time they dissolve on their own. The outer seams can be stitched with silk threads in the shape of a figure eight (the so-called Shute technique). The threads pass through all layers at the same time. The likelihood of complications and problems with the healing of such stitches is higher.
Layer-by-layer and step-by-step suturing of the wound edges is considered optimal. First, internal sutures are applied to the back wall of the vagina, then muscle tissue is sewn, and then a continuous cosmetic suture is performed outside. The sutures after the episiotomy are treated with an antiseptic and at this the birth is considered complete.
Recovery time
The presence of stitches in the perineum after childbirth complicates recovery - a woman is limited in movement, she needs to constantly remember that the perineum should not be strained. The main feature of surgical stitches applied after an episiotomy is that healing for natural reasons is slower than scarring of sutures on exposed skin surfaces.
The perineum is a place that does not allow the sutured area to come into contact with open air, which could speed up healing.
Processing is also fraught with certain difficulties and is possible only with outside help; it is very, very difficult for a woman to treat a wound herself.
Episiotomy stitches are more likely to become inflamed because there is no way to apply a sterile bandage to them, as is done with a caesarean section wound. In the first days after childbirth, it bleeds heavily from the genitals - lochia comes out, the uterus cleans itself, the uterus undergoes a process of involution - reverse development. Lochies definitely need a free exit, and a bandage cannot be applied for this reason.
Lochia, which are secretions of a blood nature (a placental wound on the inner wall of the uterus, where the placenta was located), is themselves dangerous for the sutures, because blood is a favorable environment for bacteria to multiply. And even opportunistic microorganisms that live on the skin and in the intestines may well cause serious bacterial inflammation. Given the location of the stitches, it is easy to guess that contact with bacteria is very possible.
The anatomical location of the perineum cannot provide temporary rest to damaged and sutured tissues. When moving, defecating, urinating, with tension in the abdomen, the perineum is invariably tensed. That is why, and also because of the dissection of the nerve endings in the first days after the episiotomy, the stitches hurt, in the perineal region it pulls. As the suture heals, the pain will diminish. After 5-7 days, a complete connection of the wound edges occurs.
On day 8-9, the stitches are most often removed. Often, during the healing process, they itch and ache. Gradually, after 3-4 weeks, the stitches will heal completely. Some compaction at the suture site lasts up to six months. The cosmetic seam looks aesthetically pleasing, and you don't have to worry about it. When the area of application of surgical sutures ceases to bother, it largely depends on how the woman will take care of her, whether she will follow all the doctor's recommendations.
Care advice
A woman who has undergone an episiotomy should not sit down after giving birth. Firstly, it hurts, and secondly, the tension of the skin in this position can lead to divergence of the seams. If the dissection was oblique (mid-lateral), then you can gently sit on one thigh opposite to the direction of the suture.
If the incision was made to the left, then they sit on the right thigh, and vice versa. For about three weeks, you will need to sit down just like this, and all the usual actions and care of the baby should be done while standing or lying on its side.
For safety reasons, it is better not to make sudden rises from a lying or sitting position, and move carefully, smoothly and prudently.
Proper handling and care will help avoid complications and infections and promote tissue repair. The recommendations in this case are:
change liners more often, use sterile liners provided by the maternity hospital, and on the second day you can switch to sterile special liners for women in labor;
wash yourself after each visit to the toilet, while moving your hand from the pubis to the anus, in no case vice versa;
at home, you can wash yourself with a weak solution of potassium permanganate - this effectively dries the wound;
the crotch is not wiped, but blotted with a soft napkin or diaper;
you need to process the seams every day - first, apply a little hydrogen peroxide, and then smear the edges of the wound with brilliant green. At home, a spouse can help with this.
Once a day, it is advisable to leave the perineum open for 20-30 minutes for faster healing. You should not take a bath in the first 4 weeks, this will increase the likelihood of wound infection. Better to take a shower.
A month later, when the main restrictions are lifted, a woman can start using agents that increase the elasticity of the scar - the Contractubex gel can be used if there are no complications.
Complications and treatment
Negative consequences after an episiotomy are not as rare as women and doctors would like, because healing, as we found out, has specific features. Some of the symptoms and signs need special attention.
Healing too long
If a week after giving birth, the suture continues to bleed, it gets wet, it is possible that an infection has occurred. You definitely need to see a doctor to get qualified help.
Seal
A scar, moderately compacted along its entire length, is initially considered a normal variant. But the formation of a lump on the scar or next to it may indicate an uneven docking of the edges of the wound, as well as internal hematomas. The situation requires treatment. If hematomas are found, sometimes surgical help is needed to remove them.
Inflammation
It is manifested by the fact that the seam swells, turns red, hurts when touched. It often bleeds or festers. A woman's temperature rises, discharge from the genitals may be yellowish with an unpleasant odor. The situation requires the appointment of local and sometimes systemic antibiotics and anti-inflammatory drugs. When handling, the wound is washed, if there is a lot of pus, then drainage is put. If the seam is inflamed and festering in the late period, the likelihood of fistula formation is considered.
Divergence
To understand that the seam has come apart, a woman can by the appearance of blood secretions, by increased pain. Not all discrepancies require re-closure. Only broad and deep. Minor ones do not require special treatment, except for the application of Levomekol ointment topically to the area of application of threads. Such discrepancies usually grow together using the secondary tension method.
Unpleasant sensations during intercourse
They are mechanical in nature. In this case, it is impossible to anesthetize the area of overlapping threads, you just need to wait a little, choosing positions for intimate contacts in which the tension of the perineal tissues will be gentle. Usually after six months, the dyspareunia goes away and the sexual positive feelings return in full.
With repeated births, a well-healed elastic scar does not pose a great danger. But in order for him to heal properly and not get sick either after six months or after 3 years, you need to follow the recommendations and timely treat the problems that have arisen.
