Mrs. Lynne Slater, Lecturer RW 2-39, Richardson Wing School of Nursing and Midwifery, Faculty of Health University of Newcastle Callaghan 2308
Phone 02 49217707 Fax 02 49216301 Mobile 0408 882554 The information contained in this message and any annexures is confidential and intended only for the named recipient(s). If you have received this message in error, you are prohibited from reading, copying, distributing and using the information. If you have received this message in error, please contact the sender immediately by return email and destroy the original message. >>> [EMAIL PROTECTED] 21/09/05 10:09:55 >>> 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 _________________________________________________________________ Be the first to hear what's new at MSN - sign up to our free newsletters! http://www.msn.co.uk/newsletters -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
