Does natural childbirth require surgery?

After becoming pregnant, women have to experience childbirth. The more common methods of childbirth in daily life are natural childbirth and cesarean section. Natural childbirth is through vaginal delivery, and cesarean section is directly performed through surgery. Some people think that whether it is a natural childbirth or a cesarean section, surgery is required. For pregnant women who have no childbirth experience, they can't help but feel particularly worried when they hear everyone talking about this.

Does a natural birth require surgery?

Generally speaking, the surgery required for normal delivery here usually refers to episiotomy, which is to ensure the baby is born as soon as possible and to avoid possible situations such as weakened fetal heartbeat and inability to rotate smoothly. It is a means to protect the fetus from danger. Episiotomy is usually performed to prevent perineal tearing and protect the pelvic floor muscles of the mother, and the surgical incision is easier to repair and heals better.

Suitable for the following symptoms:

1. In first-time head-presenting delivery, the perineum is tight, long, the tissue is tough or underdeveloped, there is inflammation, edema, or the perineum fails to fully expand during emergency delivery. It is estimated that a second-degree or higher laceration will occur when the fetal head is delivered.

2. Head-pelvic disproportion caused by various reasons.

3. Multiparous women who have undergone episiotomy and suture, or whose scars are large after repair, which affects the expansion of the perineum.

4. Forceps-assisted delivery, vacuum extractor-assisted delivery, or vaginal delivery for first-time breech presentation.

5. Premature birth, intrauterine growth retardation or intrauterine distress, in which case the pressure on the fetal head needs to be relieved and the baby needs to be delivered as soon as possible.

6. Mothers who suffer from heart disease, hypertension or other diseases and need to shorten the second stage of labor.

Episiotomy process

How to cut?

Timing of incision: When the doctor sees the fetal head about to appear from the vaginal opening, he or she will immediately judge whether the baby is big and whether it will cause severe perineal tear, and then decide whether to perform an episiotomy. If the doctor judges that the delivery is going smoothly and the tear is not large even if the perineum is not cut, surgery can be avoided.

Doctor's operation: Take the lithotomy position and use bilateral pudendal nerve block anesthesia. When the uterus contracts, the middle and index fingers of the left hand are inserted deep into the vagina to prop up the left vaginal wall. Use episiotomy scissors to cut the perineum from the back of the perineum to the left at 45° along the midline. However, if the perineum is highly bulging, the cutting angle should be 60° to 70° to avoid damaging the rectum. The incision is generally 4 to 5 cm. After the incision is made, gauze should be applied to compress and stop the bleeding. If necessary, clamps and ligatures should be used to stop the bleeding.

How long does it take: It does not take time to cut slowly, but it can be cut quickly and instantly with medical scissors. The length of the cut is only about 2-5cm, and it really feels like "a moment". When the labor pains are severe, some women may not even realize that the incision has been made.

Pain level: Since the incision is made at the peak of labor pain, the episiotomy is basically not felt. In addition, due to the effect of local anesthesia, there is no need to worry about pain during incision.

How to sew?

Timing of suturing: Repair surgery can be performed after the fetus is born.

Doctor's operation: Suture layer by layer according to the anatomical layers. Before suturing, flush the perineal incision with 0.2% metronidazole solution, insert a gauze roll into the vagina, and use No. 0 chromic gut to continuously suture the vaginal mucosa from 0.5 to 1.0 cm above the top of the incision to the inner ring of the hymen and tie a knot. The deep part should include part of the submucosal tissue. Similarly, the gut sutures the muscle layer intermittently to achieve the purpose of hemostasis and dead space closure. The subcutaneous fat tissue was sutured with interrupted intestinal sutures, and finally continuous intradermal sutures were made with No. 00 chromic intestinal sutures. When suturing the skin, insert the needle and tie a knot about 1.0 cm from the top of the incision. Then insert the needle downward along the skin edge on the left side of the incision and withdraw the needle 0.2 cm from the apex. Then insert and withdraw the needle along the right side with the same stitch length, symmetrical to the left side, which is a "U"-shaped suture. Make the skin edges on both sides of the apex fit tightly, then suture continuously intradermally along the skin edges of the incision on both sides with a stitch length of about 0.5 cm until the outer ring of the hymen is knotted. After suturing, perform a routine vaginal examination, remove the gauze roll and remaining gauze, and soak the gauze with 0.2% metronidazole solution and apply it to the wound. In this group of 520 patients who underwent episiotomy, all the incisions healed at grade A level.

How long does it take: It will take about 20 minutes. Of course, the time required may vary depending on the depth of the wound and the doctor. The local anesthesia during episiotomy is still effective, so the pain during suturing will not be very strong.