When do gaps appear and why? How to avoid pain in the postpartum period and how to return to normal life?

Before we talk about internal seams, every woman needs to know internal anatomy female organs , which are involved in the process of childbirth, where, in fact, a rupture can occur.

Childbirth involves the uterus, cervix, vagina, and perineum. If the birth goes well, there shouldn't be. This is a serious complication; such cases are very rare; during childbirth, the doctor can notice signs of a threatening rupture and do it in time.

Perineal rupture refers to external ruptures, and the tactics for external management after childbirth are different, since suturing perineal tears refers to sutures that are sewn with non-absorbable material (silk, polypropylene) and then removed.

Mostly we'll talk about ruptures of the cervix and vaginal walls. It is these gaps that are sutured with internal sutures, which are then not removed, but resolve on their own.

Causes of internal gaps

The most common causes of internal ruptures include:

• large fruit;
• inelasticity of fabrics;
• fast or rapid labor;
• narrow vagina;
• inflammatory diseases of the vagina during pregnancy;
• childbirth after abortion.

The physiology of normal childbirth involves prolonged dilatation of the cervix, for 12 hours or more, especially in first-time mothers. In women who give birth repeatedly, cervical dilatation usually occurs faster.

Therefore, in the first stage of labor, when the birth canal is being prepared and the cervix is ​​opening, supervision by a doctor is necessary.

If the cervix is ​​not fully dilated and the woman begins to push prematurely, a cervical rupture may occur. The doctor’s task, if he sees premature attempts, is to “restrain” the woman from this wrong step. For the same reason, the walls of the vagina are torn.

Internal breaks may not be visible immediately after birth, for this, after separation of the placenta, the doctor examines the cervix and vagina in the speculum.

The procedure is painless, but necessary so that even small cracks are sutured and do not cause trouble. Any wound that is not sutured can become inflamed after childbirth.

The procedure for suturing cervical ruptures painless. This is how nature protected a woman after childbirth from discomfort. When suturing the vaginal walls, pain may occur, because the vagina is rich in nerve endings. In this case, the doctor numbs the injured vaginal walls with novocaine or lidocaine.

Catgut– the most commonly used suture material for internal seams. These are natural threads made from sheep intestines. Its structure is similar to human tissue, and therefore after 7-10 days it can dissolve on its own, this happens under the influence of enzymes in the woman’s body.

Can be used for suturing semi-synthetic threads such as vicryl, PHA, caproag, which take a little longer to resolve, within 30-60 days.

Caring for internal seams

There is no care for sutures as such, but a woman needs to know that in the postpartum period, discharge will be released from the uterus for several weeks - lochia, which make it difficult to create sterile conditions in the suturing area. It is also not possible to apply a sterile bandage.

The tactics of managing a postpartum woman in the postpartum period have changed. If before a woman, who has internal stitches, was allowed to get up after giving birth a few days later and was brought to feed the baby on the third day, but now the situation is different.

Today, the management of women in the postpartum period with stitches is almost no different from healthy women. The presence of a woman and a child together immediately after childbirth presupposes the active behavior of the postpartum mother.

If there are stitches, then you need to remain in a lying position for at least 2-3 days, so some assistance from medical personnel may be required.

That's why precautions must be taken so that the seams do not come apart (especially deep ones) and do not fester. Sitting as usual is also not recommended; it is advisable to sit reclining, or sit on one of the buttocks. This precaution is necessary for a month or a little more.

You can start no earlier than in two months. This makes it possible for the torn walls to heal well and restore their elasticity.

If a woman starts to lead sex life Before this time, a situation may arise where infection of completely unhealed tissues occurs with all the ensuing consequences.

The child should be fed only in a lying position, and should be fed while standing or lying down. It is advisable not to lift heavy objects during this period, as this may cause the internal seams to separate. You shouldn't even lift a child, especially if you have a large baby.

The main condition self-care personal sanitation and hygiene remain behind the internal seams. Until the tissues are completely healed, You need to shower 1-2 times a day, under no circumstances take a bath!

It is necessary to use gaskets, immediately after childbirth with special postpartum ones, and then daily, which need to be changed more often to ensure dryness of the wounds.

Shapewear women who have internal seams too It is contraindicated to wear it for one and a half to two months. The fact is that such underwear creates excessive pressure on the perineum and vaginal walls, and this, in turn, interferes with fast healing seams.

Behavioral tactics after childbirth

It is necessary to understand that The usual rhythm of nutrition for a woman after childbirth is not suitable.

Due to the fact that all intracellular water rushes into the mammary glands, a restructuring of the body’s functioning is taking place; in the first days after childbirth, postpartum women may experience. Therefore, even women who do not have stitches prescribe a diet: more liquid, broths, less bread, and so on.

All this needs to be known and remembered by a woman who has stitches. Unwanted constipation may place stress on the seams, which may come apart.

If you see that there is no stool for 1-2 days, drink a laxative or do an enema. Immediately after bowel movement, you need to wash your external genitalia. warm water with an antiseptic solution, because the lower edge of the vaginal wall, where there may be stitches, comes into contact with the perineum.

If the internal ruptures were deep and multiple, the doctor may prescribe antibiotics in the early postpartum period, this is done to prevent complications. Complications may occur in the postpartum period, in which case you should immediately consult a doctor.

