Cuts And Tears During Babies Delivey

Cuts And Tears During Babies Delivey

Tearing, or being cut, is one of the biggest birth fears for many mums-to-be. Here we answer your questions on this sensitive subject

Why might I need a cut?
The only reasons to be cut are: If you need an instrumental delivery
(such as forceps). This way the doctor has more space to insert the instrument to help guide out the baby. If you need  ventouse (suction cap), a cut won’t always be needed. If the baby needs to be born quickly due to showing signs of distress.

However, a cut will only work if the birth is imminent.  If there are signs of a really severe tea happening. However, this is unusual. Many years ago it was routine to do an episiotomy (cut), particularly with a first
baby. Thankfully, things have changed and for most women a cut isn’t necessary.

Is it better to be cut or to tear naturally?
If there’s no reason to be cut (see above), then it’s better to tear. The evidence is that tears are less painful when healing, and may not be as deep as a cut so heal quicker. A cut goes through skin and muscle, whereas a tear may only involve the skin. If it only involves skin then you
might not even need stitches. And, of course, you might not tear at all, so why inflict stitches if they’re not necessary?

How is a cut made?
The area between the opening of the vagina and the anus is called the perineum. During the birth process, the vagina stretches to accommodate the baby, and the perineum stretches too.
Local anaesthetic is injected into this area by the midwife or doctor and then at the height of a contraction, a pair of special sterile scissors is used to make a cut, in the entrance of the vagina in the direction of the anus, but slightly to the side. It may sound dreadful, but the thought is worse than the reality: at the height of the contraction, when the area is stretched, you’ll not even be aware of it. Your permission will be asked before it’s done.

Can I avoid a cut or tear?
If you have an epidural you’re more likely to end up with an instrumental delivery, which is more likely to involve a cut. You might like to consider alternative methods of pain relief, such as a birthing pool, gas and air, or pethidine.
In the last weeks of pregnancy, perineal massage is thought to reduce the risk of tearing. Use a vegetable-based massage oil to massage the skin between the vagina and anus. Then insert a finger into the entrance of your vagina and gently stretch the area down towards your anus in a
U-shape. Hold this for 30-60 seconds.

When it comes to the actual birth, try to ‘breathe’ your baby out rather than actively pushing – this can help control the speed at which he’s born . Your midwife  could also press a warm pad against your perineum, which is thought to reduce the chance of tearing.

If I tore last time, will it happen again?
Not necessarily. You’re more likely to have stitches with your first baby than with subsequent ones. The area has stretched before so will be more stretchy this time. There will be some scar tissue there, so it’s
a good idea to do perineal massage (see above) to make the area more supple.

Will stitches be painful?
There’s no need for stitches to hurt as the area is numbed with local anaesthetic first. If it does hurt, tell the midwife or doctor to stop; it may be that you need to have some more anaesthetic applied. It’s important that this is given time to take effect before the stitching begins.

When do the stitches come out?
Thankfully they don’t need to come out, as they’re made of material that dissolves. Between two and four weeks after the birth, your midwife may ask if she can take a look to check the area is healing well. If they’re not healing, that can be a sign of infection, in which case you’ll need antibiotics. Occasionally a bit of the stitch might drop out, and you’ll discover it on loo paper or in your pants, but this is normal and nothing to worry about.

What if I have a home birth and need stitches?
Midwives carry local anaesthetic and can stitch wherever they need to. It’s useful if you have an angle-poised lamp, but most midwives carry torches. If the tear is tricky you might be advised to go to hospital to be stitched.

How can I help the stitches to heal?
It’s important to keep the area clean and dry – easier said than done when you think where the stitches are! A soak in the bath each day will help the area to feel more comfortable – some women swear by a few drops of lavender oil added to the water, but don’t overdo this in the first PB few days. If the area is swollen then apply something cool – sanitary towels kept in the freezer or a bag of peas wrapped in a tea towel – to reduce the swelling. If it’s uncomfortable, it’s fine to take ibuprofen or paracetamol, even if breastfeeding.

Could the stitches burst when I go to the loo?
This is a common fear but it really doesn’t happen. Drink plenty of water and eat your fruit and veg to avoid constipation, as straining will make you feel more anxious. Psychologically it can help if you hold a sanitary towel against your stitches the first time you poo, as you’ll feel you’re
giving a bit of support to that area. Pouring warm water between your legs while you wee will help stop any stinging.

What are the different types of tears?
Around 90 per cent of women tear while giving birth. However, some tears are more serious than others. A first degree tear only involves skin and probably won’t need stitches. A second degree tear involves skin and muscle and usually needs stitches. However, it’s your choice. A third degree tear means that the tear has extended into the anal sphincter (the
muscle that controls the anus). A fourth degree tear involves the rectum. These last two are more severe and you’ll need a spinal anaesthetic (similar to an epidural) while you’re stitched up by a
doctor. Most women heal well, but may need a follow-up appointment with the consultant to ensure there are no problems.

When will I be able to have sex again?
Some women feel ready almost immediately, but this is unusual. It usually takes a few weeks for the post-birth vaginal bleeding (lochia) to stop and any stitches to heal. But even women who haven’t had stitches often don’t feel like having sex for a few weeks, or longer, due to sheer exhaustion. So the simple answer is: when you’re ready.

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