RE: [ozmidwifery] when to cut an episiotomy

[Mary Murphy]

Buttonholing  is when the baby’s head stretches the perineum to the point of splitting before it tears at the vaginal opening.  Ie closed at the vagina, closed at the rectal end and split in the middle, like a buttonhole.  It can (and did) cause delayed healing because of the “blanching” of the skin. (no circulation)  It can also extend to 3rd and 4th degree tears because the vaginal opening holds firm.  That is a simple explanation.  Others might have a more concise one.  Sue, it would be good to learn to suture the tears yourselves. It is an essential midwifery skill. Get Chris White from KEMH to do a professional development day.  She does our updates every year.  Otherwise it is obvious that Obs find episiotomies easier to stitch than tears because they are so used to the straight edge.  It stretches their skills a bit to do tears.  Surely there should be less repairs all round?  MM     Not entirely sure I want to know, but Mary what is "buttonholing"?