When should you not postpone a visit to the gynecologist?

• if there is pain inside the vagina that does not go away;
• heaviness appears in the lower abdomen and pain increases;
• suddenly developed a high temperature;
• appeared from the vagina purulent discharge.

Sometimes another cause can cause these symptoms, but if you had internal stitches, you need to rule out the underlying problem! All these symptoms, to one degree or another, indicate either inflammation of the sutures or their divergence. The doctor should prescribe you treatment, which can be either local, with treatment of sutures, or general.

But you need to know: Even if you do not have any complaints, you still need to contact antenatal clinic. Immediately after childbirth, it is difficult to assess the condition of the sutures in cosmetic terms, because there is tissue swelling.

The doctor should examine the internal sutures, and special attention pay attention to the condition of the cervix. If the sutures on the neck are not fused correctly, this may cause complications in the future.

Firstly, a rough formed scar can result because the cervix needs to be tightly closed during pregnancy.

And secondly, a rough scar during childbirth may prevent the cervix from opening completely, which can also lead to dire consequences. Therefore, only an examination in a gynecological chair a month after giving birth will allow you not to worry about your future or make a decision - to have the old scar excised and new sutures applied.

During childbirth, the perineum, cervix or labia are often torn. The woman will experience severe pain and bleeding may occur, which will subsequently complicate the process of bringing the baby into the world. It is important that a doctor or midwife is present.

Internal ruptures during childbirth: how they are caused

No matter how well everything goes during the entire period of bearing a child, this does not guarantee that no surprises will arise during the birth process. A woman giving birth on a chair can face various complications.

Internal ruptures are tears in the cervix and vaginal walls. This may be due to premature pushing; during this period, a woman needs to make every effort to restrain herself and not push. When pushing, the cervix is ​​under enormous pressure, and if it is not yet dilated enough and the pressure exceeds the threshold, then inner fabrics literally torn.

Also, ruptures may be related to the physiology or size of the fetus. For the same reasons, ruptures in the vaginal walls occur. During this entire, undoubtedly most painful procedure, the woman may not notice the breaks.

The doctor's task is to thoroughly examine and apply stitches to the damaged areas. As a rule, these are self-absorbing sutures, which facilitates the healing process.

The main task after such injuries is to maintain complete hygiene and avoid putting stress on the affected area.

This includes:

• Quite a long period of abstinence from sex, 1-2 months;
• Any stress on the abdominal area (sports, lifting heavy bags and even constipation);
• Do not make sudden movements, especially in the first weeks.

To prevent complications after suturing and prevent inflammation, doctors may prescribe an appointment antibacterial drugs. It must be remembered that if a woman is going to breastfeed her baby, she should take medications with caution.

Causes of perineal rupture after childbirth

Childbirth does not always go smoothly: sometimes the baby lies too low, he is too large, or the vaginal tissue is not elastic enough, which leads to injury to the perineum. If the perineum protrudes, changes color and begins to swell, there is a risk of rupture.

This complication during childbirth is considered the most common - 35% of women (especially during the first birth) experience a perineal rupture.

In addition to the main reasons that can lead to perineal rupture, secondary factors can also be identified. These include: rapid childbirth, scarring of tissue after previous ruptures (for repeat mothers), incorrect assistance with pushing.

Most often, ruptures occur when the baby's head emerges through the perineum. The baby, or rather his head, moves along the birth canal and begins to compress the veins located in it. The movement of blood becomes difficult, the resistance of the bloodless tissues of the perineum increases, which leads to rupture.

Types of breaks:

• Spontaneous - occurs during childbirth without any intervention;
• Violent - can be provoked by a certain action of personnel or interference in the course of childbirth.

During complicated childbirth, ruptures can first affect the vagina and then move to the perineum of the woman in labor. When ruptures occur, bleeding often occurs, which is aggravated if the pregnant woman suffers from varicose veins.

Ruptures after childbirth: prevention and treatment

You can avoid ruptures by carefully monitoring the birth process. At the first hint of the possibility of rupture, the doctor delivering the baby makes a decision on surgical intervention. To prevent ruptures, an episiotomy is performed, that is, a surgical incision in the perineum.

Indications for episiotomy:

• Possibility of perineal rupture;
• Green Waters;
• Post-term pregnancy;
• Breech presentation of the baby;
• Childbirth that began prematurely;
• Oxygen starvation in a child.

The perineal incision procedure occurs during pushing and no anesthesia is used when cutting the skin. After the baby is safely out, the woman gets stitches. If the vagina is torn, the muscle is sutured with special threads, which will dissolve on their own after a while. A stitch is made on the skin with threads, which must be removed after 5 days.

The junctions of tissues can become inflamed and swollen, so a woman is not recommended to sit down for about 8-10 days, with the exception of the toilet.

If outer seam If it turns red and oozes fluid, you should immediately consult a doctor for first aid.

How long does it take for internal sutures on the cervix to dissolve?

Internal seams are made using self-absorbing threads. Such threads are made from sheep intestines or large cattle. They are used for suturing the uterus after cesarean or cervix ruptures during childbirth. It is believed that 90 days are needed for complete resorption. The threads may fall off earlier, pieces may be noticeable on the underwear, but still you should not violate the terms prescribed by the doctor and follow the rules.

