VAGINAL DELIVERY

, , , , , , , , , 1 comment

EPISIOTOMY; WHAT YOU SHOULD KNOW

During vaginal delivery, some women may sustain some injuries as the baby passes through the vagina that may require some stitches while for some, a cut might be given by the midwife or obstetrician that is taking the delivery. The cut given by the midwife or obstetrician during delivery is called an episiotomy. An episiotomy is an incision made on the posterior vagina mucosa and perineal skin to widen the vagina for easy passage of the baby. The Perineum is the region in between the thighs involving the vagina excluding the anus. Episiotomy used to be routinely given in the past but it is no longer recommended for routine use during delivery. The reasons for its routine use in the past was that, it is a well-controlled cut that is easy to repair than a spontaneous tear that is more likely to be ragged and extensive. The world health organization in 1996 discouraged the routine use of episiotomy and recommended a decrease in the rate to about 10%. This has been achieved by some Western countries but in Africa the rate still remains high.

WHEN IS EPISIOTOMY GIVEN

It is given in the second stage of labour when the cervix is fully dilated and the baby’s head has crowned that is, the baby’s head is in close contact with the vagina opening and the vagina opening forms a rim around the baby’s head. At this time, the baby’s head does not recede when the uterine contraction (labour pains) wanes. The cut is then given at the height of the uterine contraction that is, when the contraction is strongest, this is done at this time because the head of the baby will press against the cut and reduce bleeding.

HOW IS EPISIOTOMY GIVEN

When the time comes for it to be given, the site chosen for it is injected with lidocaine a medication meant to numb the area and prevent pain. However, when a woman is on epidural analgesia, there may not be a need for the injection. The midwife or obstetrician will place the fingers of the other hand between the baby’s head and the vagina to prevent injury to the baby. A scissor is then introduced between the fingers and the vagina. At the height of the uterine contraction the cut is given.

WHO GETS AN EPISIOTOMY

Your healthcare provider cannot tell with certainty if you will be given an episiotomy or not unless your history during the booking clinic is indicative for an episiotomy. That’s why your healthcare provider might likely talk to you about it during your antenatal care to get your consent because there may be no time to get an informed consent when an episiotomy is needed. As earlier mentioned it is not routinely given, episiotomy use is individualized, unlike in the past when almost every woman having a baby for the first time or one who has had an episiotomy in the past is given. There are indications to be met before an episiotomy is given and they include;

  • A very tight perineum, scars from previous tear or female circumcision threatening to tear.
  • When the baby is big
  • Delivery of a preterm baby to prevent trauma to the baby’s head
  • When the second stage of labour is prolonged due to resistance from the perineum
  • When the baby is coming with the buttocks
  • When instruments are to be used for delivery like forceps or vacuum.

COMPLICATION OF EPISIOTOMY

The complication could be to the mother or baby, immediate or late. The immediate complication could be;

  • Bleeding
  • Pain
  • Perineal swelling
  • Injury to the baby

The late complications could be Infection of the wound, breakdown of the repair or painful sex.

HOW TO CARE FOR AN EPISIOTOMY WOUND

It is very important to take care of the wound as some of the complications are due to infection from poor wound care. Your healthcare provider is most likely to place you on antibiotics to prevent infection and pain medication to make you comfortable. Perineal care using a warm Sitz bath also help. Read here to know how to make and have a Sitz bath. Wash with water after urinating or defecating and do not use a single pad all day. Ensure proper hand hygiene while handling your pad.

WHEN CAN SEXUAL ACTIVITY RESUME?

After an episiotomy, the woman could feel soreness or discomfort while walking or sitting, sexual intercourse is a no go. However, sexual intercourse can resume whenever the woman feels comfortable. An uncomplicated episiotomy wound should heal between 4 to 6 weeks.

WHEN SHOULD YOU BE WORRIED

Seek health care when the site of episiotomy opens up, when the wound starts discharging fluid or pus, when the pain becomes severe or when a painful mass forms around the area.

If this article was helpful, share and follow my blog for more informative articles on women’s health.

PERINEAL CARE USING SITZ BATH

, , , , , 5 comments

PERINEAL CARE USING SITZ BATH

Photo by Ekaterina Bolovtsova on Pexels.com

Did you just deliver a baby and you are feeling sore or discomfort around your vagina? Did you sustain some laceration during delivery? This is for you if your answer is yes. The perineum is the area around the vagina excluding the anus. Care of both the perineal and anal region is very important for all women and not only those who just had a baby. Using a tissue paper is ok but washing with water is great after urinating, sexual intercourse and defecating. The care of these regions is very important after delivery especially if you had a couple of stitches to repair the injury caused by the baby as it passes through the vagina. This will help prevent infection and opening of the stitched wound.

