What causes an internal rupture during childbirth

Puerperium knowledge: let birth injuries heal

(Advertising / affiliate links) Childbirth is a big challenge. It can also leave traces of different sizes physically. The puerperium is not only the time of arrival, but also the time when the mother's body recovers from childbirth and possible injuries heal. Most women feel a slight sore feeling after a vaginal birth because this area has been stretched and stressed. Although the birth hormones make the tissue pliable, small abrasions can still occur in the area of ​​the vagina or perineum.

In addition, it can also cause tear injuries in all areas that the baby passes through at birth. Most of the time, the cracks appear on the perineum or in the vaginal area. But they can also affect the labia or, in very rare cases, the clitoris. Injuries can also occur during childbirth in the deeper pelvic muscles, the sphincter muscle of the rectum and the cervix. Perineal cracks are divided into four grades depending on their severity. Third and fourth degree perineal injuries are serious birth injuries. They must be very carefully diagnosed, cared for and observed in their healing process in order to reduce the risk of later long-term consequences such as fecal incontinence.

The perineal incision (episiotomy) is also a birth injury. This was and is often used to avoid major perineal injuries. However, studies do not show that this approach makes sense. Sometimes a perineal incision is made in order to accelerate the birth process if there is danger to the baby, more often also in the case of births that are surgically terminated with a suction cup or forceps.

Birth injuries, large and small, take time to heal

Whether a perineal incision might be indicated can only be judged at birth. It is also important to use it cautiously and, of course, always with the consent of the woman giving birth. Studies show that the healing process of a perineal incision is perceived as more painful than a perineal tear. The concept of preventing major birth injuries or subsequent urinary incontinence with a routine perineal incision has not been scientifically proven.

How the injury is treated after the birth depends on its severity. The midwife therefore inspects the inner and outer vaginal area and the perineum after the birth. No sutures are required for abrasions. Even smaller cracks can heal without a seam if they are only superficial and no muscles are affected. In the case of bleeding or the wound edges lying asymmetrically on top of one another, a suture can also be useful in the case of rather small injuries. Sufficient numbing of the wound area before sewing is important. More extensive analgesia may be required for larger injuries.

Birth injuries, large and small, take time to heal. The postpartum midwife will observe the healing process and, if necessary, can pull the sutures once the wound has closed. Usually a suture that will dissolve itself is used. However, if threads or knots pinch or prick, removal can also be useful. Women who do not have a midwife to take care of their puerperium and who have problems with the sutures could visit a postpartum consultation (midwifery practices, clinics, family centers) or their attending gynecologist to have the healing process assessed.

Support the healing process

These measures support the healing process of a birth injury:

  • The most important thing is to take it easy and to relieve the wound area. Stress always takes place when people sit, stand or run. That is why it is particularly important to take the WochenBETT seriously and lie down a lot, especially in the case of birth injuries. For this it is of course important that you are relieved by your partner, other family members or friends when you have recently given birth. The support of a maternal carer is also really helpful. If certain requirements are met, this can also be requested from the health insurance company.
  • In order to avoid excessive tension on the wound, "closed" positions are useful. Breastfeeding in the cross-legged position with your legs apart is a rather inconvenient position. Try to avoid it, especially in the beginning. Primary wound healing takes approximately ten to fourteen days, but is ultimately an individual physical process. Perineal cuts and sphincter injuries usually take a slightly longer healing time. You should therefore be careful with the resilience of your scar tissue.
  • Rest as well as pressure and tension relief support the healing process. Breastfeeding in the side position or in the stomach-to-stomach position, while you lie relaxed on your back with your upper body slightly elevated, are certainly the most relieving breastfeeding positions. Sitting is actually always associated with pushing or pulling. This also applies if you pay attention to a very soft seat pad. Sexual intercourse puts too much strain on the wound area. Most women who have recently given birth do not need it anyway. But if you feel like it, wait until the wound has healed.

