Thursday, May 9, 2013

Care of Perineal and Cesarean Section Wounds

Most women want a normal delivery with an intact perineum but unfortunately, this may not always be possible and the majority of women will have a wound to take care of in the postnatal period.

Perineal wounds are either a tear or an episiotomy. During the second stage of labour, the perineum has to stretch to allow the baby to be born. A tear usually occurs during delivery of the widest diameter of the baby's head or the baby's shoulders. A tear normally extends from the vagina downwards to the anal region and it heals very quickly. Although rare, the tear may extend into the anus, which is more complicated and requires extra care. An episiotomy is a surgical cut in the perineum to facilitate vaginal delivery of the baby, which may be normal, by forceps or vacuum extraction. The tear or episiotomy needs to be stitched to facilitate healing and hopefully get it back to its' pre-pregnant state.

Care of perineal wounds

During the first postnatal days, the perineum will be bruised, swollen and sore. You may find it painful to walk or sit therefore it is best to lie down as much as possible for the first few days. Sometimes when you pass urine, you may feel a stinging pain on the wound. To reduce this effect, pour cool water on the area as you pass urine so that the water will dilute the stinging effects of the urine.

To help reduce the swelling and for the wound to heal quickly, the best treatment is to soak the perineum in cool salt water for 5-10 minutes once or twice daily until the wound has healed. Hot water will increase blood flow to the area which may make it more painful later.

During the healing process, the tissues will shrink causing the wound to become tight and uncomfortable. Sometimes the sutures (stitches) may become hard and stick into the flesh, which can be very painful. If you feel any uncontrollable pain, you must go back to your obstetrician who may remove a couple of stitches to relieve the pain.

Keep the area as clean and dry as possible by changing your sanitary pad regularly. It is better to use sanitary towels with loops as these can provide some counter pressure on the wound therefore making it less painful.

Do not use air rings. It does give relief when you sit but it may restrict blood flow to the area if used too long, which may delay healing of the episiotomy. It is better to sit on a soft pillow.

Please do not use feminine sprays or powder as they may interfere with the healing process.

A caesarean section is an operation whereby the baby is delivered through a cut in the lower abdominal and uterine walls. Normally, the cut is in the lower segment of the uterus at the bikini line.

Care of the section wound

Initially, the wound may be painful especially when you move or cough. This is due to internal pressure on the wound. Placing a hand firmly on the wound when you cough or move will counteract this pressure and reduce the pain. The pain is also due to tissue trauma therefore it may be necessary to take some painkillers. Keep the wound dry until any stitches are removed (normally about 7 days) so no bathing allowed. Use cotton dipped in salt water to soak and remove the scabs. Salt water also helps healing and reduces itching when the wound is healing. Do not lift heavy items for at least 6-8 weeks after the delivery.

Care tips for both types of wounds

o As far as possible, try not to bathe the baby yourself until the wound has healed properly.
o To help the wounds heal quickly, do not eat ginger for the first 10 days.
o Take extra vitamin C.
o Do not walk too much especially up and down stairs as your wound needs to 'rest' in order to heal.
o After 2 weeks, massage the wound with vitamin E oil to prevent keloid formation.
o Do not worry if the wound feels itchy even after many weeks or months.

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