Question of the Week responses
Q: What are others doing when a woman has a shallow secondary degree tear, haemostasis has occurred naturally, and the wound edges sit nicely together even with the woman's legs apart?
-Sandi
We currently (common practise for over three years) leave these wounds to heal naturally. Unfortunately we do not see these women after discharge but in the intervening time prior to discharge from hospital (5-7 days) there have been very small numbers of women who develop signs of infection. No figures on this but it could be a good research project.
-Alesa Koziol
Melbourne, Australia
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I leave it alone. Keep perineum clean. It will heal better than if I interfered.
-SW
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A second degree tear by definition involves the superficial transverse perineal muscles--it needs repair.
-Phil Watters
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Leave it! I am in strong favor of not suturing 1st and 2nd degree tears! In Scotland where I trained, many midwives were adopting the practice of not suturing 1st and 2nd degree tears that approximate nicely and aren't actively bleeding. If it is questionable, leave a pad on, legs together for awhile, then take a look. It is often remarkable how quickly a tear goes from looking pretty bad to "leavable." When you decide to leave it (and, of course, discuss the options with the mother--I bet she'll opt for no suturing), give her some advice (e.g. Arnica for swelling and bruising, frequent cleansing, lavender/tea tree baths), explain that it will probably take a full six weeks to come together completely, then don't examine *every* day as long she is comfortable, but keep an eye on it (or teach your client how to).
My baby was born at home after one of those marathon labors. I had a 2nd degree tear and it would have been a terrible thing to endure getting sutured after all that! Instead, my midwife left it, I got to enjoy my first minutes with my daughter, and I healed beautifully!
-Amy Darling
Reprinted from Midwifery Today E-News (Vol 1 Issue 41, Oct 8, 1999)
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