In the first couple of weeks after surgery to stitch up incisions (tears), a woman will experience discomfort; this is normal. Twitching, pulsation, aching may occur in the perineum. painful sensations. But if these sensations continue later, you should immediately consult a doctor.

Reason to go to the hospital:

• Heaviness in the uterus and vagina;
• Continuous pain;
• Purulent discharge;
• Temperature.

A woman who has given birth with internal sutures needs not only to monitor the hygiene of the perineum, but also to treat the sutures with healing ointment and disinfectants - chlorhexidine, potassium permanganate solution.

How ruptures occur during childbirth (video)

Failure to comply with hygiene and the rules prescribed by the doctor can lead to the fact that the sutures placed after childbirth may come apart. If the tissue junctions hurt, become inflamed, and fluid is released, you should immediately consult a doctor for treatment recommendations.

• How long does it take to heal
• How to care for seams
• What complications may there be?
• How to film

During childbirth, it is not uncommon for a woman to experience a rupture of the vagina, uterus or perineum. This situation is not difficult, because doctors skillfully and quickly sew up such tears, without paying special attention to it.

In fact, all this is very unpleasant. First, the sewing process is quite painful procedure. Secondly, stitches after childbirth can cause a lot of worries and troubles for a young mother. You need to know how to minimize and reduce them undesirable consequences there are no breaks. Proper postpartum care for these “battle” scars will largely depend on where they are located.

Species

Depending on where exactly the rupture occurred, there are external (on the perineum) and internal sutures after childbirth (on the cervix, in the vagina). They are made with threads from different materials, which means they require special care, which the young mother must be informed about.

Stitches on the cervix

• reason: large fruit;
• anesthesia: not performed, since the cervix loses sensitivity for some time after childbirth;
• suture materials: catgut, which allows you to apply self-absorbing sutures that do not have to be removed later; as well as vicryl, caproag, PHA;
• advantages: do not cause inconvenience, are not felt, do not cause complications;
• care: not required.

Stitches in the vagina

• cause: birth injuries, vaginal ruptures of varying depths;
• anesthesia: local anesthesia using novocaine or lidocaine;
• suture material: catgut;
• disadvantages: pain persists for several days;
• care: not required.

Stitches on the crotch

• reasons: natural (damage to the perineum during childbirth), artificial (dissection by a gynecologist);
• types: I degree (the wound concerns only the skin), II degree (the skin and muscle fibers), III degree(the rupture reaches the walls of the rectum);
• anesthesia: local anesthesia with lidocaine;
• suture materials: catgut (for I degree), non-absorbable threads - silk or nylon (for II, III degrees);
• disadvantages: pain persists for a long time;
• care: rest, hygiene, regular treatment antiseptic solutions.

A particular problem is caused by external sutures after childbirth, which are performed on the perineum. They can cause various kinds of complications (suppuration, inflammation, infection, etc.), and therefore require special, regular care. The young mother should be warned about this even in the maternity hospital, and also informed about how to treat such wound surfaces. Usually women have many questions about this, and each of them is very important for her health and condition.

How long does it take for stitches to heal after childbirth?

Every woman who has not been able to avoid ruptures is concerned about the question of how long the sutures will take to heal after childbirth, because she really wants to get rid of them as quickly as possible. painful sensations and return to your previous lifestyle. The speed of healing depends on many factors:

• when using self-absorbable threads, healing occurs within 2 weeks, the scars themselves resolve in about a month and do not cause much trouble;
• Much more problematic is the question of how long it takes for sutures to heal when using other materials: they are removed only 5-6 days after birth, their healing takes from 2 to 4 weeks, depending on the individual characteristics body and care for them;
• The healing time of postpartum scars may increase when microbes enter the wounds, so the ability to treat wound surfaces and monitor their cleanliness is required.

In an effort to quickly return to their previous lifestyle and get rid of painful sensations, young mothers are looking for ways to quickly heal stitches after childbirth, so that they do not interfere with them enjoying the joy of communicating with their newborn. This will directly depend on how careful the woman is and whether she competently cares for her postpartum “combat” wounds.

How to care for seams?

If ruptures cannot be avoided, you need to find out in advance how to care for sutures after childbirth in order to avoid complications and speed up their healing. The doctor must give detailed advice and tell you how to do this correctly. This is included in his professional responsibilities, so don't hesitate to ask. Typically, caring for sutures after childbirth involves sedentary lifestyle life, compliance with hygiene rules and treatment with various wound healing and antiseptic agents.

