Episiotomy during childbirth: what is it, why is it done, what could be the consequences? Childbirth and episiotomy. Possible complications and consequences

Despite the fact that the birth of a child is the happiest moment in the life of every family, it becomes a serious test for a woman. First of all, many mothers are afraid of the upcoming birth. In this regard, they are interested in whether they will be successful, how easy it will be to endure, whether the child will have any deviations.

Pregnant women have great fear when they hear about episiotomy. During a conversation with friends who have already gone through pregnancy, they can learn about this very frightening procedure. Therefore, they have a strong desire to find an opportunity not to resort to this method. Of course, people perceive differently the need for a perineal incision. Therefore, episiotomy has both supporters and opponents.

What is episiotomy and its types

Women who are about to give birth for the first time probably do not have the slightest idea what an episiotomy is. In fact, this term refers to a perineal incision made surgically in the second stage of labor. In this case, the dissection can be performed in different directions, which allows you to highlight several types of episiotomy:

perineotomy or median episiotomy. With this type of surgical intervention, the dissection is performed towards the middle: the incision created goes from the frenulum of the labia minora towards the anus, not reaching 2 cm;
lateral or lateral episiotomy. This type of perineal incision is made from the frenulum of the labia minora in the direction from the anus at an angle.

A special group is formed by unilateral and bilateral episiotomy. However, it is the first method that has become most widespread. Bilateral dissection of the perineum is resorted to in cases where there is a need to apply obstetric forceps or other complications occurred during childbirth.

Alas, in our country there are quite a lot of cases of episiotomy, although in last years the percentage of use of this technique is decreasing. A couple of decades ago, doctors resorted to this method of surgical intervention during every birth, which was the first for the pregnant woman. However, in Lately the situation has changed, and today obstetricians try, if possible, to do without making such a perineal incision.

Usually the decision to carry out such a dissection is made in the second stage of labor, when fact of eruption of the head. In other words, at the moment when the head approaches the small pelvis and does not go back even in the absence of pushing. Most often, when carrying out such surgery they do not resort to painkillers, since the muscles and skin of the perineum are in a stretched state, which is why the pregnant woman does not feel any discomfort.

Typically, the perineal incision made is about 1-2 cm in length. In most cases, a lateral episiotomy is performed, which is more preferable because it minimizes the risk of damage to the rectal sphincter. Despite the fact that when performing a median episiotomy, there is less blood loss, and the healing process of postoperative sutures takes less time, this type of dissection increases the likelihood of infection in the wound after childbirth.

It is believed that it is better to make an incision than to allow the perineum to rupture, since the former takes less time to heal and is better. The reason for this is that the incision made by the doctor available smooth edges , which are easier to fasten. In addition, the procedure for suturing second, third and fourth degree perineal tears is not only tedious, but also a lengthy process, not to mention the fact that wound healing takes longer. Although episiotomy provides a number of benefits, it can only be performed in certain situations:

Postoperative period

It usually takes time for the stitches to close after an episiotomy. takes about two weeks b. A pregnant woman should not sit down while recovering from an episiotomy. When the healing period comes to an end, she may be allowed to sit on only one buttock, but with the condition that she will be in contact with the surface with the healthy side of the perineum, while her legs should be brought together. Before feeding the baby, pregnant women need to take a lying position.

After completing the episiotomy, treat the sutures with a concentrated solution of potassium permanganate. Subsequently, the woman in labor must adhere to a laxative diet, which will facilitate easier passage of stool and help prevent the sutures from coming apart. When a pregnant woman is discharged, she needs to regularly wash the external genitalia using boiled water, after the next meeting of natural needs.

For an episiotomy, recovery involves regularly changing pads every four hours. For this purpose, napkins are used, which are previously apply levomekol ointment which helps speed up the healing process. Before it is possible to return to normal sexual activity, a woman will have to endure quite a long period of time. rehabilitation period during two months.

Consequences of episiotomy

Unfortunately, episiotomy does not always pass without leaving a trace for a pregnant woman. In some cases there may be certain complications and consequences:

Considering that many women in labor would like to do without this procedure, there are a number of recommendations that, even if they do not allow avoid unwanted cutting, then at least they will help reduce the risk of it being performed during childbirth.

Preparing for childbirth

If a woman has a good idea of how the birth will take place, then she is less overcome by fear, since she can soberly assess her condition and knows what needs to be done when the staff contacts her at a certain point in labor.

The experience gained during classes in a group of pregnant women or at home will provide good help. Then, during contractions and pushing, she will be able to take this position, change her breathing and relax to ensure best conditions for the fetus to come out.

Such actions on the part of the woman in labor will help bring the birth process closer to ideal and thereby reduce the likelihood of using an episiotomy.

If your birth will take place under a preliminary agreement or contract, then it will not hurt you to let your attending physician know in advance if you would like to give birth as naturally as possible.

Perineal massage

For this procedure to have the desired effect, massage must be performed regularly. at least 2-3 times a week. It can be done for the first time already at the 36th week of pregnancy.

During the massage, fingers are used, with which, after inserting into the vagina to a shallow depth, they begin to gently massage the perineum from the inside towards the anus. It is this area that stretches as much as possible during childbirth, thereby increasing the risk of damage. To achieve the effect, it is recommended to massage lasting about 3-5 minutes. If the woman does not feel awkward, then entrust this intimate procedure Possibly for a partner too.

