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Kettle C, Hills R, Ismail K Continuous versus interrupted sutures for repair of episiotomy or second degree tears.Chichester: John Wiley and Sons; 2007

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Clinical practice: Perineal suturing

02 May 2017
5 min read
Volume 25 · Issue 5

Abstract

This article highlights the important midwifery skill of perineal assessment and suturing. Perineal trauma resulting from vaginal birth is the most common form of obstetric injury experienced by women, and can be associated with considerable maternal morbidity (RCOG, 2015). Midwives, being the lead practitioner for normal birth, should therefore be competent and skilled in the assessment and repair of perineal trauma. Providing a service which is evidence based and personalised as recommended within Better births (National Maternity Review, 2016) has a massive potential for positive impact upon a women's quality of life as she enters motherhood after vaginal birth.

It is estimated that 1 000 women per day will experience perineal suturing following vaginal birth in the UK alone (Kettle et al, 2010). The aim of suturing perineal trauma is to achieve haemostasis, minimise bleeding, reduce the risk of infection, and assist healing through primary intention and correct anatomical alignment, maintaining overall integrity of the pelvic floor.

Midwives must be mindful that perineal suturing can be a traumatic experience for some women and can have an impact on their psychological wellbeing (Green et al, 1998). Therefore, it is vital that midwives are adequately trained and able to provide each woman with clear information regarding the procedure to be undertaken, so she is involved with her own care (Table 1).

After the information has been clearly relayed, and consent has been granted, ensure the woman has adequate analgesia before proceeding with the assessment and repair. It has been suggested that inadequate pain relief or proceeding with the repair before permitting analgesic methods to have taken effect is often experienced by women (Sanders et al, 2002).

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