1. In the maternity hospital, the midwife treats external scars with “green paint” or a concentrated solution of “potassium permanganate” 2 times a day.
2. Change your pad every two hours after giving birth.
3. Use only loose natural (preferably cotton) underwear or special disposable panties.
4. You should not wear shapewear that puts strong pressure on the perineum, which has a bad effect on blood circulation: in this case, the healing of sutures after childbirth may be delayed.
5. Wash yourself every two hours, and after each visit to the toilet.
6. Go to the toilet at such intervals that you are full bladder did not interfere with uterine contractions.
7. In the morning and evening, when you take a shower, wash your perineum with soap, and during the day simply wash it with water.
8. You need to wash the outer scar as thoroughly as possible: direct a stream of water directly at it.
9. After washing, dry the perineum with blotting movements of the towel in one direction - from front to back.
10. Another important question is how long you can’t sit with stitches after childbirth if they are made on the perineum. Doctors, depending on the degree of damage, call the period from 7 to 14 days. In this case, you are allowed to sit on the toilet immediately on the first day. After a week, you can squat on the buttock opposite the side where the damage was recorded. It is recommended to sit only on a hard surface. This issue needs to be thought through when the young mother returns home from the maternity hospital. It is better for her to lie down or half sit in the back seat of the car.
11. There's no need to be afraid severe pain and because of this, skip bowel movements. This creates additional stress on the muscles of the perineum, resulting in increased pain. To make this process easier, you can safely use glycerin suppositories after childbirth with stitches: they are rectal and soften the stool without harming the wounded perineum.
12. Avoid constipation and do not eat foods that have a constipating effect. Drink a tablespoon before meals vegetable oil so that the stool returns to normal and does not slow down the healing process.
13. You cannot lift weights weighing more than 3 kg.

These are the basic rules of hygiene, which allow the young mother’s body to quickly recover and return to normal even with ruptures. But what to do if the stitches hurt for too long after childbirth, when all the deadlines have already passed, but it still doesn’t get any easier? Perhaps some factors provoked complications that will require not only additional care, but also treatment.

What complications can occur when suturing?

Very often, a woman continues to feel pain and discomfort even after two weeks after giving birth. This is a signal that something has interfered with healing, and this is fraught various complications- in this case you will need medical intervention, treatment, treatment of sutures after childbirth special drugs. Therefore, a young mother should be extremely attentive and sensitively listen to her own feelings, and monitor the healing process of postpartum injuries very carefully.

1. if the scars do not heal for a very long time, they hurt, but when medical examination no pathologies or special problems were identified, the doctor may recommend warming up;
2. they are carried out no earlier than 2 weeks after birth to allow the uterus to contract (read more about restoration of the uterus after childbirth);
3. For this procedure, “blue”, quartz or infrared lamps are used;
4. heating is carried out for 5-10 minutes from a distance of 50 cm;
5. it can be done independently at home after consulting a doctor;
6. Kontraktubeks suture healing ointment can also relieve pain: applied 2 times a day for 2-3 weeks.

The seam has come apart:

1. if after childbirth the seam came apart, it is strictly forbidden to do anything at home;
2. in this case, you need to call a doctor or an ambulance;
3. if suture dehiscence was actually diagnosed after childbirth, most often they are reapplied;
4. but if the wound has already healed, this will not require any medical intervention;
5. in such cases, after examination, the doctor will prescribe how to treat the sutures after childbirth: usually this is wound healing ointments or candles.

1. very often women complain that their sutures itch after childbirth, and very much so - as a rule, this does not indicate any abnormalities or pathologies;
2. itching is most often a symptom of healing, and therefore should not cause anxiety in a woman;
3. in order to somehow alleviate this unpleasant, albeit favorable symptom, it is recommended to wash yourself more often with water at room temperature (the main thing is not hot);
4. This also applies to those cases when the seam is pulled: this is how they heal; but in this case, check yourself to see if you started sitting down too early and if you have to carry weights.

1. if a woman notices unpleasant, abnormal discharge (not to be confused with the restoration of menstruation), bad-smelling and suspiciously brownish-green in color, this may mean suppuration, which poses a serious health hazard;
2. if the suture festers, you must tell your doctor about it;
3. This is how complications such as inflammation of the sutures after childbirth or their divergence can occur - both cases require medical intervention;
4. if infection occurs, antibiotics may be prescribed;
5. For external treatment, it is recommended to smear with Malavit shvygel, Levomekol, Solcoseryl, Vishnevsky ointments;
6. if the scars fester, only a doctor can prescribe what can be used to treat them: in addition to the above-mentioned anti-inflammatory and wound-healing gels and ointments, chlorhexidine and hydrogen peroxide are also used, which disinfect wound cavities.

1. if after childbirth there is sutureitis, most likely the basic rule was violated - do not sit during the first weeks: the tissues are stretched and the wound surfaces are exposed;
2. in this case, it is not recommended to treat the problem area yourself with something, but to contact a specialist directly;
3. alterations may be required;
4. but most often it is enough to use wound-healing ointments and gels (Solcoseryl, for example).

If the first days passed without complications and special difficulties described above, there will be one more procedure left - removal of sutures after childbirth, which is performed by a specialist in outpatient setting. You also need to mentally prepare for it so as not to panic and be afraid.

How are stitches removed?

Before discharge, the doctor usually warns on what day the sutures are removed after childbirth: in the normal course of the healing process, this occurs 5-6 days after their application. If a woman’s stay in the maternity hospital is prolonged, and she is still in the hospital at that moment, this procedure will be performed on her there. If the discharge occurred earlier, you will have to come again.

And yet, the main question that concerns all women undergoing this procedure is whether it hurts to remove stitches after childbirth and whether any anesthesia is used. Of course, the doctor always reassures that this procedure It just reminds me of a mosquito bite. However, everything will depend on pain threshold women, which is different for everyone. If there were no complications, there will actually be no pain: only an unusual tingling mixed with a burning sensation is felt. Accordingly, anesthesia is not required.

