Caring for your perineum

Transcription

1 Feedback We appreciate and encourage feedback. If you need advice or are concerned about any aspect of care or treatment please speak to a member of staff or contact the Patient Advice and Liaison Service (PALS): Freephone (City Hospital campus): Freephone (QMC campus): From a mobile or abroad: ext or Minicom: pals@nuh.nhs.uk Letter: NUH NHS Trust, c/o PALS, Freepost NEA 14614, Nottingham NG7 1BR Caring for your perineum Maternity Unit This document can be provided in different languages and formats. For more information please contact: Labour Suite, Queen s Medical Centre campus Direct line: or Maternity Reception, City Hospital campus Tel: ext (24hrs) Parent information group, Maternity Units April All rights reserved. Nottingham University Hospitals NHS Trust. Review April Ref: 0759/v2/0411/CR.

2 This leaflet has been written in order to help you to understand how your perineum can be affected during childbirth and how you can care for it. What is the perineum? The perineum is the area of skin and muscle between the vaginal opening and the anus (back passage). ( Carolyn Hastie C/O Maureen D Raynor) 2 11

3 What if the pain does not get better or even gets worse? If you have pain that is severe or you think it is getting worse, then it is important that you tell your midwife or doctor. She or he will inspect your perineum, as pain may be a sign of infection, bruising or a haematoma, and treatment may be needed. If you would like more information on any aspect of care of your perineum, please ask your midwife or doctor. Further information The information in this leaflet is from guidelines which midwives and doctors use all the time. They are local and national guidelines, and are produced from research. Your midwife or doctor can give you more information should you require it. Further information is also available from: Nottingham University Hospitals NHS Trust website at Birth Choice UK website at National Institute for Clinical Excellence website at Royal College of Obstetricians and Gynaecologists website at NUH leaflet: Aromatherapy for mothers: guidelines & information (available on the website or ask a member of staff) What happens to my perineum during the birth of the baby? During the birth, the perineum stretches to make room for the baby and this will make the muscles and skin thinner. As the baby is born the perineum can sometimes tear. Tearing to the perineum or to the labia (the folds of skin around the vagina) is quite common and in most cases this will be straightforward and will heal very well. In a small number of women the tear will be more complicated, and will involve the muscle of the anal sphincter (the muscle that controls the passage of faeces) or the anal canal (the area just inside the anal sphincter). What is an episiotomy? An episiotomy is a cut in the perineum made by your midwife or doctor at the time your baby is being born. This helps the vaginal opening to become wider, allowing more space for your baby. An episiotomy is only made with your consent, and when the midwife or doctor feels it would be helpful. It is more likely that you will be offered an episiotomy if your baby needs to be born using forceps or suction (see the leaflet, Types of birth, which is available on our website at or on request from a member of staff). 10 3

4 What happens if my perineum tears during the birth of my baby? Although some small tears can be left to heal naturally, most tears will need to be sutured (stitched) and this will be done by your midwife or doctor soon after your baby has been born. It is important to make sure that you are not in pain as the stitches are put in. To prevent this, you will be given an injection of local anaesthetic (pain relief) before the perineum is repaired. If you have had an epidural during your labour, this will give you pain relief. Very occasionally, the suturing of a tear may be complicated, known as a third or fourth degree tear. These tears will need to be sutured by a senior doctor, and are usually repaired in the operating theatre. Your midwife and doctor will explain this to you should it be necessary, and you will see a member of the hospital team again between six weeks and three months later to check that your perineum is healing well. All the stitches dissolve after about seven days, so they do not have to be removed by your midwife. Are there any risks or complications if I have my perineum sutured? The most common complication of a perineal tear or episiotomy is infection in the stitches. In rare cases this can lead to the wound re-opening. When this occurs antibiotics may be required. Sometimes when this happens it is necessary to leave the wound open to heal naturally and occasionally to have the perineum re-sutured. Another rare complication is known as a haematoma. This is a collection of blood in the tissues which may be painful. What can I do to help my tear to heal? Keeping yourself healthy will help in the healing process; eating a good diet, drinking plenty of water and doing mild exercise will all help. Avoid constipation and straining on the toilet by eating a diet which includes plenty of fruit, vegetables and grains. Keep your perineum clean by having a bath or shower at least once a day, and change your sanitary towels regularly. Some women rely on adding salt to the bath water, but there is no research to show that this helps healing, therefore plain water will probably have the same effect. When you have used the lavatory, make sure your perineum is clean (use a bidet if you have one) and dry. Keeping your hands clean will help to prevent infection and encourage healing. If you have had a third or fourth degree tear you will have been prescribed antibiotics do make sure you complete the course of tablets and keep the follow up appointment which will have been given to you. Although sitting on a soft cushion can be comfortable, do avoid the use of cushion rings. These are not recommended as they may increase swelling, which can prevent healing. Pelvic floor exercises should be started as soon as you are able; your midwife will give you information and a leaflet. These exercises improve blood flow to the perineum, improve your muscle tone and help with healing. 4 9

