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Learning to Suture

Jul 12th, 2011 Training

Midwives are protectors of the perineum, even as students.  I have to admit, the few times I’ve found tearing I’ve cringed. It means I didn’t keep a mother intact, and my goal is to keep the mother intact. Which means I don’t have much experience with suturing – but I still need to learn the skill.

But it turns out learning to suture is more than learning about how to hold the needle.  It means I need to be able to identify what tissue needs repair, and what the best way to handle that repair would be.  With the limited experience I get, I need to make the most of every opportunity.

Truthfully, midwifery school wasn’t very helpful in this respect.  The teachers showed us the basic repair, instrument ties and one handed ties, then we practiced on chicken breast. But a perineum doesn’t look anything like a chicken breast. I knew what I was seeing was a tear, but apart from telling you where it was located I couldn’t really explain much more about it.  So I decided to spend some extra time on the subject.

I purchased Anne Frye’s Healing Passages.  I have to admit I find her use of the term “Yanni” for vagina a bit distracting.  But so far I am learning alot from the book.  Despite her insistence that it is important to learning , I am not moving from beginning to end. I don’t have the patience for that because I may need to use my new assessment and suturing skills at any time.  If I had known about the book earlier, I think it would have been valuable to read according to her suggestion. And if I get a chance to study it again, I may do that.

What I love:  Goes very into detail about how to assess for tears; how to determine the extent of tears and how to find the apex.  It also gives great detail about how to repair different types of tears. It really is a great deal of information for the $75 I paid.

What I don’t love: The spiral binding started to come apart the first time I read the book. It’s long with a lot of information I didn’t need (may be because I’ve already been suturing, have nursing training or because I simply don’t know enough to know I’d better study that yet). But as I said, I may be thankful to review the whole book as one when I have more disposable time.

I also purchased a practice suture kit from Amazon and some foam from a local craft store.  I practice ties, I practice holding the suture and I practice making even stitches and deep stitches. I do think the foam I bought is too heavy, but hopefully the skill will transfer.

I still don’t feel “ready” to be suturing on my own, but this method does seem to be building my confidence in my ability to identify the need for suturing and managing a repair.

One of my preceptors shared that in one hospital she worked at, the doctors were made to practice suturing on peaches.  Once I get a little better, I might just try that.

 

 

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Jennifer Vanderlaan CNM MPH is the author of the BirthingNaturally.net website. She has been working with expectant families since 2000, training doulas, childbirth educators, and midwives. She has worked with midwives in Central America and Sub-Saharan Africa. Her interest in public health grew in 2010, and she is now a PhD student learning to become a producer of knowledge.

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