Childbirth is an unpredictable process, so anything can happen. However, ruptures are not uncommon and are not perceived by doctors as a complication or difficulty. Modern medicine involves professional, competent suturing after childbirth, which subsequently causes a minimum of discomfort with proper care.

» During childbirth

Stitches after childbirth

At the time of childbirth, situations often arise when perineal ruptures or internal organs, associated with the peculiarities of their structure or the size of the fruit. During natural childbirth or caesarean section, self-absorbing sutures are used. This is very convenient because they eliminate the further procedure of removing sutures, which is quite problematic given the area where they are applied.

Any woman in labor is interested in the question of how long it takes for sutures to dissolve after childbirth? The answer directly depends on the type of material used for the threads. If this is catgut - material plant origin, then resorption occurs quite quickly, taking no more than 15 days; if synthetic threads such as vicryl are used, then the process takes longer - about 80 days. Self-absorbing sutures after childbirth are selected depending on the location of the tear or incision. For example, in case of perineal ruptures, threads are applied that are more absorbable long time, since ruptures in this area take a long time to heal. For caesarean section or labia tears, catgut is more often used.

Healing of sutures after childbirth, when the perineum ruptures, occurs quite quickly, but may be accompanied by some problems. In order for the wound to heal successfully, constant hygiene, asepsis and rest are necessary. After visiting the toilet, you need to wash the seam with a weak solution of magnesium permanganate and dry it with light tangential movements with a special napkin. These measures must be carried out within a month after suturing. It is also worth abstaining from high-calorie and fatty foods, replace it with a lighter one that weakens the intestines, since the integrity of the sutures may depend on pushing during stool. In addition, women are not recommended to sit down in the first few days after childbirth. From regular treatment with antiseptic solutions, permanent shift sanitary pads and if it is necessary to apply sterile dressings, it depends entirely on how long the sutures take to heal after childbirth.

Self-absorbing sutures on the uterus and abdominal wall, applied after a caesarean section, are quite painful and therefore require painkillers. The seams on the skin also need to be constantly treated and any stress should be avoided. They will dissolve as the skin's integrity is restored. Internal sutures take longer to heal, from 30 days to 5 months. Resorption of aponeurotic and tendon sutures takes the longest time, since these tissues themselves take a long time to grow together.

When discharged home, doctors give each woman recommendations, in particular how and with what to treat sutures after childbirth, taking into account their condition and location. By following all the obstetrician's instructions, the risk of infection is minimized.

There is a recommendation from obstetricians, which many women in labor “forget” - if a woman has stitches after childbirth, then she should not sit for about 1.5-2 months. You can only lie down or stand. In extreme cases, for example, when you need to get somewhere by car, a “half-sitting” position is allowed. And no lifting more than the weight of your own baby, under any circumstances.

If the stitch hurts after childbirth for a long time, you need to see your doctor, this indicates an inflammatory process. After the examination, the gynecologist will make recommendations on what to apply to the sutures after childbirth to speed up their healing.

Post tags:

Not always postpartum period for a woman it turns out to be easy and cloudless. And it’s not just about caring for a newborn, but also about other problems. Serious discomfort can be caused by the consequences of tears and cuts, that is, internal sutures after childbirth. When do they heal? How soon should you see a doctor? These questions concern many women.

How do internal seams appear?

What causes internal seams? This is usually a rupture of the cervix, which can occur when natural childbirth. If a woman begins to push prematurely and her cervix dilates slowly, her tissue may tear. This type of premature pushing can occur in most women, which is why it is important to hold it until the cervix is ​​fully dilated.

Internal tears are not always noticeable, so it is important that after childbirth the doctor carefully examines the woman and applies stitches. This procedure, by the way, is painless, since there are no pain receptors in the cervix, and anesthesia is not performed. Sutures can be placed in several ways. Basically, special surgical threads (catgut or vicryl) are used for them, which subsequently dissolve on their own.

What to do with internal seams?

As a rule, a woman does not need to do anything with these stitches - they do not require any ointments, douches or tablets.

How long does it take for internal sutures to dissolve after childbirth?

Two factors play a role here: the material from which the seams are made, as well as the severity of the tear. On average, the threads completely dissolve in 90 days. Sometimes the fusion of damaged tissue occurs earlier, and the threads simply fall off. Their remains are then visible on the underwear. And if you do not experience any pain or other alarming symptoms, then there is nothing to worry about.

In order for sutures to heal faster, it is necessary to follow all the rules of personal hygiene. Diet is also important. The fact is that in this case, constipation is extremely undesirable, since unnecessary efforts can negatively affect the condition of the seams.

You also need to follow a few simple rules– you should not lift weights or make sudden movements (for example, playing sports) in the first weeks after childbirth, and you should also abstain from sexual intercourse for one or two months.

Should I see a doctor?

During the first few days after giving birth, many women experience discomfort in abdominal cavity. Pain and throbbing sensations may also occur. For the first two or three days this is quite normal phenomena. And if they continue further, then you should immediately consult a doctor.

Others alarming symptoms there will be pain in the area of ​​the suture, a feeling of heaviness in the uterus, sharp increase body temperature, as well as purulent discharge, accompanied by an unpleasant odor.

