When giving birth, do I have to "cut" a knife below?

Many girls are afraid of a smooth delivery, one of the reasons is that they are very afraid of being stabbed below.

"I don't dare to give birth to myself, I heard that I have to cut sideways."

"I watched the video of the side cut and shivered..."

"Many friends said that in the end they all cut sideways, my legs were soft, it hurt too much, and it was not easy to have a baby."

So, how does a lateral perineal cut feel? Does every mom have to take this knife?

Today, Zhimei will come to give you a good talk.

Lateral incision is one of the methods of episiotomy.

Episiotomy refers to the method of making all openings in the area behind the perineum (the soft tissue between the vaginal opening and the anus) before the fetal head is about to be delivered, so as to enlarge the soft birth canal and assist the delivery of the fetus.

Perineal median incision and median perineal incision

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(Source: hopkinsmedicine.org)

Lateral incision is performed when the contractions are most intense and the fetal head is about to be delivered, and the pudendal nerve block is usually preceded by a pudendal nerve block anesthesia federation anesthesia.

Therefore, the pain from the incision is minimized at this time, and the main pain from the contractions is felt.

But some people may feel the feeling of cutting flesh, and if they are really scared, they can also ask the doctor to add a little anesthetic when suturing.

Nerve block anesthesia at the perineum

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(Source: Am Fam Physician)

No!

In fact, in recent years, episiotomy has become less of a routine form of midwifery, but is performed only with clear indications (to avoid more serious consequences) [1].

For example, if the mother's perineal elasticity is poor, too short or the fetus is too large [2,3], the baby is difficult to come out, and the baby is stuck in the birth canal for a long time, excessively pulling the surrounding soft tissues, which may cause the mother to have serious vaginal and lacerations.

Perineal lacerations

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Episiotomy may seem more "violent", but its incision is not as large as many people think (usually 2 cm–4 cm [4]), and the surgical incision is flatter than a laced wound and usually easier to heal.

For example, if the mother or baby has serious pathological conditions, such as preterm birth, fetal distress, etc. [2,3], it is necessary to get the baby out as soon as possible to reduce the risk to the mother and baby, and episiotomy may also be performed.

If the doctor determines that there is no risk such as severe laceration, this is generally not done.

The current rate of episiotomy is not as high as everyone thinks.

According to incomplete statistics in the past, the episiotomy rate of mainland medical institutions is about 10%-75% [5,6], and some well-controlled hospitals are less than 10%.

The first thing to note is that pregnancy and childbirth themselves carry the risk of pelvic floor muscle relaxation, which in turn causes vaginal laxity [7,8].

Under normal circumstances, the pelvic floor muscles are like a "hammock", supporting the pelvic organs to keep them stable, and when pregnant, the baby is getting bigger and bigger, and the mother is getting more and more "fat".

（来源：Continence Foundation of Australia）

When the pressure of the hammock increases to a certain extent, the pelvic floor muscles may not be "held", the elasticity will become poor, become loose, and the control of the muscles around the vagina and urethra will be weakened.

（来源：Continence Foundation of Australia）

Of course, there are several studies that suggest that lateral perineal incision may damage perineal structures (e.g., vaginal mucosa, fascia, deep transverse muscles, etc.) and increase the risk of pelvic floor muscle dysfunction [9-13].

Therefore, it will now be more comprehensive to evaluate, can not be cut, can not be cut, reduce unnecessary episiotomy.

At the same time, paying attention to wound care and timely pelvic floor muscle rehabilitation exercises can also prevent pelvic floor dysfunction.

Therefore, don't worry too much, believe in the professional ability of the doctor, and believe that the doctor will definitely make the best choice for the health of the mother and baby.

postscript

Finally, Zhimei also wants to emphasize that the popular science is not to make everyone afraid of marriage and childbearing, but hopes that every mother can learn more scientific knowledge on the road of fertility, reduce fear, protect herself, and make the process more smooth.

If more fathers can understand the hardships and pains of pregnancy and childbirth, have more understanding and love for their lovers, and become her strongest and warmest support, it will be even better.

Today is Mother's Day, I wish all mothers to give not only on this day to be seen, but also to have their own lives.

Reviewer

Liu Haiphong | Deputy Chief Physician of the Department of Obstetrics and Gynecology, Huashan Hospital, Fudan University

Sun Hong | Deputy Chief Physician of the Department of Obstetrics and Gynecology, The First Affiliated Hospital of Guangzhou Medical University

bibliography

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[2] RCOG (2015) Greentop guideline 29: The Management of Third- and Fourth-Degree Perineal tears. Available at: https://www.rcog.org.uk/globalassets/documents/guidelines/gtg-29.pdf.

[3] Cunningham FG，Clark SL． Williams Obstetrics［M］． 23rd． New York (NY):McGraw-Hill，2009:2325－2326

LIU Yuping. Application and care of modified perineal incision suture in obstetrics[J] . Chinese Journal of Practical Nursing,2010,26( 09 ): 36-37. DOI: 10.3760/cma.j.issn.1672-7088.2010.03.091

[5] Shen Ruyi,Huang Xinghua,Xiang Xiaoying. Conservation promotes support for natural childbirth[J]. China Maternal and Child Health Care,2002,19( 7) : 394-397.

HE Guolin. LIU Xinghui. Prevention and treatment of injuries to the soft birth canal. Journal of Practical Obstetrics and Gynecology Vol. 35, No. 1, January 2019.

[7] Nygaard I, Barber M D, Burgio K L, et al. Prevalence of symptomatic pelvic floor disorders in US women[J]. Jama, 2008, 300(11): 1311-1316.

[8] Mant J, Painter R, Vessey M. Epidemiology of genital prolapse: observations from the Oxford Family Planning Association Study. Br J Obstet Gynaecol. 1997;104(5):579-5859166201

[9] Carroli G, Mignini L. Episiotomy for vaginal birth. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD000081. doi: 10.1002/14651858.CD000081.pub2. Update in: Cochrane Database Syst Rev. 2017 Feb 08;2:CD000081. PMID: 19160176; PMCID: PMC4175536.

[10] Ismail SI, Puyk B.The rise of obstetric anal sphincter injuries (OASIS): 11-year trend analysis using Patient Episode Database for Wales (PEDW) data［J］. J Obstet Gynaecol,2014,34(6):495- 498.

[11] Dudding TC, Vaizey CJ, Kamm MA. Obstetric anal sphincter in jury［J］. Ann Surg,2008,247(2):224-237.

[12] Mulder F, Schoffelmeer MA, Hakvoort RA, et al. Risk factors for postpartum urinary retention: a systematic review and metaanalysis［J］. BJOG,2012,119(12):1440-1446.

Li Jie, Hou Rui, Liang Yi, Zhou Nan, Yin Shaohua, Gong Jingjing, Lu Hong. Meta-analysis of risk factors for pelvic floor dysfunction disease at 6-8 weeks postpartum[J]. Chinese Journal of Nursing, 2019, 54(8): 1241-1247.

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