5 Leave the compress in place for up to half an hour then remove and put a clean sanitary towel in place. Important points: Add only one drop of each chosen essential oil. Only three drops in total should be used (e.g. one lavender, one chamomile and one geranium). If you are using only lavender and chamomile, use only one drop of each. If you experience any stinging or burning, remove the compress and rinse your perineum with plain water. Essential oils must not be used neat on the skin. Ice pack/femepad Another helpful tip your midwife can give you is how to make and use an ice pack. It is very important that you do this safely, ensuring the ice is wrapped in a towel to avoid burns to your skin. You should not use the pack for more than an hour at a time, as this can reduce the blood supply to the area and slow down the healing process. An alternative to making your own ice pack is to use a femepad. These must be obtained from a chemist, and have been shown to be very effective. Can anything be done to prevent a tear? Tears occur naturally during childbirth, and are not usually possible to prevent. Not all women will have a tear, as in many cases the perineum can stretch sufficiently. However, most research shows that up to 70% of women having a vaginal birth will experience some tearing, but some of these tears will be small or will not need to be sutured. There is some research which shows massaging your perineum from 35 weeks of pregnancy onwards can prevent some tears. Sweet almond oil, wheatgerm oil or plain carrier oils can be used. Insert two fingers lubricated with the oil into the vagina, stretch the perineum and sweep the fingers along the length of the perineum. Only do this from 35 weeks, for five to ten minutes once or twice a day. Please ask your midwife for more information about this. What do I do if my perineum is painful after my baby is born? Although the perineum may be uncomfortable, or even painful for a few days after your baby is born, in most cases the discomfort has settled by 10 days. There are many ways you can help yourself to get comfortable, and your midwife can advise you. Different positions Finding comfortable positions for sitting or lying when you are breastfeeding will help, and you will find the most comfortable cushions and chairs. Pain-relieving tablets You can also take pain relief such as paracetamol or ibuprofen. 8 5

6 Aromatherapy Your midwife can advise you on certain aromatherapy oils which you may find beneficial and the ways in which they can be safely used. There are three different ways to use aromatherapy that may help you: bath, lavage and compress, BUT only do this if you are not allergic to any of the essential oils. Important points: When buying essential oils they must be labelled as pure essential oils. Some may be mixed already in a base oil such as almond or grapeseed please do NOT use these. You must wash your hands after adding your essential oils, so that you don t touch your eyes or your baby with neat oil. Essential oils that may help perineal discomfort are lavender (Lavendula angustifolium), chamomile (Anthemis nobilis) and geranium (Pelargonium graveolens). Bath Run the bath to the required temperature, putting in cold water as needed (do not add essential oils while the bath is running as they will evaporate and will be lost). Add a maximum of three drops to the bath (e.g. two lavender, one chamomile) and mix well to disperse (sitting on a neat big drop of essential oils may sting or burn), get in and enjoy! Important points: Do not add oils as the bath is running; they will evaporate and be lost. Do not add essential oils which are in a base oil ; these may make the bath slippery. Lavage Fill a small jug with warm or cold water and add three drops maximum of your chosen essential oil/s (e.g. one lavender, two chamomile). Mix well to disperse then sit on the toilet and slowly pour the liquid over your perineum. Dab yourself dry with tissue and wear a clean sanitary towel. Compress If your stitches feel tight or generally uncomfortable you can use a compress up to three times a day if needed. Use very cold water in a small basin/bowl (this may have been placed in the fridge for a couple of hours). Put one drop of each chosen essential oil into the water, up to a maximum of three drops in total. Mix the water well to disperse the essential oil then dip in a flannel, take it out and gently squeeze it to remove surplus water. Place the flannel directly next to the stitches or sore perineum and put a sanitary towel under so you don t get wet. You may feel a warm sensation; this is fine but if any stinging or burning is experienced then remove the compress immediately and rinse your perineum with plain water. This is extremely unlikely to happen. 6 7