Mitigating measures

  • Often there is also small or large swellings or bruises (bruises) in the wound area. Hematomas change in size and color as the healing process progresses. Some women find cooling with arnica wound cloths on them, for example, very pleasant. You can also make these pads yourself by soaking a panty liner with prepared arnica essence and cooling it accordingly. However, there are no studies that prove the actual effectiveness of these supportive measures in terms of better wound healing. Nevertheless, many women find the cooling in particular soothing in the first few days. However, cooling measures should not be carried out for too long and always only when cold.
  • Also for hip baths there is no evidence that clearly confirms their effect. But here too, many women who have recently given birth find these measures beneficial and soothing. Sitz baths should not take too long, however, so that the wound area does not soften. In the case of injuries that have been sutured, it can make sense to wait two to five days, depending on the suture material. The water temperature should be around 37 degrees. Oak bark extract can be added as an additive. Dead Sea salt mixed with essential oils such as lavender, blue chamomile or yarrow is very beneficial. In the case of essential oils, however, too high a concentration can cause irritation in the wound area. These should be dosed carefully.

Douches and hip baths

  • Then an air bath in the wound area can support the healing process. To do this, you can simply lie down on the bed on a waterproof mat "down without". Regeneration sprays for the perineum area such as the “Recover Spray” by midwife Kareen Dannhauer also have a cooling and caring effect.
  • If a hip bath is not yet possible or desired, the wound area can also be rinsed. Sitting is not so comfortable for many women anyway. The wound area is often still swollen and a hip bath could possibly even make this worse. But regular flushing with lukewarm water every time you go to the toilet is very beneficial and also makes hygiene easier with regard to the weekly flow. In addition, the rinse dilutes the urine when urinating, which significantly reduces the burning sensation in the first few days. Bidets are also quite useful in childbirth, but of course you don't have to have one built in. A so-called butt shower is also very suitable for rinsing the intimate area. This allows you to gently and specifically shower the wound area.

reduce pain

  • Birth injuries can be quite uncomfortable and also very painful, especially in the first few days. Therefore, an appropriate pain medication makes perfect sense. It's not about getting back on your feet as quickly as possible and doing the household chores. You should get to know and enjoy your baby without pain. You should discuss with your midwife or doctor after the birth which pain medication makes sense in which dosage.
  • Taking pain medication is not a contraindication for breastfeeding. Further information on the use of drugs during breastfeeding can be found at Embryotox. If the pain, swelling, bleeding at the injury site or other abnormalities persist, you should always contact your midwife or gynecologist. Wound healing disorders or infections can of course also occur in the event of a birth injury.
  • Many women with a birth injury have some concern about having their first bowel movement. Adequate drinking and a diet that stimulates digestion ensure smooth stools. For example, linseed, dried fruit, wheat bran or pear juice have a stimulating effect. You should plan enough time for the first visit to the toilet. Forced pressing should be avoided. Some women find it helpful to support the perineal area from the outside with a hand roughly wrapped in toilet paper. In the case of major birth injuries, it may be advisable to use a stool-loosening drug that promotes bowel evacuation.

Relieve the pelvic floor

  • The pelvic floor is stressed by pregnancy and childbirth. This burden is even higher due to a birth injury. In general, however, it is important and sensible for all women to relieve the pelvic floor after giving birth and to strengthen its function with activating exercises. You can find tips and advice on everyday behavior that is friendly to the pelvic floor in the article “What does the pelvic floor need after the birth?”.
  • Every woman wants an injury-free birth. The postnatal discomfort caused by a birth injury can be not only physically but also emotionally stressful. Pain or problems with holding urine or defecating after giving birth can significantly reduce the wellbeing in the puerperium. Perhaps you are also worried about how the birth injury will affect your later continence or your love life.

Take any thoughts or worries seriously and discuss them with someone. This can be the midwife or your gynecologist. In the event of persistent complaints or complications, there are also other specialized contacts such as the doctors and therapists in a so-called pelvic floor center. With regard to another birth, the injury you suffered may be an important topic that you should discuss with suitable specialists.

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