Conclusion

Despite the fact that episiotomy has been viewed as rather unpleasant surgical intervention, in some situations you cannot do without it. Therefore, in cases where it is simply necessary to make such a cut in order to so that the birth takes place without complications, a woman just needs to reconcile herself and cast aside all fears.

Although every pregnant woman has the opportunity to do without this unpleasant procedure, for which it is enough to prepare for future births. There are a number of measures that can improve the functions of the perineum, thereby creating favorable conditions for normal childbirth.

Episiotomy

It is impossible in principle to predict what the birth process will be like for a particular woman in labor. Despite all the advances in medicine and the preliminary assessment of risk factors, some processes during childbirth are subject exclusively to the forces of nature. The doctor and the woman in labor have no choice but to accept this. There are many ways to help your baby come into the world if labor is difficult. One of them is episiotomy. In this article we will tell you what it is, how it is performed and what consequences such an operation can have.

Peculiarities

Episiotomy is one of the most common minor operations in obstetrics. Its name comes from the Greek word "epision", which means "female external genitalia". The second part of the word means "dissection". In fact, this is the principle of this surgical intervention.

Episiotomy - an incision in the perineum. Obstetricians take this measure when there is a high risk that spontaneous rupture of the perineum will occur during the birth of the baby.

This measure is forced and necessary. It helps prevent serious consequences not only for women's health, but also for the health of the baby. A timely dissection of the perineum reduces the likelihood that the child will receive a severe head or cranial injury during birth.

The dissection is carried out during the second stage of labor, during pushing, and the birth of the fetal head. Anatomically, the female perineum is designed in such a way that it is possible to surgically expand it if the passage of the child’s head is very difficult. If the incision is made in time, it will be possible to avoid a rupture, which is more difficult to heal and can result in unpleasant consequences - prolapse of the pelvic organs, their prolapse, as well as severe bleeding, which will be very difficult to cope with.

Medicine knows four types of episiotomy:

mid-lateral(an incision with surgical scissors is made from the middle to the right or left side diagonally so that the end point of the incision is no closer than two and a half centimeters from the anus;
perineotomy, which is also called a median episiotomy (the incision runs perpendicular to the anus from top to bottom, without reaching the anus itself);
lateral(an incision at an angle of 45 degrees a couple of centimeters away from the center of the labia);
J-shaped(cutting begins from the center of the frenulum of the labia, moving to the lateral direction).

The location of nerves, vessels, and some glands in the perineum, as well as the speed and characteristics of healing of incisions after childbirth, have made the use of the first two types of perineal dissection more widespread.

Lateral episiotomy is considered undesirable due to the long and difficult healing of sutures; J-shaped is also used extremely rarely, since, despite its complexity, it is not considered justified and can easily be replaced by mediolateral or median episiotomy.

History of application

In history different nations and countries there are references to the dissection of the perineum of women during difficult and prolonged labor. IN Ancient China for this they used a red-hot piece of iron; in some tribes of Australia, thin and sharp shells and stones with pointed edges were used.

This tradition has reached modern doctors. In the most different countries for a long time dissection of the perineum was considered a normal practice and was carried out not only when indicated, but also just like that, just in case, to speed up labor.

Since 1960, most European doctors have decided to abandon this approach, with only Poland, the USA, Australia and Bulgaria choosing to remain committed to episiotomy. The degree of fanaticism with which obstetricians there cut women's perineums varies - in the USA, according to statistics, up to 36% of women in labor undergo surgery, and in Australian clinics up to 90% of all births occur with a cut in the perineum.

Episiotomy is widely accepted by doctors around the world. effective way avoid perineal ruptures, eliminate strong pain syndrome when spontaneous ruptures occur in different directions, prevent postpartum urinary incontinence and sexual dysfunction. At the same time, it is the surgical incision of the perineum itself that can cause all these problems. Due to this fact, the attitude towards the operation today is very, very ambiguous.

In 2010, WHO conducted a study and concluded that the absence of incisions, even if labor is slow, is more preferable, since a woman without stitches in the perineum recovers faster and has a lower risk of complications.

There have not yet been any direct recommendations to ban episiotomy, but The World Health Organization recommends against elective episiotomy limiting itself only to emergency dissections in situations where there is simply no other way out.

Who is it being held for?

According to the clinical recommendations of the Russian Ministry of Health, episiotomy is not recommended for routine use. This means that the doctor cannot, at his own discretion, cut a woman’s perineum without indication. Even if the woman in labor has previously had perineal ruptures, its dissection should not be planned.

Indications for the incision female crotch in childbirth today are significantly limited World Organization healthcare, the Russian Ministry of Health fully supports the restrictions. This is stated in clinical guidelines, set out in letter dated May 6, 2014 N 15-4/10/2-3185. These recommendations are fundamental for all physicians who assist in childbirth.

Surgical intervention is performed when it is necessary to minimize the likelihood of spontaneous rupture during pathological childbirth.

Such indications include a large fetus, the diameter of the head of which does not correspond to the throughput of the vagina, pelvic or other malpresentation fetus, if the woman categorically refused a cesarean section and insisted on an independent physiological birth.

An episiotomy is also carried out if it is necessary to use instruments - apply obstetric forceps or a vacuum extractor, which is impossible unless the entrance to the vagina is expanded artificially.

Dissection is recommended if a woman has poorly healed scars on the genitals resulting from severe ruptures in previous births, as well as after surgical plastic surgery vagina or the rite of female circumcision (and this happens in obstetric practice). If the scars are thin and heterogeneous, the risk of rupture increases tenfold.

