> "Apparently, the
> fact that I am still nursing is the cause for the slow healing and
> excess scar tissue..."
> --
> ^*^*^*^*^*^*^*^*^*^*^*^*^*^*^*^*^*^*^*^*^*^*^*^*^*^*^*^*^*^*^*^*^*^*^
> Cindy Curtis , RN, IBCLC  ~ Virginia , USA
>
Dear Cindy and All,

My disclaimer: I'm Gail Hertz the pediatric resident who wrote the little
green breastfeeding book and I own Pocket Publications -

This post got my attention.  I looked up wound healing in my Rubin's
Pathology book 2nd edition 1988 and on page 90  under factors that
influence wound healing it lists:
Type, size, location;  vascular supply[more is better] ; infection[not
good]; movement[impedes healing in early stages]; ionizing radiation[bad];
and uv light[good]  as local factors

and under systemic factors it lists:  Circulatory status[good status
helps]; infection - again; metabolic states[poorly controlled diabetes is a
problem]; malnutrition[not good] and hormones[corticosteriods inhibit
inflamation - part of the healing process]  It mentions estrogen  and
androgens as influencing wound healing by affecting the metabolic status.

From experience - observation and personal - I find that a major player in
"how a wound heals" is the type of cut and method/skill of repair.  A wound
that heals by "primary intention" [with edges that are brought together by
stitches for example] generally heals faster and forms less scar than one
that heals  by "secondary intention" [by forming lots of granulation tissue
to bridge the gap between separated edges].
Surgical cuts with clean straight edges heal more neatly than jagged tears
- and the type and placement of suture material affects the end result as
well.

I would look more toward repair method and circumstances  than to the
hormonal changes brought on by breastfeeding as being the major influence
in episiotomy "healing" outcome.
I would also relieve mom of the "this is my fault" perspective - the
breastfeeding is best for both her and her baby.  She deserves praise for
breastfeeding that long in our culture - not "the rap" for the outcome of a
surgical repair that was done on her.

That's my perspective.  Gail. [taking the exam in July]
Gail Hertz, MD
Pediatric Resident - PennState Geisinger Health System

Pocket Publications
40 Mapheliah Road
York PA 17402-8214








heals