These are signs that either the internal seams have come apart or there are inflammatory processes. In any case, only a doctor prescribes treatment. These may be procedures using special ointments or antibiotics, re-overlay stitches or simply applying ice.

If nothing bothers you during the postpartum period, a preventive visit to the gynecologist should not be delayed either. The doctor must look at the condition of the scars, check whether there is any deformation of the uterus, or whether improper tissue fusion has occurred. All these problems can later develop into various diseases. Full recovery tissue loss occurs differently for each woman, but usually over a period of 3 to 6 months.

The other day, I was talking with a friend about episiotomy; she told me that it was better to tear during childbirth... I remember during my labor the doctor decided to do an episiotomy, then explaining that it was much easier to stitch up a cut than a tear, so I found an article about this)

WHAT DO YOU THINK?!

Unfortunately, injuries during childbirth are very common, and their frequency is significantly higher in primigravidas over 30 years of age. They are possible both in the perineum and vagina, and in the cervix. The most severe, deadly dangerous complication is uterine rupture during childbirth. If external injuries after childbirth are simply sutured, uterine rupture requires an emergency cesarean section, since it threatens the life of the mother, and the child can rarely be saved.

Perineal lacerations during childbirth

Perineal ruptures during childbirth are the most frequent injury women in labor. They occur in both primiparous and multiparous women.

The main causes of perineal ruptures: - large fetus - high perineum - rigidity (non-extensibility) of the perineum - inadequate behavior of the woman in labor, violent pushing and rapid labor - breech birth, incorrect insertions fetal head - inflammatory processes of the genital organs - swelling of the perineum during prolonged labor Damage to the perineum usually occurs at the moment of eruption of the fetal head, while possible problems easily determined visually by the midwife. The skin of the perineum turns pale and becomes shiny. In such cases, it is more correct and effective to perform a perineotomy or episiotomy, since cut wound It always heals better and faster than a torn one, and the scar turns out smooth. A perineotomy is an incision along the midline, from the vagina to the anus, an episiotomy is an incision to the side. An episiotomy is safer because with a perineotomy, continuing the incision may cause it to extend all the way to the anus. However, on the other hand, after perineotomy, suturing the incision leads to a better functional result; the anatomy of this area is much simpler. Damage to the perineum is classified into 3 degrees depending on its extent: - 1st degree is accompanied by involvement of only the vaginal mucosa and the posterior commissure of the labia. - Grade 2 involves the muscles of the vagina and perineum. - 3rd degree is accompanied by damage to the anus, and even the wall of the rectum. Such complications are always accompanied by bleeding, which is detected immediately after the birth of the child. After childbirth, the gynecologist examines the perineum and vagina for damage; if necessary, the wounds are sutured with catgut sutures, which are subsequently removed on the 5th day before discharge from the hospital. With inadequate suturing, the formation of a perineal hematoma is possible in the future, and unsutured ruptures lead to healing of the wound with a rough scar, as a result of which the woman suffers from problems in sexual life and during subsequent childbirth. Moreover, insufficiency may develop pelvic floor, and this leads to prolapse of the genital organs (uterus and vagina), which requires quite large and complex operations in the future. The stress suffered predisposes to a repetition of the situation during subsequent births. Sometimes it is necessary to make an artificial incision in the perineum even if there is no threat of rupture. This is done in the following cases:- premature birth. In such cases, a perineal incision (episiotomy) reduces pressure on the fetal head; it is not yet ready for this. - the need to speed up the second stage of labor in some cases somatic diseases mother (for example, with heart defects), or if the child is at risk (hypoxia in utero). - breech presentation. In a breech presentation, the baby's relatively large head compared to the pelvic end can make labor difficult. - surgery during childbirth, for example, vacuum extraction of the fetus.

Vaginal ruptures during childbirth

Damage to the vagina does not occur in isolation; it occurs in combination with the perineum or the walls of the uterus.

Cervical ruptures during childbirth

Occur at the beginning of the period of expulsion of the fetus. In almost all cases, it is the fault of the woman in labor herself. At the very beginning of the expulsion period, when the dilation of the cervix reaches 8 cm, and the head is pressed against the outlet of the small pelvis, there is a strong desire to push, but you cannot push until there is full dilation, 10 cm. If a woman does not listen to the midwife, and starts at this moment to push, the pressure of the baby’s head on the not yet ready cervix leads to inevitable pain. In this case, the same occurs high risk injury to the child. You need to breathe through these contractions and attempts, they are the most painful during the entire period of labor and require the greatest self-control. Typically, full dilatation occurs within 15-20 minutes, and these minutes decide the fate of your cervix.

Cervical ruptures

They are also divided by degrees. 1st degree - damage to the cervix on both sides no more than 2 cm long; 2nd degree - more than 2 cm long without extending to the vaginal vault. 3rd degree - extends to the vaginal vaults. Manifests itself in the form of bleeding after the birth of a child. Damage of the 3rd degree is often accompanied by accumulation of blood in the parametrial (peri-uterine tissue). Anesthesia during suturing is not required, since the neck does not have pain receptors. If the wounds are not sutured, ectropion (eversion) of the cervix, erosion and cervicitis may subsequently develop.