Not long ago, dissection was performed for indications such as high perineum or rigidity. Today, the Ministry of Health recommends that such concepts should not be considered indications for mandatory episiotomy.

A rigid perineum may only need an incision if the head is not born within an hour. And the concepts of “high risk of rupture” and “threat of rupture” do not exist at all in obstetrics. Therefore, it is not worth cutting a woman’s perineum just because the obstetrician thought that a rupture was likely.

In practice, the list of indications is somewhat wider. Dissection of the perineum can be performed on women who are prohibited from pushing for a long time and strongly, for example, with myopia. This is done to speed up labor with minimal pushing. At the same time, there is a safer delivery option for a woman in labor - C-section, one of the indications for which is myopia.

Dissection of the perineum is also performed in the case of intrauterine oxygen starvation of the fetus, which is detected already during childbirth. In this case, the doctor needs to quickly make a decision - to cut the perineum or decide on an emergency caesarean section. It all depends on the condition of the baby.

Episiotomy is also used for dystocia of the child's shoulders - when they are wider than the head. This does not solve the problem, but after the incision the obstetrician gets more space for the necessary manipulations.

Technique

Once the decision to perform an episiotomy has been made, the perineum is treated before incision. antiseptic solution. The woman may have an epidural if the catheter is already in the spinal canal, or local anesthesia with lidocaine. Often the dissection is performed without anesthesia. If the perineal tissues are tense, acute pain the woman will not feel it when cut.

Dissection can be performed only when the effort is at its maximum stage of development and the head protrudes from the vagina by 3-4 centimeters. Without pushing, you cannot cut the perineum.

Surgical scissors are used for cutting. One branch of them is inserted in the direction of the intended incision, when the woman is calm and relaxed, without pushing. Then the obstetrician waits for the contraction to begin and, at the peak of pushing, makes an incision with a quick movement.

It is not possible to calculate the length of the incision down to the millimeter by eye, so the obstetrician makes it of an arbitrary length. It is believed that an incision less than three centimeters long is ineffective and dangerous - the perineum does not expand significantly, but a small incision may begin to spontaneously tear further.

Episiorrhaphy or perineorrhaphy is suturing the incision and restoring tissue integrity. They are carried out after the baby is born, the placenta has passed and the doctor will examine the cervix in connection with possible ruptures and injuries. Even if the perineum was cut without anesthesia, then before suturing it is customary to carry out infiltration anesthesia - inject lidocaine or another analgesic directly into the tissue that is to be sutured.

The choice of material for suturing and the suture technique influence the characteristics of wound healing, regardless of how the perineum was cut. Sutures can be performed using silk surgical sutures, which do not dissolve. They will need to be removed after healing.

This method (Shuta technique) involves placing sutures resembling figure eights passing through all layers of tissue. Such sutures quite often become inflamed and infected in the postpartum period.

Suturing can be layered and gradual. First restore integrity back wall vagina. Then the muscles are sewn together. Immersion sutures are made using self-absorbable material. A continuous cosmetic seam is made on the outside. Upon completion, the perineum is once again treated with an antiseptic solution.

The place where the incision is made, in all respects, is not very convenient for it to be easy and simple to provide the necessary care in the postpartum period. After a caesarean section, the suture is isolated from the rest of the body with a sterile bandage. It is not possible to put one on the perineum - the woman needs to go to the toilet, wash herself, and ensure unhindered passage postpartum discharge- sucker. All this does not imply any bandages.

The lochia themselves, which are released from the genital tract, are a desirable breeding ground for pathogenic bacteria. This is why there is a possibility of infection in the area where postoperative sutures are applied and for the same reason seams require careful care.

The perineum often tenses - when moving, walking, pushing during bowel movements, therefore the risk of sutures coming apart is quite high. If the postpartum mother does not follow all the doctor’s recommendations, complications can be very serious. The most common questions women have after an episiotomy require detailed and detailed answers.

How to sit?

After childbirth, in which doctors were forced to dissect the perineum, you should not sit, as this will most likely lead to the sutures coming apart. How long the ban on this position will last depends on how large the wound is sutured in the perineal area. Typically, women are not recommended to sit down for 2-2.5 weeks. If the incisions were deep and long, the postpartum woman will theoretically be able to sit down no earlier than 3-4 weeks later.

You cannot sit down, but you can sit down with support on the thigh on the side opposite to the direction of the incision. If the episiotomy was performed to the left, you need to sit down with support on your right thigh.

It is recommended to eat, drink tea and feed the baby at this time either standing or lying on your side. There are no restrictions on lifting weights for women after a physiological birth with an episiotomy, but you should still limit yourself to the weight of the child and not strain unnecessarily. You need to walk and stand with caution, to avoid sudden changes in body position, which will cause the muscles of the perineum to become tense.

How long does healing take? Caring for seams

The length of time the sutures heal depends directly on how carefully and correctly they are processed. If there are no complications early postpartum stage did not arise, there was no inflammation, fusion of the wound edges occurs within 5-6 days. If the stitches were applied using threads that do not dissolve on their own, it is customary to remove them after a week. If pathologies and complications of the suture are identified, the healing time may increase indefinitely.