Sitz bath is a bath in which the buttocks are dipped up to the level of the hips in water. It is can be done using warm, cool or alternating between a warm and cool water. Salt, vinegar or baking soda can be added to the water or the water can be used alone. For the purpose of caring for the injury in the vagina and around, I will be describing how to do a warm sitz bath using salt. The laceration in and around the vagina might be sustained accidentally as the baby passes through the vagina or intentionally made by the midwife or obstetrician to widen the vagina opening for easy passage of the baby and this is called an episiotomy. After every delivery is completed, the vagina and the area around it is inspected for any laceration and stitched. If an episiotomy is given it is also stitched. The thread used for stitching can be damaged by heat resulting in opening of the wound which will require a second application of stitches. If you were stitched after delivery, do not let hot water get to the area. Yes, that’s what you just read, I know this is the opposite of what you thought or must have heard some folks say. If the bathing water is too hot, do not use it, you do not have to announce to the neighborhood when it is time for your bath as a result of very hot water being used.

CATEGORY OF WOMEN WHO MIGHT HAVE AN EPISIOTOMY

Episiotomy is a deliberate incision made on the vagina mucosa, perineal muscle and skin to widen the vagina to ease the passage of the baby. It’s more controlled compared to when the tear occurs accidentally as the baby is delivered which is more likely to be rugged and extensive. It is important to note that episiotomy is not routinely given until there is an indication for it. So, don’t be scared you might not need one however, the following category of women are more likely to have it;

  • When the perineum is tight and threatening to tear
  • Women with severe female genital cutting/female circumcision
  • When the baby is big
  • Previous scar that is threatening to tear
  • Delivery of a baby coming with the buttocks
  • When an instrument is to be used to assist the delivery example a vacuum or forceps

HOW TO PREPARE AND HAVE A SITZ BATH

To prepare a sitz bath, you need a lukewarm water in a receptacle either a bowl, bath tub or bidet. There are bowls that can fit on the toilet for this purpose or even electronic bidet that can be connected to the toilet. Add salt to the water until it becomes highly concentrated that the salt no longer dissolves easily as you add it to the water. Sit in it for about 15- 20 minutes 2 to 3 times a day. It should also be done after defecating. Ensure that the temperature of the water is comfortable enough for you and not hot as it will affect the stitches.

BENEFITS OF SITZ BATH

  • It has a soothing effect
  • It increases blood flow to the perineal region which helps with healing
  • Helps to reduce swelling
  • Helps to reduce pain
  • It has an antiseptic effect
  • Prevent infection at the site
  • Keeps the area around the wound clean

WHO CAN USE A SITZ BATH?

Apart from women who just delivered, sitz bath can also be used in the following conditions;

  • Hemorrhoids before or after it’s operated
  • Bartholin’s cyst
  • Anal surgery
  • Vaginal surgery
  • Vaginal infection

DOES IT HAVE A SIDE EFFECT?

It is rare to have any unpleasant effect from doing a sitz bath. However, one could rarely feel dizzy or the heart might be beating too fast. This might be as a result of an increased blood flow due to the dilation of the blood vessels caused by the warm water at the perineal region.

If this article was helpful, share and follow my blog for more informative articles on women’s health.

VAGINAL BIRTH AFTER A PREVIOUS CAESAREAN SECTION IS POSSIBLE

, , , , , , , 0 comments

VAGINAL BIRTH AFTER A PREVIOUS CAESAREAN SECTION IS POSSIBLE

CAN I HAVE A NORMAL DELIVERY?

“What is a ‘normal delivery’ to you?” is the question that comes from me whenever a woman asks if she can have a normal delivery after a previous caesarean section. Their answers are always the same, which is, “vaginal delivery is what a normal delivery is”. Yes, it is possible to have a vaginal birth after a previous caesarean section. The natural way of delivery is via the vaginal route, however, when that is not possible, the alternative is a caesarean section.

On the contrary, some women hold on to the belief that a woman who has not had a vaginal delivery is not a real woman. For them, a test of real womanhood is to have experience of the pains of labour and vaginal delivery. This cultural misconception has caused a lot of harm to women both physical, psychological and even death for the ones who are not lucky enough.

Apart from this cultural misconception, their religious belief often influence their decision whenever the word caesarean section is mentioned. Some faith preachers associate other route of delivery with the devil, as believers are expected to have a ‘normal delivery’ like the ‘Hebrew’ women. As believers, this is supposed to be their inheritance.