Uterine rupture during childbirth

Uterine ruptures during childbirth are very rare, but almost always result in the death of the child and can lead to the death of the mother. Usually occurs in the lower segment of the uterus. Causes of uterine rupture during childbirth: - large fetus, its incorrect presentation, which prevents birth. - availability narrow pelvis or other mechanical obstacles to childbirth. - poor scar on the uterus after a previous cesarean section. It is manifested by soreness of the uterus in its lower segment, and this pain does not go away between contractions; upon examination, the gynecologist discovers special threatening symptoms indicating overextension of its lower segment. The only possibility good outcome childbirth - emergency C-section. If this is not done, the woman feels “like something has torn inside” sharp pain, the clinic is developing internal bleeding, and the fetus develops acute hypoxia, leading to intrauterine death within minutes.

Treatment for ruptures during childbirth

After any birth, the doctor examines birth canal. All internal ruptures after childbirth are usually sutured without anesthesia, since the cervix is ​​not sensitive, external ones are sutured under local or general anesthesia, depending on their degree. Permanent sutures are placed on the cervix, in the area of ​​the vagina and vulva, too, and catgut or lavsan sutures are placed on the skin of the perineum, which are removed before discharge from the hospital. Everything is sutured in layers, restoring the correct anatomical relationships of the tissues. Treatment depends on the degree of complication. While the woman is in the maternity hospital, before the stitches are removed, the wounds are treated with brilliant green or 5% potassium permanganate, this is done once daily by a midwife, with serious damage and the risk of infection, antibiotics are prescribed. With pronounced pain syndrome Sometimes it is necessary to prescribe painkillers to reduce swelling; an ice pack is used. Usually you are allowed to stand up after childbirth within a day, but you will not be able to sit for about two more weeks, and you will even have to eat while standing. When you leave the maternity hospital, you will only be able to sit half-sided, on healthy side, and only for hard things. You will feed the baby in a lying position. It will be the hardest in case of 3rd degree damage. After childbirth, a slag-free diet (tea, juices, broths) is prescribed, since there should be no stool in the first days after childbirth. And only on the 7th day after the laxative it will be possible to go to the toilet in a big way, but pushing is prohibited. Until the stitches are removed, and then for at least a week, the perineum requires especially careful care; every time you visit the toilet, you need to wash it with running water from front to back, then dry the skin thoroughly. The pads need to be changed frequently, every hour and a half, the wound needs to be dry. Significant injuries that take a long time to heal may bother you for up to 3 weeks after birth.

How to avoid ruptures during childbirth How to prevent ruptures during childbirth?

Problems during childbirth are not always inevitable, with the help special exercises By massaging the perineum before childbirth, you can reduce the risk of any complication to a minimum. In most cases, problems arise due to the perineum being unprepared for childbirth, inelastic and inextensible.

Perineal massage

One of effective means Preparing the perineum for childbirth is a perineal massage. This is especially true for those who have already undergone a perineal incision in a previous birth; the remaining scar may be difficult to stretch. You can start this massage at any stage of pregnancy, but at early stages It is enough to do it once a week, and by week 32 you can do it once every 3-5 days. Immediately before giving birth, it can be done daily. If you are now close to giving birth, and you haven’t started massage, do it every three days for a week, every other week for another week, and then every day until giving birth. Best time for massage - evening, and best helper- your husband. It’s difficult to do on your own, your tummy will get in the way. Massage is done using natural oils, for example, olive or even just sunflower. Hands should be clean, wash them with soap, then lubricate the perineum and labia with oil. It is enough to insert 2 fingers into the vagina no deeper than 2-3 cm; they should be lightly pressed, rocking, on the back wall of the vagina towards the rectum; tingling and tension sensations indicate that everything is being done correctly. Rear wall tighten for 2-3 minutes and release, then repeat the exercise again, and so on for 5-10 minutes. At the moment of tension, you need to learn to relax, not pay attention to this feeling, this practice will be very valuable at the time of childbirth. At the end of the massage, the perineum is again treated with oil, the labia minora are massaged, they often tear during childbirth, and it won’t hurt to give them elasticity now.

Exercises to stretch the muscles and ligaments of the perineum

In order to do home exercises for the perineum, you do not need any special equipment. You can use a chair: - Stand next to the back of the chair, with your side to it, using it for support and balance. Raise and move first one and then the other leg to the side, to the maximum distance possible for you, 6-10 times. - From a similar position, bend your leg at the knee and lift it up to your tummy, 5-6 times for each leg. - Holding the back of the chair with both hands, slowly squat all the way, spreading your knees to the sides, spring up. Repeat 5-6 times or as many times as you can without special fatigue.

This exercise will require maintaining balance. Squat down, stretch your leg to the side. Shift your body weight first to one leg, then to the other, keeping your balance with your hands. Some poses should be made your usual ones. For example: - sit in a tailor's pose (crossing your legs in front of you) - butterfly pose, pull your heels towards your perineum, while in a sitting position, your knees in this position really resemble the wings of a butterfly. - use the “on your heels” pose in everyday life, stand on your knees, bringing them together, and sit back on your own heels. - you can diversify it by spreading your feet and sitting on the floor between your heels. - it is very useful to wash the floor while squatting, and simply squatting often. It is very important: you must be psychologically prepared for childbirth, you should not be afraid of anything, and you must listen carefully to the medical staff, even if it will be very painful and scary. Then the risk of injury for you and your baby will be much less.