To contribute more fast healing, a woman must remember a few simple, but important rules for caring for sutures:

pads in the maternity hospital, and then the pads need to be changed regularly - best every 2-3 hours;

after defecation or urination, each time you need to carefully wash your genitals in the bidet warm water and immediately change the gasket;

you need to wash with your palm in the direction from the pubis to the anus, and not vice versa (this will help prevent the introduction of intestinal bacteria into the wound area);

you can wash yourself weak solution potassium permanganate (this will dry out the area of the wound surface);

wipe the perineum with the seams rubbing or sudden movements it is impossible, it is better to use sanitary napkins and apply them with gentle blotting movements;

in the maternity hospital, the seams are treated every day with brilliant green, this is done by a midwife; at home, a woman can ask her husband or one of her close female relatives to help with the treatment.

If in the maternity hospital they are found expressed problems with the appearance of the sutures, swelling and signs of inflammation appear, physiotherapeutic methods such as laser therapy and ultrasound may be recommended. To relieve pain, a woman may be recommended painkillers.

Sometimes circumstances develop in such a way that good seam, which does not raise doubts among doctors in the maternity hospital, after discharge it suddenly diverges or becomes inflamed. The reason in most cases lies in the loss of vigilance by the postpartum mother.– at the time of discharge, some, out of excess happiness, simply forget how to properly get into a car, as a result of which the stitches are damaged.

The way home should be spent for the happy mother in the back seat of the car in a semi-lying state with support on the hip on the healthy side. We must not forget about this.

You should not take a bath in the first month. You should limit yourself to showering and washing. If you don’t have a bidet, you need to wash yourself with running water from a jug or ladle. In the basin standing water It is forbidden to wash yourself.

The rate of healing of sutures depends on hemostasis. Therefore, the diet must contain foods that have a positive effect on blood thickness. It is not recommended to eat baked goods, flour, fatty and fried products. Constipation should not be allowed, therefore, if it is difficult to empty the intestines, you should use an enema, microenemas, or laxatives approved for nursing mothers.

In order for the scar to form more evenly, women are recommended to use one month after episiotomy. by special means, for example, Kontraktubeks gel. It has a moderate effect on collagen production and prevents the appearance of an unsightly and rough colloidal scar.

Physical activity and sports routine

Every young mother wants to get herself into... good shape after childbirth - to lose weight, get rid of the tummy, which does not immediately return to its previous appearance. Therefore, the question of whether episiotomy affects sports activities is quite relevant for postpartum women.

In general, the regime physical activity women who have undergone such surgical intervention are not much different from the regime for ordinary postpartum women who did without dissection of the perineum.

Two weeks after giving birth, it is allowed to perform general strengthening exercises, which will include simple and calm exercises, without stretching the legs and squats. After two months you can do fitness, swimming, yoga.

A postpartum bandage will help get rid of the belly, which will carefully support the abdominal muscles.

Possible complications and consequences

Do not forget that episiotomy, despite its simplicity in execution, is still a surgical intervention, and therefore various complications cannot be excluded after it.

Even during the birth process, the surgical incision can be aggravated by its subsequent spontaneous divergence until the fact of a 3-4 degree rupture of the perineum is stated. In this case, not only ruptures can occur skin, but also gaps muscle tissue, as well as injuries to the intestinal sphincter and intestinal wall. In the most difficult situations, a vaginal-rectal fistula can form.

The seal on the seam is considered quite alarming. You need to take the situation when a lump appears on it with all seriousness. This may be a manifestation of improper joining of the wound edges, complicated by the healing of individual layers during layer-by-layer healing.

A suture that takes a long time to heal usually has one or more complications. The following symptoms are considered dangerous:

suppuration in the area of sutures;

green, gray, brown or yellow discharge from the genital tract or from the area of postoperative suture;

putrid or fishy odor;

increased pain;

asymmetrical arrangement of the labia in relation to each other;

swelling of the seam, redness, if they persist for a long time;

high temperature, feeling of weakness, chills, dizziness;

any problems with urination - pain, difficulty passing urine;

violation of the integrity of the seam.

Suture dehiscence is manifested by the appearance of ichorous and bleeding from the suturing area. After removing the remnants of the threads, if they were not self-absorbing, the unhealed areas of the wound heal on their own, growing together by secondary intention. Sometimes stitches are placed again if the first ones come apart, but only on the condition that healing has not occurred over most of the wound.

If you suspect a suture divergence, you should definitely contact a gynecologist.

A wound can become inflamed due to contact with pathogenic or opportunistic bacteria, which large quantities live in the intestines and perineum. Thought about possible inflammation should be allowed if long time swelling and pain in the suturing area do not disappear. The appearance of pus - reliable sign infections. You should also contact your doctor at antenatal clinic. In this case, the wound in the perineum is washed, the purulent contents are removed, and if necessary, a drainage outlet is installed. Treatment requires application antibacterial agents, which is not always combined with breastfeeding.

Asymmetrical labia, a lump on the scar can be a manifestation of hematomas. If they are small, treatment with antibiotics is also recommended, but if the hematomas have formed solid and deep, sometimes it is necessary to resort to surgical care for the removal of hematomas.

One of the most talked about consequences of episiotomy among women is dyspareunia. This term refers to the pain that a woman may experience in the vagina during sexual relations. It is recommended for a woman to abstain from sexual intercourse until one and a half months after giving birth with a dissection of the perineum. Then the relationship is not forbidden, but it may not be too pleasant for the woman herself.

A woman and her partner cannot influence dyspareunia in any way. Neither gels nor lubricants can significantly alleviate the discomfort. Properly selected poses will help reduce them somewhat. After six months, manifestations of dyspareunia usually disappear.

