Spontaneous tearing, episiotomy... Childbirth sometimes leaves scars on the perineum. Can we avoid them? What to do in case of itching? How to promote wound healing? Answers and advice from Camille Tallet, midwife.
According to the latest National Perinatal Survey carried out in 2016, the perineal tear at the time of childbirth concerned six out of ten women . The cause: a large baby, an overly toned perineum, a lack of elasticity or a push that is too strong. If this phenomenon is feared by future mothers, it should not be demonized because good care allows rapid and optimal healing.
Two types of spontaneous tears can occur during childbirth. The incomplete tear , which concerns only the skin and mucous membranes. It is the most frequent. And the complicated full tear now called LOSA (obstetric lesions of the sphincter anal). 'In the spontaneous tear, different types of lesions are distinguished: superficial scratching, cracking of the skin, cracking of the skin and muscle, cracking of the mucosa, skin and muscle' , develops Camille Tallet.
Unlike tearing which occurs spontaneously, the episiotomy is a surgical gesture carried out voluntarily by the midwife or the gynecologist when a complicated tear is announced or when there is a medical indication. According to the last National Perinatal Survey carried out in 2016, the episiotomy rate in France is now 20%. A figure in sharp decline, since the rate was 27% in the previous report dated 2010. 'For a long time, episiotomy was performed almost systematically. Today, there are medical or fetal criteria that justify it. This surgical gesture is demonized when it is never done for pleasure! It is better a well-performed episiotomy with the right indication rather than a tear that will go all over the place and that will be difficult to suture. the side, in order to protect the sphincter of the anus and to make a scar which is the least embarrassing possible “, comments the midwife.
Unfortunately, there is no no way to prevent a tear or an episiotomy during childbirth. Several techniques are mentioned (massages, epi-no, exercises...) but their effectiveness has never been scientifically demonstrated. 'It's not what happens when you give birth that matters, but what happens afterwards. Rather than being afraid of the tearing which is unpredictable, you have to think about the aftermath! Because a good support allows rapid healing, effective and with the least possible unpleasant sensations ' , reassures the specialist.
'No perineum is a muscle covered by the vaginal mucosa. This area heals very well because it is a very vascular moist area. ', reassures Camille Tallet. To promote healing and avoid pain, it is essential to take painkillers systematically for 24 to 48 hours, you should not wait until you have pain. ' Prohibition of sitting on your buttocks or as little as possible and favor the half-sitting or lying position so as not to compress the scar, we favor the half-sitting or lying position but not sitting ', she continues. The application of local analgesics such as ice also works very well. The right tempo? Ten minutes every hour. You can also dab the scar with a numbing cream then, as soon as things get better, we can put some inside the vagina to desensitize the area. At the same time, the midwife advises mobilize your perineum with 'contract, relax' because the contraction induces a venous supply and the relaxation causes a blood return which will bring good nutrients to the perineum area and thus help healing. 'When you are in pain, you tend not to move anymore, but it is very important to mobilize the tissues. Moreover, if you know that you are healing badly, you must tell your gynecologist or your midwife to put in place close monitoring, indicates the midwife.
The threads usually reabsorb or fall out 15 days to 3 weeks after childbirth. In case of pain, some threads may be removed by the midwife or doctor.
Having a bowel movement with a perineal tear shouldn't hurt . Pain may be a sign of a fissure in the anus, to be checked with the midwife. To avoid pain when having a bowel movement, it is recommended to brush the area of vegetable oil or healing cream and to have a bowel movement as often as possible. At the same time, we consume a maximum of fibers and we drink a water rich in magnesium like hepatic . And above all, don't worry, it's impossible for the scar to open, even if this fear seems legitimate.
Itching is inherent in the healing process. The best way to limit this inconvenience is to hydration with healing cream , vegetable oil or aloe vera.