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Re: Episiotomy/lacerations From: charlie chambers (cchamber@mnic.net) Tue Jan 12 21:54:41 1999 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: charlie chambers: "Re: Patients who can't take estrogen - what are you using to treat" Previous message: Cheryl McLaughlin: "Re: Patients who can't take estrogen - what are you using to treat" Maybe in reply to: James Connerth MD: "Episiotomy/lacerations" Next in thread: W. Brown: "Re: Episiotomy/lacerations" Agreed that delivering without episiotomies, means learning to manage the perineum with any efforts and maneuvers possible. I do a combination of stretching, massage, and careful guidance of the head with a Ritgen manuever, and careful delivery of the posterior shoulder. Rarely do I get the periurethral tears, and even less often do they need suture. I usually find it easier to apply some pressure and achieve hemostasis, unless I need to reapproximate distorted anatomy. Also, without an episiotomy is a the best chance for a patient to walk away with an intact perineum. I've been surprised with how many times, my judgement suggests that the patient will have a laceration, only to end up with a small nick, or no laceration at all. Appreciate the response to the question of suture. Seems that most of us use what we were trained with and were told was less "reactive". On cesareans, I use Biosyn which handles like chromic but reputed to be less reactive. But I'll be honest, I am unencumbered with data. In the vagina, I like using the vicryl rapide especially for any lacerations. -- ############################################################################ Charlie Chambers, MD "No matter where you go... Owatonna Clinic-Mayo Health Systems there you are." cchamber@mnic.net chambers.charles@mayo.edu Dr. Buckaroo Banzai ############################################################################ ---------- >From: elishyde@connix.com (Betsy Hyde) >To: Multiple recipients of list <ob-gyn-l@talk.obgyn.net> >Subject: Re: Episiotomy/lacerations >Date: Tue, Jan 12, 1999, 10:12 PM > > >> >>NOW---how does one "manage" the perineum?I know some have advocated >>almond oil massage begining around 36 weeks----- >> >>-- >>JConnerth md facog > > I agree w/ Deborah. I don't do any massage or ironing of the perineum. I > avoid directed pushing as much as possible....causes too much perineal > edema. If an epidural, I don't do any pushing until the head is well down. > I try to keep the legs/hips adducted, rather than abducted or flexed up by > her ears.. I think this puts less tension on the perineum. I think > side-lying position results in better perineal outcomes, but position of > birth is such a cultural thing....and most women around here are reluctant > to do sidelying or hands-knees. My hand positions are as she described, and > I also sometimes rock/flex the head gently back into the vagina a small > distance to get some blood flow to the perineum. I do use a perineal > massage oil of olive oil, calendula, St. Johns wort, vit E and apricot > kernal oil when the head starts to distend the introitus and, according to > my record keeping over the past several years, it has definitely improved > my perineal outcomes. > > Betsy Hyde CNM > Branford,CT > Next message: charlie chambers: "Re: Patients who can't take estrogen - what are you using to treat" Previous message: Cheryl McLaughlin: "Re: Patients who can't take estrogen - what are you using to treat" Maybe in reply to: James Connerth MD: "Episiotomy/lacerations" Next in thread: W. Brown: "Re: Episiotomy/lacerations"

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