Prevention

To avoid episiotomy during childbirth, a woman is recommended to perform exercises during pregnancy that increase the elasticity of the perineal muscles - Kegel exercises. A woman can also benefit from light external massage with any neutral oil - massage the genitals for 5 minutes a day. Blood supply improves, muscle elasticity increases.

During the birth process, a woman should strictly follow the instructions of the obstetrician or doctor and push only when there is an appropriate command.

The birth process cannot be fully planned. It is possible to predict the risks on the part of the mother and child, but it is impossible to fully know how the process itself will proceed and what complications will arise. Therefore, episiotomy remains a manipulation that is performed unplanned, when indications arise during labor.

Anatomical rationale

Episiotomy is a dissection of the perineal tissue in the second stage of labor. Anatomical structure perineum allows you to make a neat surgical incision to prevent tissue rupture and formation laceration. Healing during surgery occurs faster, with the formation of a neat barely noticeable scar. In case of spontaneous rupture, the direction of the wound is unknown; it can lead to prolapse and prolapse of the pelvic organs, and massive bleeding.

The structure of the perineum is such that the incision can be made in two directions, without damaging the neurovascular bundles or large muscles. If the incision is directed from the vagina to the anus, then it is a perineotomy, or median episiotomy. Another option is a mid-lateral episiotomy. A purely lateral incision is used very rarely, because wounds heal worse after it, and the risk of damage to the Bartholin gland is increased.

The difference between perineotomy and episiotomy is in the direction of the incision. IN the latter case it is performed along an imaginary line connecting the posterior commissure of the vagina with the right ischial tuberosity. This direction is preferable due to the location of the vessels and nerves of the perineum.

Indications for performing the manipulation

Surgical intervention is not a doctor’s whim, but is carried out in case of a threat of perineal rupture. In recent years, there has been a decrease in the frequency of manipulation. This is associated with a decline in elective episiotomy, as well as a trend towards a decrease in active aggressive labor management.

Episiotomy is also performed in cases where it is necessary to minimize pushing in case of high blood pressure, high myopia, etc. The application of obstetric forceps or a vacuum extractor is impossible unless the entrance to the vagina is widened. In some cases, after labor anesthesia, a woman loses the ability to push effectively. Then an episiotomy is necessary to speed up delivery.

Indications may arise from the fetus. combined with high risk damage to the fetal head. To reduce pressure and speed up labor in this case, a perineal incision is necessary.

Other fetal indications include:

when it is necessary to expand the passage for the subsequent birth of a larger head;
dystocia of the shoulders is observed when their size is larger than the head;
large fruit;
intrauterine, which is diagnosed during childbirth during CTG.

A high, rigid perineum stands out as an indication. It can be determined even before birth; the distance from the posterior commissure of the vagina to the anus will be more than 7 cm. With this type of perineum, perineotomy is permissible. Absolute contraindication for her there will be a low crotch - 2 cm or less.

Episiotomy technique

The incision is made only in the second stage of labor at the maximum of one of the attempts. The perineum is treated with an antiseptic. Local anesthesia is not always fulfilled. When there is a threatening rupture of the perineum, the tissues are bloodless and stretched, so the incision does not cause acute pain. If anesthesia is necessary, it is performed infiltratively using a lidocaine solution.

Dissection of the perineum is performed using scissors. While the woman is resting from pushing, one jaw is carefully inserted between the presenting part of the fetus and the tissues of the perineum in the direction of the future incision. After the start of the next contraction, the woman in labor pushes, the tissues are stretched as much as possible. At this point, an incision is made.

Its length is determined intuitively, but it must be at least 3 cm. A “gentle” short incision will not provide the necessary expansion of the vaginal outlet and can provoke further tissue rupture.

If an episiotomy was performed during childbirth, a suture (raffia) is performed after the birth of the placenta and examination of the cervix for ruptures. If no anesthesia was performed at the time of the incision, then infiltrative anesthesia is performed before suturing.

Are used various techniques restoring the integrity of the perineum:

Perineorrhaphy according to Shuta involves placing figure-of-eight sutures through all layers of tissue. Non-absorbable suture material. After the wound has healed, the threads are removed. The disadvantage of this method is frequent infection and inflammation of the sutures.
Layer-by-layer suturing of the perineum begins with the mucous membrane of the posterior vaginal wall. The cut muscles are then connected using immersion sutures. In this case, synthetic absorbable threads are used. Catgut is not recommended for use due to the large number allergic reactions. A continuous cosmetic suture is applied to the skin.

At the end of the manipulation, the sutured wound is treated with an antiseptic.

Caring for seams

The crotch area is very uncomfortable in terms of postoperative management wounds. Suckers are released from the genital tract, which serve as a breeding ground for microorganisms. You cannot attach a sterile bandage or bandage to the seam. There is always a risk of suture divergence if the woman in labor does not follow the doctor’s recommendations.

How long can you sit after an episiotomy?

The timing is determined depending on the size of the wound. In most cases, 2 weeks is enough. For deep incisions, the period is extended to 3-4 weeks. You can sit on the hip on the healthy side. During this period, you will have to eat or feed the baby while standing or lying down.

How long do stitches take to heal?

