Transfer
Pain relief for stitching
Method used to stitch
Pain relief after the stitching
Who does the stitching?
Both 3rd and 4th degree tears need to be repaired by a senior obstetric registrar or an obstetrician. In Australia, midwives, GP's (local doctors) and junior obstetric residents are not qualified to repair these types of tears with the skill that is required. If the tear extends into the bowel, some obstetricians ask a surgeon who specialises in bowel surgery to perform the repair (called a Colo-rectal Surgeon).
Transfer
Repairs of 3rd and 4th degree tears can be similar to having a minor operation. The surgeon needs good light and easy access to the woman's perineum and anus to repair them optimally. For this reason the woman needs to be lying down positioned in stirrups during the repair, with the caregiver using an examination spotlight to see the muscles and tissues clearly. For women who give birth in a birth centre or at home, the repair will require transfer to the hospital delivery suite or perhaps the operating theatre and at times a general anaesthetic may be used.
Image 6-76 shows a woman in stirrups.
Pain relief for stitching
Repair of a 3rd or 4th degree tear can take a while (30 to 60 minutes) and may be done using local anaesthetic, an epidural or a spinal (if you already have one in place) or a light general anaesthetic.
There is a volume limit to how much local anaesthetic can be used. So if the amount used is not sufficient to numb the whole area, it may be preferable to have an epidural or spinal (if you don't have one in place) or a light general anaesthetic. Some caregivers combine the use of local anaesthetic with the woman breathing on the gas. All these options depend on the extent of the tear, the effectiveness of the anaesthetic, the comfort of the woman and the caregiver's preferences.
Method used to stitch