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PERINEAL TEARS & EPISIOTOMY
The perineum must stretch far beyond its ordinary limits as the baby is born. Most women's body's are capable of achieving this, but some are not and the skin gives away and tears or to prevent "just in case tears", an episiotomy is performed by a health care provider or midwife. This procedure is standardly performed in hospital settings and very seldom is it used in a homebirth setting with an experienced midwife. Most midwives take pride in delivery babies over an intact perineum with a minimum of trauma.
MoonDragon's Pregnancy Information: Episiotomies: What You Should Know
PREVENTING PERINEAL TEARS OR EPISIOTOMY
If you are planning a homebirth (or even a hospital or birth center birthing experience), it is easier to prevent problems than it is to solve problems. Here are some suggestions that can be used to prevent perineal trauma:
Massage. Massage is used to soften and stretch the perineum throughout the pregnancy with the aid of olive oil, Comfrey ointment, wheat germ oil, lanolin, or sesame oil. This can be done by the pregnant woman or by her partner towards the end of her pregnancy in preparation for labor. Your midwife will be able to tell you how to properly perform perineal massage.
Compresses. Use a warm oil or hot compresses of herbs, such as plantain or comfrey leaves during labor to encourage pliability of the perineum. A strong tea of comfrey leaf, kept only hot enough to place on the skin without burning and a wash cloth can be used during the pushing stage of the labor. This not only helps to relax the perineum, keeps blood flowing into the tissues while they are being stretched, but it also gives a warm focal point for the mother to concentrate her pushing efforts. Two washcloths work well, keeping one in the comfrey infusion while using the other on the perineum until it cools, then trade it out with the soaking washcloth, placing the cool one back into the warm infusion. The mothers enjoy the warmth and it feels good on stretching tissues.
Birth Position. Trying different positions and choosing a birth position is important during labor and birth. The birthing position will apply different types and quality of pressure on the perineum, depending upon the choice. The best positions are hands-and-knees, squatting, and semi-setting are much less likely to provoke tears than lying flat on the back (most often seen in the hospital) with legs extended wide. Discuss options with your midwife about what you want and don't want. Find a position that you, as the birthing mother, feel comfortable with and works for you.
Controlled Fetal Descent. If the baby is born too fast, the tissues don't have enough time to stretch properly and tears are more likely to occur. A midwife may use a combination of perineal massage and support as the head crowns on the perineum, keeping the baby's head in a flexed, chin-down attitude to allow the smallest part of the head to emerge. Once the head is out, care is taken to prevent the baby's shoulders from delivering too quickly and causing tears. Small babies may deliver their shoulders very quickly while larger babies may take more work or have problems with shoulders getting stuck under the pubic bone. Most babies deliver without incident or with a little corkscrew maneuver performed by the midwife to "unstick" shoulders.
Birth Devices: At home we do not use these devices, but they are fairly common in a hospital setting. Forceps and vacuum extraction devices are often used to "pull" a baby out of the birth canal. These devices and the procedures that accompany them are notorious for large episiotomies and massive tears with major repair work having to be performed. Avoid these devices unless there is a life and death situation for the mother and baby. Some doctors will automatically use these devices on a first time mom with the idea that she is "untried" in delivering a baby or because he is in a hurry and just wants to get the baby out.
My first son was delivered by forceps. I was very sore for such a very long time after his delivery. I got my hospital records and found that I had 103 stitches taken to repair my vagina, bowel, and perineum after his delivery. It was a very traumatic experience for me. The trauma still continues to haunt me, physically and emotionally from that birth. A major reason for me to choose homebirth later.
REMEDIES FOR PERINEAL TEARS OR EPISIOTOMY
Discomfort from an episiotomy, tears or hemorrhoids can be a problem after a delivery. Symptoms may sometimes persists up to 3 months.
For Midwives: Before suturing, give the mother a dropperful of Valerian tincture under the mother's tongue to stop "the shakes" that often occurs right after delivery. This will help to have a neatly done suture. Following birth, mothers may want to take ten to fifteen drops of echinacea tincture twice a day in water as a preventive measure against infection. Some people feel dizzy when taking echinacea. This side effect can be alleviated by preparing it with licorice.