This depends on proper processing. During normal course postoperative period, in the absence of infection, this lasts 5-7 days. At the end of this period, the doctor removes the external suture. To prevent this process from taking too long, it is important to follow certain rules:

sanitary pads are changed after 2 hours;
after each visit to the toilet, you need to wash yourself in a bidet with warm water from front to back and a solution of potassium permanganate to dry the skin;
wipe the seam with blotting movements;
after water procedures it is necessary to lie down without underwear to allow the perineum to dry completely;
The sutures in the maternity hospital are treated daily by a midwife, they are lubricated with a solution of brilliant green, and assessed appearance and the presence of signs of inflammation.

If swelling appears in the suture area, physiotherapy is prescribed: ultrasound, laser therapy, quartz tube. They improve microcirculation and accelerate the healing of postoperative sutures. In the first few days, apply a heating pad with ice through the underwear to the wound area.

After being discharged home, the woman should ride in the back seat of the car in a reclining position. At home, you should refrain from taking a bath for a month. You should wash in the shower or bidet.

The diet should be balanced and not contain foods that have a binding effect. It is not recommended to eat baked goods. On the third day after birth, a laxative is given so that the woman has a bowel movement without straining. If problems with bowel movements occur at home, you can use Microlax microenemas to make bowel movements easier.

Full recovery after episiotomy occurs no earlier than after 1-1.5 months. Unpleasant sensations in the vagina can persist for up to six months. For better scar formation, it is recommended to apply Contractubex gel. It fights inflammation, stimulates cell regeneration without the formation of a keloid scar. But they begin to use it only after the wound has healed; it is prohibited to apply the drug to a fresh wound surface. The course of treatment is 4 weeks.

Possible complications and how to deal with them

Like any surgical procedure, episiotomy can be accompanied by complications. During childbirth, it can aggravate obstetric trauma or continue to rupture III-IV degrees. This serious condition, which is accompanied by rupture of the skin, muscles of the perineum, external sphincter of the rectum and its wall. IN severe cases long-term consequences may manifest themselves in the form of a vaginal-rectal fistula.

A seal in the suture after an episiotomy should alert you. Also alarming symptoms are:

purulent discharge from the suture or genital tract;
unpleasant odor;
a sharp increase in pain;
asymmetry of the labia;
long-lasting swelling or redness;
increased body temperature, weakness and malaise;
problems with urination.

If a woman does not follow the recommendations, she may experience symptoms that the seam has come apart. In this case, bloody or bloody discharge from the wound. When such signs appear, the doctor removes the threads, and the wound heals on its own by secondary intention. Depending on the specific clinical situation, they may resort to re-suturing. A young mother may notice that the stitch is bleeding after discharge from the hospital. You should contact your gynecologist for medical help.

Inflammation of a postoperative wound is accompanied by swelling and severe pain. When suppuration occurs, it is opened, washed with antiseptic solutions, and drained. The woman in labor is prescribed antibiotics to suppress the infection.

How to treat stitches after episiotomy at home?

It is enough to continue using the same drugs that were prescribed in the maternity hospital.

Asymmetry of the perineum, bulging in the suture area can be symptoms of a hematoma. Treatment depends on its size and rate of formation. Small hematomas are treated conservatively with antibiotics. If a large vessel is damaged, the hematoma quickly increases in size, symptoms of anemia appear, it is necessary surgery. The wound is opened, the bleeding vessel is bandaged or stitched. The woman is also prescribed intramuscular antibiotics.

TO long-term consequences Episiotomy includes dyspareunia - pain that occurs during sexual intercourse. Sexual rest is recommended for up to 6 weeks after childbirth with a perineal incision. But discomfort can bother a woman for up to 3-6 months. To alleviate the condition, you need to choose poses in which the sensations are not so painful.

When can you play sports?

After just 2 weeks, you can perform simple general strengthening exercises to improve your overall well-being after childbirth. After 2 months, if you feel normal, begin fitness or gymnastics classes in groups for beginners, gradually increasing the load.

Controversial issues and prevention

Scientists from North Carolina, USA, conducted a number of studies in which it was established that episiotomy was not justified. Complications and unpleasant consequences for women that affect general health And sex life, force doctors to approach the manipulation more carefully. The range of indications is gradually narrowing. It is believed that with proper prenatal preparation, the perineal tissue can be prepared, and adequate protection helps avoid dissection.

This leads to avoidance of planned episiotomy; in many countries it is performed for indications that arise during childbirth. Prevention and preparation is the implementation. These are various contractions of the pelvic floor muscles that are rhythmically repeated or performed in waves. Gymnastics can be continued after childbirth, starting from 3 days.

Reduces muscle stiffness external intimate massage using any neutral oil. At the same time, blood supply to this area improves, the tissues become softer and more elastic. To achieve the effect, 5 minutes a day is enough.

During childbirth, the prevention of rupture and possible incision of the perineum will serve correct execution doctor's commands. Screaming during pushing reduces its results and often leads to injury. Proper breathing, straining with proper force and right moment will help you give birth healthy child and minimal consequences for the mother.

Childbirth is not only an exciting, but also a rather unpredictable process, during which the child may encounter some difficulties in moving forward. birth canal. For example, the baby will be too large for the mother and will not be able to be born without injuring the vaginal tract.

In such cases, the doctor performs the birth with an episiotomy. What is it and how to prevent it possible ruptures perineum at birth?

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Episiotomy – what is it?

Episiotomy during childbirth is a kind of preventative measure, which helps, through surgery (a small and precise incision in the soft tissue of the vagina), to prevent serious breaks crotch.

Such injuries to the entrance at the birth of a baby, directly at the moment of passage of the head, are, unfortunately, not uncommon.

