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Wednesday
Jun112008

One Dose of Antibiotics...

...can prevent postpartum pain and infection in 3rd and 4th degree tears (and episiotomies?).

A combined Stanford University, Packard Children's Hospital and Santa Clara Medical Center study shows that one dose of intravenous antibiotics can greatly reduce the infection or breakdown of tissue that can cause repurcussions such as bowel incontinence and sexual dysfunction.

"The researchers found that four of 49 patients (8.2 percent) treated with antibiotics and 14 of 58 patients (24.1 percent) who received the placebo showed symptoms of infection or breakdown two weeks after the repair."

The study is thought to transform the postpartum regimen for women with the deeper of the tears that can occur through birthing.

Because we all want to avoid antibiotics as much as possible, lets hope this doesn't just change the actions of physicians, but also women who will find ways to minimize tearing - including not pushing while the staff hollers to 10 (Val Salva/purple pushing), positioning that doesn't have a woman on her back with her legs in stirrups and keeping the providers' hands OFF the perineum as the baby is being born.

Wishful thinking, probably, but one can hope, right?

Reader Comments (5)

What exactly is meant by "hands off perineum"? meaning, right as the baby is coming out, or altogether during the birth process? I distinctly remember my midwife doing perineal massage while I was pushing my daughter out. She was born in 17 min with no tears (just what MW called "more like an abrasion" not requiring any sutures). Is perineal massage not recommended anymore?

June 11, 2008 | Unregistered CommenterAnonymous

I guess there's no answer to this question (from my previous post)? Is perineal massage no longer recommended? What is meant by "hands off perineum"? Thanks, Jen

June 17, 2008 | Unregistered CommenterAnonymous

Oh, sorry, Jen! I meant to answer, just hadn't. Thanks for asking again.

Hands-off means just that. The midwife allows/encourages the woman to have her autonomy, even during the actual birth.

What I've found is the more someone touches/annoys/manipulates the perineum and vulva, the more a woman swells and subsequently tears.

I find that women push until it hurts, hurts... and then they stop pushing, allowing the perineum to stretch slowly, but surely. When the burning/hurt slows or stops, they begin pushing again... until they feel the need to stop pushing again, once again allowing the perineum to stretch.

One of the best reasons to have a baby in the water is the midwife can't do much -if anything- to her bottom. While I have had a woman tear while birthing in the water, I believe it would have been much worse had someone been manipulating the actual delivery.

Now, *some* women LIKE to have perineal support or even fingers in the vagina to show them where to push and I help women along when they get their needs met. A woman struggling to find where to push (these women flail, cry, bug their eyes and cheeks out for many contractions, etc.) can find great solace in having some guidance. But, once they have the idea, it's great to allow them their space to continue on their own.

Perineal massage is SO unnatural and SO damaging to the perineal tissues, it irks me no end to know some childbirth methods (namely Hypnobirthing) teaches it. Women HATE it (for the most part) and I would much rather see couples enjoy their time before the baby comes instead of fighting about painful homework. The best "perineal massage" is intercourse or sexual interactions that include penetration. Doesn't that sound like more fun than "stretch the tissue *just* until it burns and then release... continue until she tells you to stop." Aargh! How boring and damaging to the poor body.

Does that help explain things some?Sorry I didn't answer sooner! Thanks for your patience.

June 17, 2008 | Unregistered CommenterNavelgazing Midwife

Thanks for answering. I never did the PM called for by hypnobirthing (although I did read the book and listen to the cds). I wanted a drug-free birth, but I was progressing really fast, and my contractions were one on top of another so I ended up with an epi- I was physically exhausted by 6 cm. and had an hour long contraction by the time I actually got the epi at 8 cm. It didn't take on my left side, and the doc gave me another bolus and put me on a pump, which made me completely numb (not what I wanted). When it came time to push, I couldn't feel a thing. So I asked for the pump to be shut off, and I labored down until I could feel enough to effectively push. I remember my midwife doing PM for a few minutes while I was pushing. My daughter was born in 17 minutes and I required no stitches. I always thought PM was recommended as a way to prevent tearing, but I guess things change! This is funny because I was having a conversation (well, several) with my mother over how much has changed in maternal and pediatric care since I was a baby. ("what, no episiotomy? They *don't* knock you out any more? How is breastfeeding any better than formula? Its all so much propaganda, don't you know! You're seeing a mid-WHAT? You need to see a real doctor, not some witch!" and on and on, my mother is a riot!) I guess its my turn to be a little shocked at all this "new-fangled" science! Thanks for explaining this to me, Jen

June 18, 2008 | Unregistered CommenterAnonymous

This was my response to ACOG and the AMA in Song, I thought you would appreciate.

http://www.youtube.com/watch?v=2pN58kf3Ims

June 21, 2008 | Unregistered CommenterDemetria

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