I wouldn't suture a 3rd or 4th degree tear at all - at home or in hospital
for a number of reasons. A 3rd+ degree is not within my expertise and can
lead to long term complications if not done properly. I would rather it was
done by someone with expertise and experience in a well lit theatre. Also
you would need really good analgesia (ie. a spinal block) to effectively
suture without causing agony. There is no reason that partner and baby can't
be in theatre with the woman during the suturing, and she can have skin to
skin and breastfeed.
Our hospital guidelines in the UK were that all 2nd degree tears should be
sutured. This was based on the fact that there was no evidence to support
not suturing, and that you would suture an arm or leg injury if it involved
muscle. I have a few problems accepting this standpoint (too long to go
into). In practice I leave it up to the woman do decide. I explain the
guidelines and the theory behind them. Give her an explanation about her
tear (and show her with a mirror if she wants). Explain any concerns I have
- if a vessel is bleeding, or tissues are poorly aligned. Then ask her what
she wants me to do.
It was quite interesting to follow up these women in the community. Some who
declined suturing (who I thought probably needed it) healed really well. A
colleague had a woman who did not want to be sutured following an epis - her
perineum healed perfectly. I caught her second baby at home and I would
never have guessed she had had a previous epis (intact this time). My best
friend declined my suturing at her homebirth even though she described her
perineum as an exploded mattress (5th baby and bad tears + stitches with
all). A year on and she still raves about how much better healed and less
painful her perineum was unsutured.
So, I guess what I am saying is that perhaps we suture too much. Perhaps the
perineum is designed to tear and heal. Anyhow, I am not 'allowed' to suture
here in Australia, so I will probably lose the skill anyway.
Rachel
From: "Philippa Scott" <[EMAIL PROTECTED]>
Reply-To: ozmidwifery@acegraphics.com.au
To: "ozmidwifery" <ozmidwifery@acegraphics.com.au>
Subject: [ozmidwifery] Question
Date: Wed, 21 Sep 2005 07:59:02 +1000
This question/assumption was put forward on another list & I wondered
whether you wonderful women would be able to answer it for me as I have no
idea really.
What happens if the mother sustains a 3rd or 4th degree tear at a
homebirth?
Do they then have to travel to a hospital to get it all repaired? Surely
this would increase the possibility of infections and post birth problems?
I know there is NO WAY a midwife could stitch up that serious a tear so was
just curious about what would happen in that situation (if anyone knows??)
Cheers
Philippa Scott
Doula
Birth Buddies
Supporting Women ~ Creating Life
President - Friends of the Birth Centre Townsville
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