HEDI - Injuries to the Perineum: Perineal laceration and episiotomy

Various injuries can occur during childbirth. In particular, the perineum - i.e. the area between the vaginal opening and the anus - is often affected. This area between the anus and the vagina consists of skin, muscle, fat and connective tissue. As your baby is pushed into the world, this area is strained and stretched. Often the perineum tears. In rare cases, the medical professionals attending the birth decide to make and incision in the perineum as a precaution. Injuries to the perineum are usually easy to treat and heal. Complications only arise occasionally. Perineal laceration and episiotomy are among the most common birth injuries.

First and second degree perineal injuries

There is an official classification for perineal injuries. With first-degree injuries, the skin of the perineum and vagina is torn. The wound is sutured immediately after birth under local anaesthetic. Sometimes doctors and midwives do not even put in a suture and the wound heals by itself. With second-degree injuries, the muscles of the perineum are also injured. These kinds of wounds are always closed with a suture. Both first and second degree injuries can occur often. However, they usually heal quickly.

Perineal injuries of the third and fourth degree

Third-degree injuries requires that a tear of the anal sphincter be treated. Injuries of the fourth degree also affect the mucous membrane of the bowel. In the case of very serious injuries, doctors operate on the affected person under general anaesthetic. It may then take a few weeks for the perineum to recover and heal. In rare cases, the sphincter may not function properly for long after the procedure. Sometimes fistulas or abscesses also form and need to be treated. A fourth degree perineal tear occurs very rarely.

Can I prevent a perineal tear?

You can prepare your perineum for birth. About six weeks before your due date, you can start massaging your perineum regularly. This makes the tissue between the anus and the vagina more elastic. It is best to use almond oil or jojoba oil from the pharmacy. You should also massage the labia, as this will also make them more elastic. Some midwives also perform perineal massage during birth if the mother wants it.

Episiotomy

An episiotomy is when an incision is made in the perineum in the direction of the sphincter muscle. This can help facilitate the birth process. Today, an episiotomy is only performed if serious problems arise during delivery, for example, if the baby's head is particularly large or if the baby is exposed to severe stress during birth and therefore has to be born quickly. As a rule, obstetricians try to avoid an episiotomy. During this procedure, nerves, vessels and muscles are cut that would otherwise remain unharmed. Unlike an episiotomy, perineal tears only occur in thin areas of the tissue and can therefore heal better.

Gentleness, water and air support the healing process

You can do a lot to help your perineum recover after birth. The important thing is to go easy on the perineum. Even if it doesn't hurt, you should first try to sit as little as possible and avoid upright positions that put strain on the perineum. Careful wound maintenance also supports healing. Change your postpartum pads every two to three hours and clean the wound or sutures regularly. Lukewarm water will do. You can also use a mild, pH-neutral soap. If you feel a burning sensation while using the toilet, you can run warm water over your private parts while you urinate. It's best to use a watering can with a long spout for this purpose. As soon as your post-birth vaginal discharge (known as lochia) is not so strong, you should allow the wound to get a lot of air. Refrain from wearing underwear as often as you can.

When the wound hurts

Sitz baths can support the healing of the perineum and relieve the pain. Ask at the pharmacy or ask your midwife for suitable bath additives. You can take baths starting on the fifth day after delivery. Cool packs or cooling gels also help to reduce the pain. If you experience pain during bowel movements, you should eat foods that aid digestion and drink plenty of fluids to prevent your bowel movements from becoming too hard. For example, eat wheat bran, flaxseeds and soaked prunes. This helps relieve any strain on the injured region between the anus and the vagina.

Check-ups for the area

If your perineum is being cared for after a perineal tear or incision, your wound should be checked regularly. This is usually done in the clinic. But the midwife who visits you at home will also check the progress of your healing. At the final check-up after the postpartum period, a further examination of the perineum is carried out. Usually, the sensitive area is already well healed by then.