Perineal trauma during childbirth can occur naturally as tearing or may be intentionally created through a surgical incision known as an episiotomy. While once routine in many labor wards across Nigeria, modern evidence supports restricted use, performed mainly for fetal distress, shoulder dystocia, or instrumental delivery. Midwives must understand the classification of perineal tears to assist effectively:
Before any perineal repair begins, proper preparation ensures both comfort and infection prevention. Explain the procedure clearly to the mother using simple language, reassuring her while she remains in the lithotomy position. Ensure adequate lighting is focused on the perineum. Assemble a sterile instrument tray containing needle holders, dissecting forceps, suture scissors, and appropriate suture materials such as absorbable polyglycolic acid. Cleanse the perineal area gently with an antiseptic solution from front to back, maintaining a strict sterile field to prevent postpartum infection.
A midwife assisting with perineal repair plays a critical support role. You must manage adequate lighting, hand instruments to the operator safely, and monitor the mother's vital signs and emotional state throughout the procedure. Keep track of all swabs and needles used to ensure none are retained inside the vagina or wound. Anticipate the practitioner's needs by holding sutures ready and providing gentle suction or swabbing with sterile gauze only when necessary to keep the field clear of blood.
Good postnatal hygiene promotes rapid wound healing and prevents infection. Instruct the mother to wash her perineum gently with clean warm water from front to back after every toilet use. Advise her to change her maternity pads frequently, usually every four hours or whenever soaked. Emphasize that she should never apply harsh chemicals or unprescribed herbal concoctions directly to the fresh wound, as this causes irritation and delays healing.
Pain is expected following perineal repair, but excessive or worsening pain requires immediate investigation. Assess the wound regularly for signs of hematoma formation, excessive swelling, or localized infection such as foul discharge and spreading redness.
Accurate record-keeping ensures continuity of care and legal protection. Document the type of episiotomy or tear, the suture material used, the name of the practitioner who performed the repair, and how well the mother tolerated the procedure. Before discharge, provide clear education on pelvic floor exercises to improve muscle tone, signs of infection to watch out for, and when to return to the clinic for follow-up evaluation.