Although childbirth is natural for a woman, it is not for nothing that doctors came up with a caesarean section. Babies are not always born smoothly, and even if the ultrasound specialist and obstetrician assure you that the dilation is complete and the baby is small, it is not a fact that it will not end in a rupture or crack. These wounds can vary in severity and are located in different places, and in any case they need immediate care from a medical professional. In general, here's another reason for you not to give birth in the bathroom.

In this article we will talk about the reasons for the appearance of such tears, methods of treating them, as well as the consequences of intimate wounds.

Tears in the perineal area

This injury occurs due to the pressure of the baby's head on the mother's skin and muscles during childbirth. As a rule, the culprit is the weak elasticity of a woman’s tissues.

There are several degrees of ruptures, differing in the depth of damage:

• 1st. The weakest. Small tears in area, from which only the skin and mucous membranes suffer.
• 2nd – muscles also tear.
• 3rd – the gap reaches the sphincter.

Seeing that the situation is about to end in rupture, the obstetrician can make an incision during childbirth (as they say, he will choose the lesser evil). In addition to the threat of rupture, indications for an incision are also considered to be incorrect (breech) presentation of the baby, as well as weakness or prematurity of the baby. As a rule, the incision is made at the height of the contraction, without anesthesia - during pushing, the woman will still hardly feel the work of the scissors.

How are tears treated? The gynecologist places sutures on the muscles and skin, and less often on the vaginal wall. There are two methods: the threads are either removed after 4-5 days, or they dissolve on their own (which is more convenient for the mother in labor - no additional “pleasant” emotions, moreover, there is no need to set aside a day for a visit to the clinic, placing the baby with the grandmother or spouse).

Consequences of ruptures: inflammation, suture separation. In this case, the wound takes longer to heal. In more difficult case The anatomy of the perineum may change - which is why you will be asked to visit a gynecologist some time after birth for a follow-up examination.

Vaginal lacerations

Sometimes birth occurs prematurely, or vice versa, with a slight delay, when the baby’s head freezes at one point for a long time. If bleeding suddenly started in the delivery room, or later the doctor discovered hemorrhage under the vaginal mucosa, this is just such a case.

Such wounds are “darned” with absorbable threads.

The wound can threaten the appearance of inflammation, less often - “fusion” of the uterus and rectum or urinary intestine, which is called a fistula. These complications require surgical intervention.

Cervical ruptures

Occurs with premature pushing, when the cervix has not yet fully dilated, but the pushing reflex has already “started”, the fetal head has begun to move “out”, literally breaking through all obstacles.

There are three degrees of depth of such gaps:

• First, the gap is less than 2 cm,
• Second, wound about 2 cm,
• Third, the damage affects not only the cervix, but also the uterus itself.

If the wound is small (about 1 cm), it is invisible to the patient. Deeper tears cause bleeding, which intensifies even more after the baby is born.

After the birth is over and the baby is placed on the mother's breast, the gynecologist will thorough examination uterus, examining the duration of the ruptures, and then suturing them with absorbable threads.

As with previous ruptures, damage to the cervix can result in inflammation. To avoid these unpleasant consequences(especially if the damage is large), the gynecologist may prescribe antibiotics to the woman in labor. And besides, if the stitches come apart (or they were not applied for some reason), the situation may be aggravated by inversion of the cervix, and then by pathology, damage to the mucous membrane. What is especially dangerous is that advanced cases this process can lead to the appearance of neoplasms (malignant).

If the sutures placed by the doctor come apart, the cervix may become “decorated” with isthmic-cervical insufficiency, after which the uterus will not be able to close as before. This is bad in any case, but if this is your first birth and you want to get pregnant again, it is worth remembering that with such an illness a woman cannot bear a baby.

If your labor ended in ruptures, take care of yourself! If you have a “darned” crotch, the gynecologist will forbid you to sit on the “fifth point” for up to ten days, so that the seams do not come apart. This is very inconvenient - you have to immediately lie down on the bed on your side, and feed the baby only while lying down...

But what can you do? On the 6th or 7th day you can already “land” a little on a loose fitball or swimming circle. And you may not be prohibited from using the toilet while sitting (check with your doctor).

Don’t forget the common truths: personal hygiene is worth its weight in gold! Take a shower (or remember to use a bidet) after every visit to the toilet. It’s also a good idea to arrange air baths for your poor “darned” body: after taking off your underwear, lie on the bed with your legs spread apart (a disposable diaper will protect you from leaks). In some cases, such “airing” is recommended to be done in the maternity hospital (you can throw a sheet over your legs).

Healing can be accelerated by ointment (say, Solcoseryl or Bepanten). If the tears are massive, you can apply a bottle of frozen water to the “darned” area; this “physiotherapy” will ease the pain. If the wounds, instead of quickly healing, begin to turn red, swell, the pain intensifies, and even pus appears, you need to stop self-medicating and put yourself in the hands of professionals from the residential complex.

Did your birth end in ruptures? Don't worry - this happens to many women, and these wounds are not dangerous to health. But even if you have a complication, listen to the recommendations of your doctor. This will help you stay healthy, and you will have many more children... If you want it, of course!