"Birth of a baby really is not easy" series of reports -
Lateral is timely help or worse
In recent years, the rise in caesarean section rate at the same time, episiotomy rate rise. A survey data show that domestic maternal episiotomy rate in some hospitals up to 85%, higher than the World Health Organization's less than or equal to 20% of the standard.
What is a "lateral"
"Lateral" refers to the mothers in the natural delivery process for the episiotomy. Perineum is between the vagina and anus a few centimeters of the narrow part in the birth mothers have not started when it is taut, when the pain started to become a regular when the formal labor pains. It becomes as soft as pudding. This is a hormone called prostaglandin secretion caused by a large number of changes, for the baby was delivered successfully, the perineum must become soft and have a good stretch. When the delivery to the exit from the birth canal can see baby's head, so not hard to see when the fetal head, the perineum is stretched oppressed fetus, gradually become as thin as paper. Lateral episiotomy suture that is on the second stage of labor for the simple minor surgery, to avoid delivery of the baby when the mother severe pelvic soft tissue around the fetal head laceration and reduce pressure. This procedure usually performed under local anesthesia, in the perineal incision 2 to 3 cm wound, the baby is delivered after the suture, 3 to 4 days postpartum suture. Now Multi-absorbable sutures, usually do not need stitches.
Lateral, is timely help, or worse
Lateral, a timely help or worse? The medical profession is still controversial. Proponents believe that episiotomy can reduce that pain, but also conducive to eugenics, on the maternal and fetal beneficial, it should be said to be timely assistance. Fetus from the birth, mother's birth canal, including the bone birth canal birth canal (pelvic cavity) and the soft birth canal (the lower uterus, cervix, vagina, perineum), the perineum is the last paragraph of the birth canal. Childbirth, the cervix and vagina of fetal first disclosed by the Department needs to expand slowly, perineum also need some time to expand the song. Although the fetus through the birth canal time varies, but generally longer than the average of 12 hours, first born child's mother will be longer. The longer, fetal hypoxia or even the greater the chance of suffocation. So, seize the opportunity to do perineal incision to expand, the fetus can be shortened stay hang on in production, both to protect the fetus, but also reduce the mother's labor pain. If you do not do lateral, when about 10 cm in diameter, and matrix fetal head was delivered from the maternal vagina, if there is no midwife on the maternal protection of the perineum, so that mothers will Yinfa Sheng will be varying degrees of tearing, or more seriously, uterine prolapse occurs, incontinence and other consequences. Mothers will Yinfa Sheng tear, its very neat wound edge. This will not only maternal perineal wound healing time prolonged, and in wound healing, but also the formation of scar easily, so that when the lived sex for foreign body sensation. Therefore, if women give birth in a timely manner so episiotomy technique, you can avoid this from happening. Therefore, maternal natural childbirth, even if born, midwives are often cut for maternal knife.
However, in recent years, against the indiscriminate use of the voice of lateral growing. Opponents argue that, lateral, after all, a traumatic surgery, which has suffered the pain of childbirth the mother is undoubtedly worse. Not only to increase lateral maternal physical pain, and increased health care costs and medical risks. In favor of the lateral's main point is lateral to avoid possible risk of perineal tearing. So, if the strengthening of maternal prenatal training and education, to strengthen midwifery and nursing products, both to prevent maternal perineal tear, not to suffer knife lateral up to it not better? It was observed 1558 cases of maternal, natural results and perineal laceration compared with suturing episiotomy rate of postoperative infection, wound healing time is long, expensive hospital stay, length of stay is long. Therefore believe that clinical practice in obstetrics, medical staff to improve accountability, strengthen the production process to improve midwifery skills of observation and to minimize the episiotomy in vaginal delivery patients.
Lateral risk
Many obstetricians and midwives on the risk of lateral insufficient understanding, coupled with the easier route and to reduce the trouble of midwifery, so many instincts of maternal suffering from multi-lateral endured a knife. A group survey, nearly 92% of the natural mother had received lateral production operation; of which 77% of people do not know why in the end to accept lateral; about 44% of the people to lateral and no anesthesia before surgery; nearly 32% of people think that lateral postpartum sex life for their impact; early maternal perineal incision was nearly Jiucheng, such a high rate can be won the world title.
In fact, maternal episiotomy often occur following risks: 1. Wound hematoma: performance in the suture 1 to 2 hours after the knife-edge position that is in serious pain, but more important, even a heavy feeling in the anus. You should immediately tell the staff, check in time, probably not enough doctors to stop bleeding in the suture. This situation, as long as the time open seams, remove the hematoma, suture live bleeding, re-sutured wound, treated the pain will usually disappear quickly, most can be healed normally. 2. Wound infection: the performance in the 2 to 3 days postpartum, the wounds of local red, swelling, heat, pain, inflammation, etc., and may have induration, purulent discharge when squeezed. In such cases, should take the appropriate antibiotics, and removal of sutures, to pus out. Also can be used to help the anti-inflammatory therapy, or 1:5000 potassium permanganate solution temperature hip bath. These measures, due to perineal rich blood supply, there is a strong healing ability, it is generally 1 to 2 weeks after will get better or heal. 3. Wound dehiscence after suture removal: Some mothers in the perineal wound dehiscence occurred after suture removal, this time as have been discharged, shall immediately go to hospital treatment. If the wound tissue fresh, split time is short, can be properly disinfected immediately after the second suture, 5 days after the removal of stitches, mostly good long again; if the wound tissue is not new and there is discharge can not be repaired, available potassium hip bath potassium solution, and antibiotics to prevent infection, wait until after the partial formation of scar healing.
