This is an automatically translated article.
The article was professionally consulted by Specialist Doctor Obstetrician and Gynecologist - Department of Obstetrics and Gynecology, Vinmec Hai Phong International General Hospital
Perineal incision during vaginal birth is always a big obsession of pregnant women during labor. Most vaginal births involve an episiotomy.
1. When is a normal birth with an episiotomy?
1.1 Indication on the mother's side The labor is prolonged, the mother's strength is reduced, the mother's uterine contractions are not strong enough to push the fetus out. Perineal flexibility and dilation are poor, especially in mothers over the age of 35 or those who have given birth to multiple babies. Mother has diseases of the genital area: vulvovaginitis, perineal inflammation, edema or other infections. Women with cardiovascular disease or signs of gestational hypertension. 1.2 Indications for the fetal side The fetus is too large, the fetal head has a large biparietal diameter. Premature pregnancy Shoulder or breech position. There are signs of fetal distress when the fetal head is low. Indications for episiotomy at birth usually include forceps, suction or intrauterine rotation of the fetus.
2. Steps of perineal incision during vaginal birth
2.1. Principle of episiotomy Cut at the right time, neither too early nor too late. Cut when the perineum and vulva both show signs of maximum stretch (when the fetus is deep into the vagina) and cut during uterine contractions to relieve pain.
Cut before the top book .
Should suture the incision with absorbable suture: in normal delivery, suturing the dissolving suture into the incision in the perineum can help the mother limit the possibility of infection through the protruding suture tip, reducing the risk of scarring. , and at the same time limit the friction on the painful suture.
Do ideological work for pregnant women before performing episiotomy.
2.2. Steps of perineal incision during vaginal birth
Step 1: Anesthesia of the cutting area
In fact, specialists still recommend that the use of anesthetics should be limited to anesthetize during episiotomy. However, each person's pain threshold is different and in mothers with poor pain tolerance, local anesthetics can be used to relieve pain during an episiotomy.
Step 2: Determine the cutting location
Usually episiotomy at 5 o'clock or 7 o'clock, cut at the upper and lower middle vulva margins in the direction of obliqueness from top to bottom and out, avoid cutting too deep because there are can cut into the levator anal muscle. Note that usually only one side of the perineum is enough, it is very rare to have to cut both sides of the perineum to get the pregnancy out.
Step 3: Conduct episiotomy
With straight and sharp scissors. Actions must be precise and decisive.
After episiotomy continue to conduct delivery.
Step 4: Stitch the perineum
Carry out the stitching after all the vegetables have come out. Clean the perineum and ensure it is sterile before suturing. A local anesthetic may be given during stitches if the woman cannot tolerate the pain. Carrying out suture: divided into 3 stages, sutured according to each layer of the structure of the perineum: -Vaginal suture: sutured with dissolvable thread, sewn from the inside out, the two edges of the suture and match each other to avoid leaving a tunnel. after stitching.
- Then sew the muscle: should stitch close to the skin, close the stitch to avoid creating a hole between the 2 layers of muscle and skin.
-Skin suture: The same stitch as the other 2 but can use a slower type of thread only in the vagina and muscle layer.
Clean the sutures and vulva area. Note when suturing the perineal incision:
Sewing according to the episiotomy anatomy Do not leave a tunnel after suturing, easy to cause complications later. The distance between the stitches is just right, not too tight and not too loose. After stitching, let the stitches dry.
3. How long does it take to give birth and how does it take care after an episiotomy?
3.1. Wound healing and possible complications after an episiotomy In the case of a vaginal birth with an episiotomy, after the anesthesia is gone, the mother will feel discomfort, pain in the incision area and around it. even bleeding at the cut.
Normal birth stitch pain usually lasts for about 1-2 weeks after giving birth. Fast or slow healing time depends on each person's location and how to take care of the wound, but it will usually heal itself after about 2-3 weeks and really stabilize after about 1 month after birth.
In addition to pain, episiotomy can also cause other complications on the body, including:
Inflammation and infection that is severe, incisional abscesses due to improper hygiene. Swelling and hematoma at the incision site. After healing, there may still be pain at the incision, even leaving scars, causing cosmetic loss to the anal area and affecting the couple's sex life. In severe cases, gas or stool may leak through the wound. 3.2. How to take care of the perineum after giving birth often with an episiotomy After an episiotomy, proper care will help minimize the complications that occur on the incision.
Do not wear tight and tight underwear because it will cause friction with the incision, causing pain, possibly bleeding.
You can move around and gently exercise to increase blood circulation to increase nutrition for the wound, helping to support the healing and healing process faster. Gently clean the intimate area with warm water or diluted physiological saline 3 times a day, especially pay attention to cleaning after each bowel movement because urine and feces can cause severe pain and increase the risk. infection at the incision site. A reasonable diet, providing adequate nutrients, especially fiber and vitamins. Drink enough water, at least 2 liters/day. Do not have sex until the wound is completely healed because sex can make the wound open and infected, taking longer to heal. Most cases of vaginal birth require an episiotomy to make the birth of the baby more convenient and smooth. Do not be too worried and concerned about this matter. Please choose reputable and quality medical facilities to get the most complete and accurate health advice to be able to successfully give birth.
Customers can refer to the package maternity care program at Vinmec International General Hospital with a route of scientific examination for pregnant mothers before - during - after birth with experienced doctors in the field of pregnancy. obstetrics and gynecology, ensuring close follow-up helps women have a healthy pregnancy and safe labor.
Please dial HOTLINE for more information or register for an appointment HERE. Download MyVinmec app to make appointments faster and to manage your bookings easily.
