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Suture Beats Stitches for Tears During Childbirth

Study finds women report less pain than with conventional method

THURSDAY, June 27, 2002 (HealthDayNews) -- A continuous suture to repair perineal tears during labor is less painful than the conventional interrupted stitching method used to close the wounds.

The study, appearing in this week's issue of The Lancet, showed that women who received the one-thread stitch were about half as likely to report pain 10 days after delivery, and were much less likely to need the absorbable sutures removed three months later.

The perineum is the area between the vagina and the rectum, and it rips in nearly 90 percent of women during labor as the baby's head moves through the birth canal. What to do about these tears -- which require sutures in about 70 percent of cases -- is a matter of hot debate in the obstetrics community.

Some doctors advocate a surgical cut, or episiotomy, to make the wound clean and easier to sew up. Others argue that leaving it ragged encourages better healing. The natural camp appears to be winning the battle, at least in the United States, where the rate of episiotomies has plummeted in recent years.

The advantage of the continuous stitch is that it heals better by eliminating knots that present pressure points along the wound, says study author Chris Kettle, a researcher at North Staffordshire Hospital in Stoke on Trent, England. And it's less uncomfortable because the relatively loose sutures run deeper in the tissue, away from the sensitive nerve endings that lie near the skin's surface. The technique takes a little longer to perform, but it requires less thread in the process.

Kettle, who is using the study as part of her doctoral thesis, and her colleagues compared the two suture methods in 1,542 pregnant women who incurred spontaneous, moderately severe tears of their perineum during delivery. Half received interrupted sutures and half a continuous stitch. Within those two groups, some were sewn with a newer, rapidly absorbed thread while the rest received traditional absorbable stitching.

Some discomfort after the procedure followed for many women. However, those given the continuous sutures were much less likely to be in pain two and 10 days after delivery than were those who received interrupted stitches. They reported less pain walking and sitting and in performing other daily functions.

They also were far less liable to need their stitches removed -- 3 percent versus 12 percent. Neither group was more likely to report pain during sex three months after labor.

The newer suture material proved superior to the conventional variety, causing no more pain or discomfort during sex and requiring removal only a quarter as often.

Switching to the continuous stitch could prevent pain 10 days after perineal repair in one women in six, Kettle says. Using the newer sutures could avoid having to remove the stitches three months later in one women in 10.

Nancy Fleming, a nurse at the University of Illinois-Chicago, was influential in popularizing continuous sutures for perineal tears in this country. Fleming agrees with Kettle that the technique, which was invented about 70 years ago, is easier to perform, causes less pain and uses less thread than traditional wound repair. "Patients can walk better sooner and have less discomfort," she says.

However, professional obstetrics organizations, such as the American College of Obstetricians and Gynecologists and the American College of Nurse-Midwives, haven't taken a stand on either method. Instead, Fleming says, the choice of what approach to use is up to individual doctors and midwives.

Fleming says the continuous stitch is the only technique she uses, although she would make an interrupted suture if a woman suffered a third-degree tear in which her rectum was compromised. So far, she adds, that hasn't happened to any of her patients.

What To Do

For more on perineal tears and trauma during labor, try gentlebirth.org, Childbirth.org, or Pregnancy Today.

SOURCES: Chris Kettle, Ph.D. candidate, North Staffordshire Hospital, Stoke on Trent, England; Nancy Fleming, Ph.D., instructor, department of maternal-child nursing, University of Illinois-Chicago College of Nursing; June 29, 2002, The Lancet
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