Wednesday, May 29, 2013

The One that Makes you Cringe

I'm back with the next installment of L&D 1102. This one... it's a little... um, personal. So here's the disclaimer: If you don't have the necessary organs to grow and deliver a child, you might want to keep on surfing. What I'm trying to say here is --guys, boys, men, XYfolks-- beat it. For the ladies that stick around, also be warned, I'll use anatomical terms that might make you blush. For certain though, this is the one that'll make you cringe. This is the kind of topic that sometimes comes up between friends outside of work and I can rarely make eye contact while talking about it.

Today, we're getting to the bottom line. Literally. Like, as in tears, lacerations, and episiotomies.

Did the air just suck out of the room?

I told you this one would be fun.

So, babies come out and sometimes things tear in the process. But what does that mean??? What is the difference between an episiotomy and a laceration? What is the recovery like? We'll tackle all things tear-related, and I'll share my tips for post-delivery bottom care.

First things first: Lets get super simple... when delivering, sometimes to accommodate the baby's head, shoulders, or body, things tear apart in the mother's bottom area (here comes the anatomical words.... google searches eat your heart out.) and most often you'll have tears around the vaginal walls, perineum, periurethral area, or cervix. There is a continuum of tearing, going from a First degree all the way to a Fourth degree; the first degree being very superficial and requiring very few stitches to put back together, and the fourth degree is, well, um, pretty significant. We in the biz like to call 4th degree tears a "vaginal c-section." Basic anatomical structures have to be reconstructed. Lets just say, take the colace. The difference between tears/lacerations and an episiotomy is that the latter includes the use of scissors. Catch my drift? For all comparative purposes, the depth of cut with an episiotomy is roughly equivalent to the depth of a second degree tear. Is everyone feeling a little light headed yet?

Do your kegels ladies.

There are basically two camps: pro-epis and anti-epis. Most doctors will fall into one category or the other. Those who are pro-episiotomy are open to cutting an episiotomy if it appears like the patient will tear anyway. Some doctors are even more snip-happy and will cut an episiotomy regardless. The draw is that episiotomies are a clean cut that are easy and straightforward to repair. We're talking stitches in your bottom, people. The anti-epis camp will do whatever it takes to deliver without doing an episiotomy. The theory here is that the perineum is designed to stretch to accommodate a baby, and while repairing a tear is sometimes more complicated than an episiotomy, cutting an epis can lead to deeper tears. Humor me for a minute and go get yourself a sheet of paper.

I'll wait.

Are you back yet? With that sheet of paper? Lets do a little experiment, shall we?

Grab your sheet of paper where the arrows are and try to tear the paper by pulling it apart. This isn't a strongman experiment, just try to tear it.

NOW... cut a slit in the middle of the piece of paper and try it again.

Ok, so paper #2 was way easier to tear in half, right? It's the same principle with episiotomies and the anti-epis camp. Disrupt the integrity of the perineum and it's easier to tear even further -- doesn't always happen, but the possibility is there. Make a little more sense? Have a discussion with your doctor to see which side of the fence he or she is on before it's time to push a baby out, but whatever you do, do not ask for a daddy stitch. It's revolting.

Lets reel this back in... I mean, in the end, you still have stitches in your netherrrregions. And stitches that bring a torn bottom back together feel pretty much exactly like those stitches that bring an episiotomy back together. So what do you do about basic life functions? Like sitting? And using the bathroom? Here are my top tips for keeping post-delivery bottom discomfort at bay

  • ICE ICE BABY. Ice packs are your greatest friend. Be that annoying patient and ask for a new ice pack frequently. You should aim to keep ice on that bottom for at least the first 24 hours. Not only does it significantly cut down on swelling (please please please dont--- I repeat DONT--- look down there. You can never un-see things. Just say no to hand mirrors) and it also keeps things pretty numb. So, use the ice. After the first 24 hours has passed, some people like to do sitz baths, which is like a bottom-spraying-basin-warm-water thing. Personally, I never used a sitz bath, but some people swear by them. 
  • Pharmacological agents. Around the clock motrin and or tylenol will help. Your doctor may send you home with a prescription for a narcotic pain reliever, just make sure you aren't doubling up on the tylenol in that case. There will be a few painful days (Day #3 is always the absolute worst.), but it won't take long until things are just kind of inconveniently uncomfortable. Don't worry, you won't need to sit on a pillow forever. Speaking of pillows, stay away from the donut pillows. 
  • Topical agents. This is stuff like dermoplast (numbing spray), tucks pads (technically for hemorrhoids, but great for the stingies & itchies), and hemorrhoid cream (actually for hemorrhoids, but not good with those awful 4th degree tears). I like to make a nice little pad-sandwich for myself my patients: pad on the bottom, then an ice pack, then a layer of cold tucks, then topped with a generous spray of dermoplast. Ahhh, sweet relief.
  • Colace, Water, Fiber. The first time you need to go number 2 after pushing out a baby and getting stitched back together, you might consider asking for another epidural. That isn't actually an option by the way. Taking colace (an OTC stool softener), lots of water, and a high fiber diet will make that bathroom experience less harrowing. And a note: if you're breastfeeding, you need even MORE water to keep the constipation at bay. (FYI: Narcotics can also make you constipated. Yowch.)
  • Keep it clean. You'll receive a plethora of diaper-sized pads and a handy dandy squirt bottle, so with each potty trip, do the rinse off/pat dry/pad change. Most sutures dissolve on their own, so keeping them clean and dry is the only thing you should bother worrying about.
  • Rest. Lastly, give your birth canal a break for a few weeks. Stay away from tampons and men. Wait until your doctor gives you the go-ahead to do anything besides ice and spray. Things will heal back to normal with time. 
So. 

That was awkward. 

3 comments:

Because of your love, is better than life. said...

After reading all of this. I dont think I want to have babies when I marry......

Because of your love, is better than life. said...
This comment has been removed by the author.
amanda said...

Love the pad sandwich. Our hospital has the pads that have an icepack built in...awesome :)

My friend described the post tearing pain as like being shot in the ass with a musket-spot on.

When I was in the hospital with my first son, I got four different sets of directions on how to use the sitz bath-they were all akward and unhelpful. Our county sends a nurse to the home of every new baby, and our smart start nurse told me that the important part was getting warm water on the cervix. She said, fill the bathtub up a few inches and sit with your legs open-no circulating water necessary. The warm water supposedly stimulates blood flow, which encourages healing. I swear by the sitz bath now, but the silly, uncomfortable pan with the tube isn't necessary :)

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