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Healing Times

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

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Healing Times

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  1. Healing Times Barbara Hastings-Asatourian

  2. 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

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

  4. 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

  5. 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

  6. 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)

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

  8. 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

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

  10. 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

  11. 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)

  12. 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

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