Refusal of suturing?

I was under the impression that some 2nd degree tears would heal on their own. My mentor left a woman the other day with one. Do they never heal?

Having done this subject (though with second degree tears) I know have a (ok, pretty limited still, I know) teensy bit of knowledge of the subject now. The evidence is pretty inconclusive atm, but the results of the PEARLS study should be interesting, with a large sample too. Most research suggests that healing takes longer when tears are left unsutured, but that pain is worse when the tears are sutured. Also that those tears left unsutured are 70% more likely to warrant referral for further repair (second degree tears)

There is some evidence to suggest suturing the muscle layer, but leaving the skin unsutured causes less postpartum pain and decreases the need for analgesia when compared with the fully sutured group. So haemostasis is maintained, the deeper parts of the tear are realigned and if the skin perineal tear is not bleeding it is therefore better to leave it unsutured.

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Thanks smwife, thats what I thought and what my mentor told the woman in question. Interesting topic though

This is one of those can of worms topics! Nice guidelines are quite comprehensive on the topic (http://www.nice.org.uk/guidance/inde...wnload&o=36275) but I have worked with midwives who have gently steered women towards declining suturing. I don't think I'd be too happy to do this - a bit of an abuse of informed consent when the evidence is for suturing for all but well opposed first degree tears.

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