src Inkscape
On Saturday, I was on call duty from 8 am in the morning to 8 am the next day.
I managed to finish the call and attend to some personal duties because my senior decided to be understanding and allow me to pick up my fridge and attend to some of my unit activities.
To say the truth the call day was not so busy during the morning hours but that has not stopped some seniors from turning down requests like this. They say, "At any time a woman can come into the labor ward". That small occurrence can change a seemingly chill day on call to a day where you no longer have time to sit.
When the day ended I went to see a new patient and we had already seen 2 others. The night was becoming one where we wouldn't have time to sleep at all. I managed to sneak in 30 minutes anyway...
One patient who we had started ripening her cervix (so she would go into labor) finally went into labor.
This was after a woman who went for a pregnancy photoshoot came to be attended to and delivered in about an hour.
I missed the delivery because I was so sleepy and I begged the Matron (Chief Nurse) to let me know if there was another delivery.
Finally the case came
There I, was gloved up and taking my first delivery.
I did a vaginal examination with my fingers and felt the baby's head...It was stock between layers of muscle, skin, and epithelium. These were the tissue it would have to make its way through to be brought into the world.
As I watched this baby navigate through the vaginal opening I noticed just how big the head I felt was and I said immediately that this woman might sustain a perineal injury from this delivery.
The Perineum
The perineum is the area between the abdomen and the thighs that holds the pelvic and the pelvic organs (Such as the gonads and the bladder).
It has a bulk of muscle that forms the base of the basin that is the pelvis and is attached to the opening of the vagina and the anus.
When The Vagina tears
During childbirth, it is possible for the vigna and the muscle described above to get damaged as the head of the baby passes through.
If the process of tearing is left to take place it can cause an injury that the obstetrician doesn't desire and can be difficult to heal, so sometimes the obstetrician will actually make an artificial cut to the vagina and the muscles surrounding it.
This is called an Episiotomy.
Other times, because the tear is not anticipated, the tear can happen on its own in the process of birth.
Perineal Repair
After the baby had been born, and I gave birth to the placenta, I noted after the lochi and placenta blood had been cleaned up that there was a cut in the vagina.
I reported it to my senior who was just reporting for duty by 8 am the next morning.
My duty was over and I was supposed to be going home..but my senior said she was feeling too exhausted to do the repair and asked if the other House Officers who reported for duty wanted to do it.
They hesitated to answer and I jumped at the opportunity.
How to do a Perineal Repair
The first step in doing all medical procedures is to gain consent.
This could be in the form of a written document that is signed or in this case the woman keeping her legs open for the procedure to be done.
The woman is placed in a lithotomy position where her legs a kept suspended by stirrups or in the normal birthing position known as the dorsal position.
A very important aspect of the procedure is having a good light source. This is to ensure that the area is seen properly and properly sutured.
The tools for repair
Sterile pads are used to clean and block the upper part of the vagina so blood doesn't keep flowing from the uterus.
A syringe with lidocaine to infiltrate the area with a local anesthetic is also important to reduce the pain to the barest minimum.
Vicryl 2-0 is used as the suture material. It is absorbable and it is thicker than 3-0 which could cut tissue under tension or 1-0 which is generally too big for this procedure.
Needle holding forceps to make sure the suture material is easy to hold in place while suturing.
Fine suture scissors, toothed forceps, more pads, etc.
The actual repair process
The two ends of the vagina are put close to each other using continuous sutures. it serves to stop bleeding around the area and also allows for proper repair.
The suturing done for the vagina is like what you would do if you wanted to join to clothes side to side to each other while sewing...at least that was what I had in mind while watching from the sidelines for so long and that is what I did.
My senior said she was impressed for a first-timer how well I did, so...
The rest of the work is done by the vagina
The tissue of the vagina is sort of like skin, except it does not have keratin. The skin is keratinized and more so hair in the skin and the fingernails.
The vagina has an acidic environment to protect it, but its healing is similar to the way the skin tissue heals but with much less scar formation. The vaginal and skin tissue are constantly shedding and regrowing
As a side note, other tissue such as the Liver only regrows after an injury while nervous tissue can't regrow even in injury.
I hope you enjoyed this post.
Take home
I'm a badass...lol
The area of the body between the abdomen and the thighs is known as the perineum.
The organs in the perineum.
What the surgical tearing of the vagina is called...Episiotomy.
The procedure for a Perineal Repair, from content to closing the wound.
The similarities between the skin and the vagina.
The differences between the skin and the vagina.
The way other tissues heal differently from the vagina and the skin.
Thanks for reading!!
I hope to see you next time!!