​PERINEAL TEAR: THE PRICE OF ‘PUSHING’ 

Vaginal delivery remains the better option than C-section; unless there’s a medical indication for the latter. But nothing comes without its own downside. One of the downsides of vaginal birth is the higher risk of genital tract injuries: ranging from slight bruising to various degrees of tear. 

Episiotomy is the surgical cut made in the vaginal wall and peri-anal (perineal) muscles which is sometimes necessary to widen the space for the passage of the baby and to prevent irregular lacerations during delivery (which are more difficult to treat). 

When a woman is given an episiotomy or she sustained genital laceration during childbirth, a proper repair must be done by a trained personnel (midwife or doctor). Failure to repair promptly and skillfully can result in immediate and longterm complications. 

The steps involved in repairing perineal tear and episiotomy are essentially similar:
*The doctor will examine your vagina and anus to visualize the extent of injury, check if the anus is involved and decide whether the repair should be done in the labour room or operating theater. 

*You will be given an injection at the site of the wound to numb the pain. You shouldn’t feel anything during the stitching and a few hours thereafter. 

*The cut will be stitched layer-by-layer, ie. Vaginal wall, muscles, then skin. Absorbable sutures are widely used nowadays, so need to go back for removal of stitches. 

*If the deep anal sphincters (special muscles controlling the anus) are involved, the procedure should be done in an operating theater, by a specialist doctor, under anesthesia. 

After the repair, care must be taken to ensure proper healing of the wound. Painkillers, antibiotics and stool softening medications must be taken for at least 2 weeks. Sitz bath (immersing the perineum in lukewarm water) should be done twice daily until full healing. Long-term contraception is advised to reduce the risk of wound breakdown during the next delivery. Next pregnancy and childbirth should be hospital-supervised, taking into consideration the past events.
 
If perineal tears are left unattended for a long time after delivery, severe bleeding can occur; necessitating blood transfusion. Other complications include:

*infection 

*poor wound healing 

*constipation 

*chronic pain

*faecal incontinence (inability to control flow of stool) 

*flatulence (uncontrollable farting) 

*fecal fistulae (abnormal connection between anus and vagina – soiling the vagina with feaces) 

*sexual dissatisfaction and other sexual dysfunctions 

*difficulty in subsequent deliveries 

*low self esteem 

Genital tract injuries can be prevented by allowing the baby to descend gradually, with controlled pushing, guarding of the perineum by the midwives, doing episiotomy when needed or planned caesarean section when the fetal weight is estimated to be above 4kg. 

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Author: Khadijah Sanni-Tijani

Khadijah is a young Nigerian woman, a muslim, a wife, a mum, a doctor and a blogger. She was born and raised in Ibadan, Nigeria. She is currently practising in Saudi Arabia.

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