In addition, poor socioeconomic status is a reason why some couples view caesarean delivery with horror apart from the fear of possible complications from the operation. I have not come across a literature that said a particular route of delivery is normal while the other is abnormal. I am open to learning if you have come across any.

Photo by freestocks.org on Pexels.com

Maybe this is so to avoid the stigma that might be associated with what is termed to be abnormal. This will make it difficult if not impossible to persuade a woman to take the other route of delivery classed as abnormal. If you are talking about labour, yes, there is a normal and abnormal labour. However, this is not the talk for today.

Notably, there are only two routes of delivery, these could be the vaginal route or the abdominal route. The aim is always to have a vaginal delivery but this might not be the case at all time. Your healthcare provider will advise you appropriately on vaginal delivery if indicated. Delivery via the vaginal route during labour will depend on three factors; the strength of uterine contractions, the size of the baby and the adequacy of the birth canal. The vaginal route is the most preferred by most people for reasons stated above.

Also, viewed as the safer and least expensive route of delivery, the vaginal delivery might also become an operative one. This is when instruments are used to assist the delivery such as forceps or vacuum. However, the vaginal route of delivery is not without its short and long term complications. In the short term, the baby might be in distress or delivered with birth injuries; been unable to use one of it limbs.

In addition, the woman’s cervix might be injured resulting in heavy bleeding that might necessitate blood transfusion, the vagina might also have injuries requiring stitching, there may be a pelvic floor damage. In the long term, women with a pelvic floor damage or repetitive small pelvic floor damages are at risk of developing pelvic organ prolapse (when the cervix or uterus is descending into the vagina).

Furthermore, the abdominal delivery route can also be called caesarean delivery or caesarean section (CS). This is when the abdomen and uterus is cut open during an operation to deliver the baby. This is the route of choice when the vaginal route is not going to be possible. Your healthcare provider will advise you when the need arises for a caesarean section. Usually, if vaginal delivery will be dangerous to the mother and or the baby. 

If the baby is too big, the birth canal is too narrow for the baby to pass, the presence of some disease of the birth canal or other reasons to avoid vaginal delivery. Your healthcare provider will advise you for a caesarean section. Some women now request for caesarean section for social reasons when the baby is due and they are not in labour. This is often to enable them participate in an event which the pregnancy would have prevented. Some also request for caesarean section for fear of labour pains.

Actually, caesarean section can prevent small pelvic injuries thereby protecting against pelvic organ prolapse. This protection is lost after menopause and the risk becomes almost similar for both routes of delivery. The feminine hormones that play a role to prevent the prolapse are no longer produced during menopause. Just like any other surgery, caesarean section also has it complications which your healthcare provider will counsel you on before the operation.

In fact, vaginal birth after a previous caesarean section is very possible. There are certain criteria you must meet before your healthcare provider will advise you to try vaginal delivery after a previous caesarean section. Read here for what you need to know about vaginal birth after caesarean section. The main purpose of this article is to educate those who have had a previous caesarean section and their healthcare provider is advising for a repeat in the index pregnancy from his professional point of view.

Importantly, do not let religious or cultural misconception influence your decision against your doctor’s advice. Anything is possible in medicine but it is not wise to ignore your doctor’s advice. Some did and lived to testify, some did and lived but too ashamed to testify while some did and are not alive. Instead, they added to the maternal mortality statistics.

VAGINAL BIRTH AFTER A PREVIOUS CAESAREAN SECTION SCENARIO 1

Some years back when I was an intern on duty. A woman entered the labour ward with labour pains. While the delivery couch was being prepared for her to lie on, she screamed and said the baby is coming. I asked when the labour pains started and she said about 10hours ago. Did you book for antenatal care? Yes, she said. I also got another yes when I asked if she had delivered a baby before. I was surprised why a booked patient with her experience will stay at home for a long time after the onset of labour.

As soon as she laid on the delivery couch with her legs apart. I could already see the baby’s head protruding through the vagina. Before anything could be done, she delivered a 4.1kg baby.

However, I noticed a scar on her lower abdomen while delivering the placenta. After the mother and baby had settled. I went back to enquire about the scar. She told me she had had two previous deliveries. The first was delivered via the vaginal route while the second was via a caesarean section. The baby was in distress during labour.

Finally, she said God has disappointed the doctor who advised her to have a repeat caesarean section. Because her scan in the index pregnancy showed that the baby is big. So, that was why she stayed back to only come when she is far advanced in labour. This is to avoid operation and also intentionally didn’t volunteer the history of a previous caesarean section.

