Wound dressings and drains
The most common types of wounds encountered by midwives are perineal and caesarean section wounds. Perineal tearing is classified as a traumatic wound, whilst episiotomies and caesarean section wounds are classified as surgical wounds. Due to the positioning of perineal wounds, dressings are not applied but the perineum is observed throughout the postnatal period to ensure that healing is taking place and infection does not hamper the healing process.
In order to identify deviations from normal healing with regards to wound management and an understanding of the physiology of the healing process is essential. Healing involves a complex and systematic chain of events which, whilst divided into phases, often overlap. This process is outlined in Chapter 67. In midwifery care, most healing occurs by primary intention after successful suturing.
Wound dressings are used to mimic the properties of skin by providing a clean, protective barrier and removing exudate from the area. These properties are all conducive to the healing process. Work carried out by Winter in the 1960s has led to many criteria being suggested as to what constitutes an ‘ideal’ dressing (Box 68.1).
Dressings may be removed 24 hours postdelivery, with assessment of the wound for signs of infection, although, in practice, some will leave wounds covered for between 5 and 7 days and observe the external dressing surface for signs of excessive exudate. Due to the short-term nature of the dressing and lack of evidence surrounding choice of dressing, often the dressing used is dependent on the opinion and preference of the surgeon involved; therefore a variety of different dressings may be encountered.
Table 68.1 gives some of the common types of dressing. It is essential that decisions regarding dressing choice are made on an individual basis to ensure best care for the woman. Negative pressure wound therapy may be useful for managing some wounds.