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Date: | Sat, 6 Jun 1998 01:53:46 -0400 |
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> "Apparently, the
> fact that I am still nursing is the cause for the slow healing and
> excess scar tissue..."
> --
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> 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
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