Lateral indication to strictly control
The following some cases of maternal, consider doing episiotomy procedure: 1. Perineal elasticity is poor, narrow vagina or perineal inflammation, edema, etc., when the fetus is estimated that there will be severe perineal tear. 2. Fetal larger fetal head position is not correct, coupled with weak productivity, fetal head was blocked in the perineum. 3.35 years of age or older mothers, or associated with heart disease, pregnancy induced hypertension and other high-risk pregnancy, in order to reduce maternal physical exertion, reduce labor, reduce the threat of delivery on maternal and child, when the fetal head down to the perineum, the episiotomy can be considered done. 4. I have to open the whole uterus, fetal head low, but the phenomenon of fetal hypoxia significantly, abnormal fetal heart rate changes or heart rhythm irregularity, and turbidity or a mixture of meconium and amniotic fluid. 5. Fetus can not smooth delivery, requires the use of forceps delivery time.
Because of the perineum after vaginal o anal close before, many bacteria, it is not a sterile perineal incision surgery. Moreover, there are many vaginal bacteria parasitic, if premature rupture of membranes, prolongation, usually inflammation of the vagina and perineum, and edema, the perineum may be poor healing of the incision. With postpartum bowel movement, lochia discharge, also subject to pollution can cut inflammation. As an additional lateral to the perineum wound, so the need to strengthen post-natal care.
The new law could greatly reduce health care midwifery lateral rate
In order to improve the quality of midwifery, to lower the episiotomy rate
Health care in clinical practice in recent years, explored and summed up by hand with care anal vaginal expansion of the Combination of protection of the perineum method proved effective. Began to allocate a specific method is revealed when the fetal head, according to routine cleaning and disinfecting, shop towel. Mothers who stand on the right side of midwifery, first check the thickness of the hymen, if the hymen thick can be cut into jagged, bleeding hemostasis when the use of gauze, left thenar part of the touch of occipital fetal head, so fetal head overlooking the song, right four fingers (thumb excluded) inserted into the vagina posterior perineal Department, pulp out, slightly forced outward, downward expansion, contraction intermittent stops, so repeated several times, allowed to fully expand . At this time, decreased fetal head, right hand placed on the joint Department of perineum, side pull side of the situation observed expansion of the perineum. To prevent perineal tearing. When the fetal head with crown, the right to stop the expansion, to prop up anal method. Intermittent contractions when to let go a little to avoid oppression for too long causes tissue edema, but need to stay in place do not move to prevent uterine contraction suddenly pressed, midwifery were too late to protect. Left hand to help expulsion of fetal head, shoulders and torso, his right hand before being let go. The method for expanding protection of the perineum anus vagina Fa Jiatuo to full rate of maternal perineum increased by 8% episiotomy rate has dropped 12%
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The traditional trust law to protect the perineum anus is upward and inward trying to lift up the power of the perineum, to control the discharge and helped to increase the export of perineal relaxation. Now many people think that this approach does not fully expand to the perineum, reduced exports, lower the perineal skin, muscle flexibility, easily lead to perineal tear. Even if the perineum good condition, no tear, may result in multiple laceration occurred on both sides of the vaginal wall, resulting in difficulties or suture closure extended, affecting wound healing. Care anal law alone, probably because of the long duration of perineal compression resulted in local tissue ischemia, edema, may also affect wound healing, but also probably because of compression of fetal head a long time, resulting in relaxation of pelvic floor tissue, causing postpartum urinary retention. Anal vaginal Fa Jiatuo by expansion method can avoid this from happening. This is because the late pregnant maternal perineal and vaginal soft thickened, loose connective tissue has softened, the vagina longer and wider, have great skin stretch muscles, pelvic relaxation occurs in all joints to accommodate the expansion of high birth . Expansion method using the full expansion to the perineum, vaginal cleft increased, the export increase, flexibility increase, when the fetal head with crown-Yang Shen, the midwife who use child care anal law, the amount left to support the Department of the fetal head to assist in fetal head Yang extension, and has asked the maternal use of abdominal pressure, slow fetal head was delivered. Maternity and midwifery were then asked appropriate cooperation is an important factor to prevent perineal tearing. The midwifery process, should guide the proper use of the maternal abdominal pressure, should also pay particular attention, although the perineal skin and muscles have a certain extend, but not unlimited expansion. Shen Yang in the fetal head and therefore use care when rectal method, so that slow fetal head is delivered, before they can avoid or reduce perineal laceration. The law conditions for success: 1. Fetus: the fetal heart sounds good, no fetal distress as soon as possible indications for the end of the second stage of labor, weighing 4,000 g or less. 2. Maternal: the perineum in good condition, no need to end delivery of obstetric complications, no extension of the second stage of labor, maternal in with.
Newspaper correspondent Wei Yiming