In response to a question about applying Betadine to the perineum [Issue 2:6]:
The reason you're finding it hard to find evidence to support changing the
practice in your hospital from painting the perineum etc. with Betadine or
similar, to washing with soapy water, is that neither method is generally
used. I have never heard of this practice in this country (UK) and think it
is completely unnecessary and archaic. If your unit wants research to
support dropping the use of Betadine, why not ask them to try and find
research to support keeping it, or in fact doing anything at all?
-C.
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The only thing that comes to mind is that Betadine will actually kill
microrganisms on contact whereas ordinary (non germicidal) soap is
basically just an agent to make "germs" slippery so that they may be rinsed
off. At the bedside, unless you have a bed that is broken down, a bucket,
and lots of water to rinse, I wouldn't have confidence that micro-organisms
would be removed. Also there is the matter of having to really scrub to get
germs to rinse off, which will be unpleasant for the mom.
But do we really need to protect babies from the mother's germs? In my
practice I served a particular group, and I saw plenty of less than
frequently showered (as in never) perineums. I also saw less than average
rates of infection in both mom and baby. I used a light mixture of Betadine
in water (the color of dark tea) applied with washcloths to the perineum as
a combination warm pack and mild disinfectant. I never applied it straight
from the bottle. This was in houses that smelled strongly of barnyard and
who knows what was floating around.
My basic feeling on babies and mothers developing postpartum infections is
that if left undisturbed, quiet, safe, and not exposed to harsh lights,
noise, and unfamiliar surroundings, the immune system will take care of
things. I am not saying what I did at a client's home will work in a
hospital, but I found it to be effective within my practice.
-E.
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When I was working in Scotland, the Simpson (big, prestigious hospital in
Edinburgh) conducted a large study of Chlorhexidine vs. plain tap water.
They found no difference in infection rate and concluded that tap water was
cheap and effective. I was used to washing down the perineum with
Chlorhexidine so I would always warn women that it may sting (following
birth). When we switched to warm water, I stopped seeing the usual "wince"
as I rinsed the perineum. Many women in fact found it comforting.
Why not write to the Simpson, Royal Infirmary, Edinburgh Scotland EH and
ask for a copy of their report?
-Amy
Reprinted from Midwifery Today E-News (Vol 2 Issue 7 February 18, 2000)
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