Lacerations, unlike incisions, are more difficult to heal because they have torn edges. After suturing, a scar appears that is quite difficult for further resorption.

Sutures after an episiotomy are easier to treat and dissolve because the precisely cut tissues are placed on top of each other, and the healing process is faster.

Types of cuts

Cut the crotch to make it easier birth process mother and child, it can be done in different ways. How many types of such an operation are there?

There are 4 types of similar surgical procedures used in medicine, the first two of which are used quite often:

Mid-lateral - the incision is made in the middle between the opening of the anus and the ischial tuberosity. The obstetrician-gynecologist performs such an episiotomy diagonally to the right or left, depending on the situation.
Perineotomy - sometimes also called median. The difference between a perineotomy and a simple episiotomy is that the incision in in this case carried out exactly in the middle from the end of the vaginal opening to the opening of the anus.
Lateral - the incision is slightly angled and extends 1-2 cm from the end of the vagina. The lateral incision differs from the median one by a shorter distance and often occurs on the Bartholin gland, which is responsible for secreting lubricant in the vaginal passages. Due to the high risk of damage to this gland, this method is no longer used during childbirth.
“J” – episiotomy in the form of the same name English letter. The incision goes straight down the middle, as in a perineotomy, and then bends from the opening of the anus to the left or right by 1.5 cm. This method is also not very popular due to the risk of damaging the muscles leading to the anus.

Indications

In Europe, such surgical intervention began to be used less and less in order to protect the mother in labor as much as possible from postpartum scars. European doctors hold in high esteem a long period of pushing, during which there are practically no ruptures of the vaginal tract.

In Russia, this operation is used quite often to help women who have given birth avoid serious postpartum injuries and long recovery.

And Latin America has generally introduced incisions such as perineotomy and episiotomy into the category of planned ones.

In addition, there are serious indications for:

risk of II or III degree perineal rupture;
the risk of stopping the supply of oxygen to the fetus, in this situation it is necessary to sharply tame the period of pushing;
the baby is too large for the mother;
rigidity (hardness) of the perineal muscles, in which they are so inflexible that they cannot allow the baby’s head to pass through;
There are prerequisites for instrumental birth, that is, you will have to help the baby be born using obstetric forceps. This is a rather controversial thing in gynecology, as they put pressure on the baby’s skull and lead to the appearance of various diseases subsequently, for example, paralysis. For a woman, the use of obstetric forceps also has its consequences: perineal ruptures and internal damage vagina. In this situation, making an incision will be a less traumatic option for both the mother and the newborn;
in the case of female circumcision - removal of parts of the perineum. Unfortunately, this practice still exists in a number of tribes and Islamic states. By and large, female circumcision is associated with the beliefs and religious prerequisites of a certain people, who decide in this way to cleanse the woman of “filth” and give her the opportunity to ascend after death to the divine kingdom. From a medical point of view, this is simply crippling. female body, making a woman sexually inferior and interfering with the birth process;
the fetus's heart rate slows down;
The baby's shoulders do not pass through the crotch.

Sutures after episiotomy

The suture heals after an episiotomy within one to two months: it all depends on individual characteristics body. The sutures are removed after the incision 3–4 days after birth. All this time the woman in labor is present pulling sensation, however, it goes away after the stitches are removed.

Attention! If self-absorbable sutures are used during surgery, the sutures do not need to be removed. They will disappear on their own within 2-3 weeks.

During healing, you need to keep the seam clean and constantly treat it with a solution of brilliant green. Afterwards (approximately 4–5 days after the baby is born), there is no need to process the seam.

It is enough to keep it clean, wipe it dry and wash it with soap without additives or dyes so as not to cause allergies.

You cannot sit after an episiotomy for about a month. Moreover, this applies mainly to full squats on the seam itself and on the soft surfaces of sofas, beds and chairs. In this case, ruptures may occur, especially if a perineotomy was performed, which takes longer to heal.

Is it really impossible to sit after an episiotomy? How to continue to lead normal image life? In this case, many learn to deftly bypass the unpleasant prohibition and either sit, but at the same time control the process of squatting: when sitting, choose hard chairs and transfer your body weight to the leg opposite the side of the cut.

In addition, you can sit on your lap and on a special inflatable ring - an analogue of children's swimming rings. The fact is that due to the hole, which is located in the middle, the load on the perineum becomes less, and therefore you can sit on such an inflatable ring, as well as on the rim of the toilet bowl, already in the first hours after the operation.

Second birth

Childbirth after an episiotomy may also occur naturally. If the situation with the fetus repeats and an incision is required again, it is usually carried out along the same scar to avoid new ones.

However, often the second birth differs significantly from the first, and the baby passes on its own, without incisions of the vaginal passages.

Why such an operation is performed is now clear. How to avoid episiotomy and subsequent stitches and scars?

In fact, this operation is only necessary in in case of emergency, therefore, it does not make sense to do it to every woman in labor, and often the woman herself can withstand a long period of pushing and wait until the perineal tissue stretches enough for the baby to come out.

In addition, you can prepare well for childbirth:

Best to learn proper breathing during childbirth: two short inhalations and a long exhalation, during which the muscles of the perineum relax.
Non-traditional methods have a good effect, such as preparing the vaginal passage for 9 months for the process of childbirth: rubbing special oils, such as almond oil, which helps increase tissue elasticity. One more unconventional method, helping to avoid ruptures is considered to be regular sex life during pregnancy (if there are no indications for sexual rest).
Keeping yourself in sports shape is considered a very good prevention, for example, exercise on a fitball, gymnastics for pregnant women, swimming and other light sports, such as jogging.