VAGINAL BIRTH AFTER A PREVIOUS CAESAREAN SECTION SCENARIO 2

I was in the labour ward when a woman was rushed in bleeding from the vagina. She had a previous caesarean section about a year ago and was advised for a repeat caesarean section because of a short inter-pregnancy interval. She declined and instead went to a traditional birth attendant when she was in labour. She was only taken to the hospital when she started bleeding.

After our clinical assessment, she was rushed to the theatre for an emergency operation for a ruptured uterus with a dead baby as the baby’s heart beat was not heard. The damage to the womb was extensive and we could not control the bleeding so, the womb had to be removed to save her. She had multiple blood transfusions and ended up in the intensive care unit.

The above scenarios are the lucky ones that made it, the first scenario will be widely publicised of course by the patient and some women will work with the information than what their healthcare providers will advise. I will like to state that having a caesarean section does not mean you cannot have a vaginal delivery. Read here to know the criteria for having a trial of labour after caesarean section and this would help you to make informed decisions.

I hope this article was helpful, do well to subscribe to my blog for more informative articles on woman’s health.

WHAT YOU NEED TO KNOW ABOUT VAGINAL BIRTH AFTER CAESAREAN SECTION

, , , , , , , 2 comments

WHAT YOU NEED TO KNOW ABOUT VAGINAL BIRTH AFTER CAESAREAN SECTION

Photo by Jou00e3o Paulo de Souza Oliveira on Pexels.com

Did you know that if you meet the criteria for a trial of labour (vaginal birth after caesarean section), you might not need a repeat caesarean section? After a woman undergoes delivery via a caesarean section, at discharge, she is reminded of the reason why the operation was done and also told that her subsequent pregnancies are high risk because of the operation. She will be advised to book for antenatal care in a health facility that has the capacity to carry out caesarean section, also to space her pregnancy to give adequate time for her body to return to the pre-pregnancy state. It is important to volunteer information on the fact that you have had a previous caesarean section during your pre-conception counselling and care, at booking for antenatal care and during any emergency situation while pregnant. The aim of vaginal birth after caesarean section is to reduce the overall rate of caesarean section.

At the 36th week of antenatal care, your healthcare provider will carry out a clinical examination on you. These will involve measuring the length of the womb which gives an estimate of the baby’s weight. A clinical pelvimetry might be done to measure the dimension of the birth canal if it is wide enough for the baby to pass through, or a radiologic pelvimetry using either X-ray, computer tomography scan(CT-Scan) or magnetic Resonance Imaging (MRI) might be done. Pelvimetry helps to identify whether there is a disproportion between the baby’s head and the mother’s pelvis thereby preventing obstructed labour. A scan will be requested to measure the thickness of the previous scar and estimate the weight of the baby. With the information from your examination findings, medical history and history of previous deliveries, your healthcare provider will advise you on the option of delivery (vaginal or caesarean delivery).

CRITERIA THAT FAVOUR VAGINAL BIRTH AFTER CAESAREAN SECTION

The following criteria involving the unborn baby favour a trial of labour after a caesarean section at term and include;

  • the baby’s head should be at the lower part of the womb,
  • the weight of the baby should be ≤3.5kg,
  •  there should be a single baby in the womb.

The following criteria involving the mother favour a trial of labour

  • If labour starts spontaneously.
  • Previous vaginal delivery before caesarean section.
  • Vaginal delivery after the caesarean section.
  • If the thickness of the previous scar on the womb seen via an ultrasound scan is ≥3.5mm.
  • If the indication for the previous caesarean section is no longer present in the index pregnancy.
  • The previous incision on the womb during the previous operation made transversely on the lower part of the uterus.

If the above criteria are met, then trial of labour can be the option of delivery. However, meeting the above criteria does not guaranty a successful trial. The labour will be monitored closely for signs of uterine rupture which is the most feared complication of trial of labour after caesarean section.  Such signs are excessive pain even though the woman is not contracting, the presence of vagina bleeding, low blood pressure and high pulse rate. When vaginal delivery cannot be achieved that is, a failed trial of labour, a repeat caesarean section is carried out.

CRITERIA THAT DO NOT FAVOUR VAGINAL DELIVERY AFTER CAESAREAN SECTION

They include any condition that vaginal delivery is not advised or contra-indicated such as;

  • When the placenta covers the cervix.
  • presence of two or more babies in the womb
  • When the interval between the last delivery and the conception of the index pregnancy is less than 14 months.
  • Maternal short stature.
  • Contracted pelvis.
  • Diseased pelvis example rickety pelvis.

I hope this article was helpful, follow me on my blog for more informative articles on women’s health.

enEnglish