Healing Times Barbara Hastings-Asatourian

Pregnancy, childbirth and the post natal period These periods bring enormous changes in physical, mental, emotional, social and spiritual terms Hormonal changes bring about adaptations to body shape and function irrespective of surgical interventions When surgery is then super-imposed a number of additional considerations are required This presentation will focus on episiotomy and Caesarean section

Outline of session The procedures The structures affected by the procedures The Healing Process Factors contributing to healing

Episiotomy A surgical incision into the perineum between the vagina and anus. Sometimes performed during the second stage of labour (‘pushing’ stage) Prior to instrumental delivery (forceps, vacuum) to widen the vagina

Caesarean Section A surgical procedure to open the abdomen, separate the muscles and lower segment of the uterus to deliver a baby cannot be born vaginally. (LSCS) May be Elective (planned) e.g. in dysproportion Or Emergency e.g. in foetal distress

Types of Healing Wounds heal by Primary intention (closed by sutures, needs little new tissue) Secondary intention (new tissue fills the damaged area and is covered by new epithelium)

Deeper tissues affected by episiotomy (and tears) Beneath the skin and fatty layers, superficial and possibly deep pelvic floor muscles

Basic physiology of healing  A number of different processes contribute to healing  Blood Clotting ( platelet activity)  Inflammation (production of cytokines from white blood cells)  Granulation (fibroblasts and new blood vessels)  Increased blood supply  Contraction of the scar  Migration of epithelial cells over granulation tissue

Healing times Three overlapping phases Inflammation Proliferation –granulation –angiogenesis –epithelialisation Maturation (7-100 days)

Returning to exercise Every person is an individual Dependent on type of class/activity Screening Post partum blood loss? Sutures (dissolved or removed)? Infection? Involution? Wound healing? Pain? Rec check

Factors affecting the rate of wound healing Blood supply (O²) smoking, diabetes, shock, swelling, trauma, anaemia Dietary factors malnutrition, eating disorders, inflammatory bowel disease, vitamin deficiency Infection dead tissue, excessive suture material, location of wounds (anus, skin creases) Drugs (POM and recreational) e.g. Steroids (lower resistance to infection), Tobacco (CO)

And finally…... to stimulate healing From day 1, mobility and changes of position, flexion and pointing of feet ( prevention of thrombosis) ‘Normal’ well balanced eating to accommodate both breast feeding and demands of healing. Extra fluid - avoid constipation (straining) Breathing effectively (to increase supply of 0² to damaged tissues) Deep transversus abdominal and back work - pulling in, correcting posture, engaging lats Pelvic floor exercises - slow and fast twitch (improves perfusion) Relaxation, massage, other alternatives