For relief of discomfort caused by the episiotomy or tears, use ice packs, warm-water cleansing, apply an astringent, such as witch hazel on gauze pads or a commercial preparation such as Tucks Pads or Tucks Clear Gel. A topical anesthetic (Americaine, Dermaplast) may be used to relieve discomfort.
Comfrey leaf infusion is used to build new cells rapidly and helps alleviate pain. As a drink, drink a cup of tea daily. A sitz bath with comfrey leaf infusion soothes and heals, keeps the tissues flexible and keeps itching to a minimum. Comfrey's anti-inflammatory properties reduce swelling and allow bones to reunite effectively. Apply a tepid moist poultice around the entire injured area as soon as possible, and allow it to stay in place as long as possible. Repeat several times a day. The prickly quality of comfrey leaves can be an irritant to inflamed and swollen tissue so keep the plant materials encased in the poultice cloth. If the fractured body part can be immersed in a warm infusion prepared in a bucket, this can be effective as well. Comfrey is especially indicated for a broken tailbone or a separated symphysis pubis.
Some midwives use tea tree oil on the suture wound. A few days after a woman has had an episiotomy or has torn, she is given a syringe with the needle still attached, filled with tea tree oil. She is then shown how to use a mirror to see her wound and to drop a few drops of this wonderfully cool oil directly on it. If she is not comfortable doing this, the postpartum midwife will apply the oil. Putting the oil in the syringe with needle allows accurate application. Tea tree oil works well for this purpose.
Other herbal sitz baths that help prevent infection, aid healing, and offer pain relief are yarrow, rosemary, golden seal, oak bark, witch hazel, sea grape bark, myrrh, many more. If you have sutures from an episiotomy, limit your sitz baths to once a day.
Aloe vera gel is a wonderful remedy for healing wounds. You can obtain bottled aloe vera if it doesn't have any preservatives that may irritate sensitive skin. However, it is best to use the gel from the fresh plant leaf to make a poultice to heal and cool a torn perineum. This is done by removing the green skin from several leaves, placing the clear gel on a gauze pad or menstrual pad. Hold it in place or tape it in place. Apply it directly upon the tear or incision. Aloe is a wonderful pain killer when used in this way (I used it when I had my wisdom teeth removed and the pain killers would not work... I put the gel directly into the tooth sockets and relief came almost immediately). Replace the poultice with a fresh one when the pain returns.
Slippery elm bark in a paste made from the powdered bark, water and olive oil or vitamin E can be used after the tear is well closed, or after the third day on a sutured wound. Frequent applications are most effective. Take special care with cleanliness, as the oil attracts dirt, lochia, etc. and could promote infection. If using vitamin E, use only a pure oil as synthetics and vitamin E preparations often contain flavoring oils and substances that are not intended for use on sensitive skin areas.
Hemorrhoid discomfort can be treated by warm sitz baths (10 to 20 minutes, twice a day in water 4 inches deep in the tub), non-prescription topical hemorrhoid medications and oral medications such as acetaminophen or ibuprofen (little of each of these drugs is excreted in breast milk).
MoonDragon's Client Handouts about nutrition and diet for pregnant and breastfeeding mothers are available at the links below. Examples of sample diets and menus are given, including some holistic suggestions. Nutritional analysis for various foods and nutritional therapy information is also available.
POSTPARTUM CARE INFORMATION
Postpartum Care: Index
Postpartum Care: Weight
Postpartum Care: Diet
Postpartum Care: Bowel Movements & Urination
Postpartum Care: Bathing
Postpartum Care: Breasts & Breastfeeding
Postpartum Care: Perineal Care
Postpartum Care: Vaginal Bleeding (Lochia) & Menstruation
Postpartum Care: Exercise & Back Care
Postpartum Care: Sexual Intercourse
Postpartum Care: Contraception
POSTPARTUM VISITS
PostPartum Visit: Day One
PostPartum Visit: Day Three
PostPartum Visit: Day Seven
PostPartum Visit: 4 to 6 Week Visit
POSTPARTUM CONCERNS
Baby Care & Concerns
Fatigue & Exhaustion
Postpartum Depression (The "Baby Blues")
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
You or your family member has questions about postpartum care.
You or a family member develops any unexpected and/or unusual symptoms.
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