• The Fit Midwife

A Stitch In Time......

Sorry for the long break folks, travelling the length of the UK for christmas holidays really took its toll, especially paired with a house move at the same time. Anyway, we discussed tearing and episiotomies, so next it makes sense to discuss putting you back together again.

Different tears require different attention. So lets go in order, based on what we discussed in the last post:

First degree tear - just the skin is damaged here. If this is not bleeding then consider leaving it to heal naturally. Natural healing is always good. Your body already knows what to do. Sometimes to repair a small first degree tear, you have to put the needle through healthy skin…… that doesn’t make sense. So ask your doctor, what degree the tear is, if it will heal well and is not actively bleeding then can you leave it.

Second degree tear - With this tear, the muscle of the vaginal wall/pelvic floor has been damaged also. These usually require suturing under local anaesthetic (an injection in to the damaged area to numb it). I do know of plenty of women who have asked to let it heal naturally and this has been left to the Doctor’s or midwives clinical judgement. Currently all second degree tears will be sutured especially in the UAE. The evidence does not suggest any difference in pain management of those not sutured but does show noted differences in healing and approximation of the edges (joining together). In my opinion, muscles are there to perform a function and if you ever want to jump on a trampoline, skip or have good sex or laugh till you cry (instead of pee)…. i’d get the sutures.

Third degree tear - This is where the skin, muscle and part of the rectal muscles are damaged. These ALWAYS need suturing. This is to ensure the muscles are put together to heal efficiently and back to working as they should. This should be done in an operating theatre. Why? Because in the theatre you can have a spinal/epidural top up which means you are pain free and the lighting is better, it’s important to see what you are stitching.

Fourth degree tear - This is where the skin, muscle and more than half the rectal sphincter muscle is damaged. Again, it has to be repaired, no doubt about it. And in the operating theatre. Pain killers and physic will also be mandatory.

Episiotomy - This is similar to a second degree tear and usually requires the same as above, sometimes the damage can extend in to amore severe tear but this isn’t so common.

Some tears first or second can happen higher up, near the clitoris or the urethra (pee hole). These usually always require sutures because its a really vascular area and will bleed a lot. Again with anaesthetic.

Pain Relief:

You will be given a suppository (painkiller that goes in your bum!) for any suturing, you can also request it with a first degree tear. It is called Voltaren and is a non steroidal anti inflammatory, similar to ibuprofen, it gives you good 8 hours of relief. It cannot be taken if you have asthma and ibuprofen is not advised for you.

Paracetamol can be taken as prescribed, like you would at home. It is safe for breastfeeding.

For third and fourth degree tears you will also receive antibiotics, to reduce the risk of infection AND a laxative. You’ll want this, it softens everything so that first poo won’t feel like giving birth again!

What else can i do………??

You can use lavender oil, in the bath as directed and sit in it. You can have a bath, just don’t use ridiculous bath products, keep it simple.

Shower twice a day, keep them clean and dry. No products directly on it.... the last thing you want is more irritation down there, it's had enough!

Wash your hands BEFORE AND AFTER changing your pads, change them often. Don’t leave them soaked, it is a breeding ground for bacteria.

Drink all the water. The first pee will sting like a mother…. But the more diluted the pee is, the less it will hurt.

And when it comes to numero 2…. it will feel like a smaller baby is being born, the very first time. Good tip, hold a clean sanitary pad against the perinuem to add counter pressure, a lot of women find this helps.

Your stitches will not break. This is very, very unlikely. The most common material is dissolvable and will breakdown in around 7-10 days. They may itch or be irritating but this is normal.

What is not normal, is found smells, abnormal discharge, pain, redness or swelling. Now these are not good signs for any body part so go and see your midwife or GP!

So that is all you need to know about how we put you back together….. remember third and fourth degrees are less common, and to revisit….. listen to your midwife ;)

All questions welcome, as ever. And i'll be back to regular posting now... promise :)

The Fit Midwife xx

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