Important! Any sports exercises during pregnancy can only be performed after consulting a doctor.

Useful video

Thus, opinions on the topic of whether an episiotomy is necessary during childbirth are divided in modern medicine. Some obstetricians believe that this surgical incision prevents ruptures of the female genital organs and anus, while others speak out sharply negatively, believing that any interference in the process of childbirth will slow down the natural recovery of the female body.

However, the luminaries of medical science agree on one thing: this operation will help to avoid large blood loss during forced ruptures and will minimize future dysfunction of the genitourinary system.

Good day, dear readers! Today I propose to continue the topic of childbirth with you. All expectant mothers know that the higher the gestational age, the more worries due to upcoming birth. I know this from personal experience. Uncertainty weighs heavily, and the pregnant woman begins to study all the literature, trying to “paint a picture” that awaits her in the near future.

Unfortunately, medical literature“knows how to scare” and an impressionable woman is afraid of day “X” even more. Of course: caesarean section, medical forceps, episiotomy during childbirth, and so on. How can you feel calm here? And okay, if every woman has heard about CS, but what is episiotomy? Let's figure it out.

In layman's terms, episiotomy is used to prevent perineal ruptures during childbirth. That is, a pregnant woman is made an incision from the anus to the perineum.

This procedure is not something supernatural, and quite a few women in labor have experienced it themselves. There is no need to be afraid of such an operation at all, because it is completely natural and, with proper care after childbirth, heals relatively quickly.

There is also no need to think about cutting your skin. Episiotomy involves making an incision in the tissue of the perineum, rather than the skin in the intimate part.

2. In what cases is episiotomy performed?

There are several reasons why this operation. I want to tell you about the most common of them:

during childbirth, the vaginal walls cannot withstand the load (the fetus puts a lot of pressure on the tissue of the perineum, causing it to “uncork” - in this case an incision is made, because subsequently the vagina can tear like a “web”, such a tear is much more difficult to sew up than an incision after an episiotomy) ;
the birth occurred prematurely and labor activity the woman in labor is too weak (in this case, an incision is made for a faster birth);
labor takes a long time and doctors determine that the fetus does not have enough oxygen (the baby begins to choke), in which case they cut the perineum to use medical forceps.

One way or another, the decision to perform an episiotomy is made not by the woman in labor herself, but by the obstetrician. And such an operation is prescribed only when other methods to speed up labor do not help. It is important to accept the fact that a perineal incision is necessary to save the baby’s life or preserve women’s health.

3. How is an episiotomy performed?

Like any operation, episiotomy is performed according to certain recommendations:

Initially, you need to wait until the woman’s cervix is maximally dilated; if it is not dilated enough, a decision is made to make a perineal incision.
A sterile instrument is taken for the operation.
If necessary, anesthesia can be performed (usually it is not required, since when the tissues of the perineum are “stretched,” the pain from the incision is not felt at all, but some women in labor experience strong fear in front of the “knife” and therefore ask for novocaine).
The incision is made in one of two possible ways:
- from the perineum to anus directly (such an incision heals much faster, but is not the most effective);
- from the perineum down and “slightly to the side” (such a wound takes longer to heal, but this method is used much more often, since it is more effective).
After childbirth, the tear is stitched up.

4. Postoperative treatment

After the perineal incision, the woman needs to undergo a course of treatment. In fact, proper care of the intimate area is considered treatment after an episiotomy.

In order to recover, the young mother will need to adhere to several important rules:

After every trip to the toilet you need to wash yourself.
After washing the wound, you need to “dry it out”.
The wound must be treated with special solutions (I can’t advise here, only a doctor will give the proper recommendations).
It is important to follow a gentle regimen (do not overwork, sit rarely and only strain the vaginal muscles so that the seam does not come apart).

5. Complication after episiotomy

The perineal incision is sufficient frequent procedure during childbirth. Therefore, doctors know how to perform such an operation as efficiently as possible. Typically, after an episiotomy there are no significant consequences if proper care is taken for the suture placed on the perineum.

However, we should not forget that inappropriate hygiene for the intimate part of the body, and especially for postoperative suture may lead to inflammation.

6. Prevention

Statistics show that up to 70 percent of women in labor undergo an episiotomy. Of course, this figure is disappointing, which is why, even at the stage of pregnancy, women think about what is right - to give birth without tears and on their own, or to accept the fact that the perineum will be cut and mentally prepare for subsequent recovery.

In fact, you need to be prepared for anything, but even the likelihood of a rupture (and subsequent cut) of the perineum can be minimized.

Being in interesting position, a woman needs to do exercises to improve the elasticity of the vaginal tissues (tighten the vaginal muscles);
in the last trimester you need to massage using vegetable oil in the perineum to prepare the vagina for childbirth.

How to do massage and exercises correctly, you can ask your doctor or read in specialized literature. I heard that some books “about a happy pregnancy” contain a lot of information with visual pictures and photos. They talk about how to protect yourself as much as possible from possible consequences during pregnancy and after childbirth.

It’s better to initially set yourself up for a calm birth and not create problems for yourself! And everything will be fine with you!

Here you can watch a video on how to give birth without ruptures and episiotomy:

On this note, I propose to say goodbye, but not for long! Subscribe to my blog, see you soon. Bye bye!