what do you mean "you are not allowed to suture in Australia", or do you mean within the hospital you work? Sonja ----- Original Message ----- From: "wump fish" <[EMAIL PROTECTED]> To: <ozmidwifery@acegraphics.com.au> Sent: Wednesday, September 21, 2005 10:09 AM Subject: RE: [ozmidwifery] Question
> 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.
