Katlyn Carter

(Updated 3/13/19)

Perineal Laceration Repair Informed Consent/Refusal

Definition of treatment:
In the event of a perineal laceration, repair is sometimes recommended depending on the severity
of the laceration. Repair may include, but is not limited to, the use of suturing materials for
stitching tissues together to better approximate them for the best possible healing situation.

Risks/benefits:
Risks/Benefits of suturing/repair:

 Infection
 Allergic reaction (to anesthetic, suturing materials, etc.)
 May increase healing time due to introducing drug and foreign product
 May be an uncomfortable procedure
 Aids with anatomically correct healing
 Decrease risk of pain following healing, especially pain associated with intercourse

Risk/Benefit of not suturing/repair:

 Urinary incontinence (fecal incontinence if the laceration extends to the anal complex)
 Pelvic organ prolapse
 Pain with intercourse
 Infection

Basic procedure:
Assessment, care, and repair of laceration damage from childbirth is routinely recommended and
performed for the benefit and health of healing and your long-term pelvic health.

Contraindications:
Sutures may be contraindicated in the event of history of severe allergic reaction to suturing
anesthesia or materials.

Alternatives for care:

Alternatives may include the following:

 Skin adhesive
 Seaweed adhesive (nori)
 Katlyn Carter
(Updated 3/13/19)

Provider scope of practice:

My midwife is not able to suture severe perineal lacerations involving the anal sphincter complex
and a severe laceration (3rd and 4th degree) is best repaired at a hospital.
Client choices: (circle one)

 I consent to perineal repair as my midwife recommends, including suturing.

 I consent to alternative repair method
o Tissue adhesive
o seaweed
 I refuse perineal repair.
 I consent to transfer for repair.

I acknowledge I have been given the materials and verbal education regarding options for
laceration repair. I have been given the information regarding the purpose of repair, and
anesthesia, the procedure, any alternative treatments options, and the necessary diagnosis and
follow-up. I understand the risk and benefits of laceration repair. I have had time to ask
questions, and do my own research, as I desire, regarding the recommendations.

I have read and understand the content of this Informed Consent. I take responsibility for all
outcomes.

Client (full name) _________________ Signature: ________________________ Date: _______

Other (full name) _________________ Signature: ________________________ Date: _______

Midwife ________________________ Signature: ________________________ Date: ________

References:

Frye, A. (2010). Healing passage: a midwife's guide to the care and repair of the tissues involved in birth. Labrys Press.

Gilpin-Blake, D., & Elliot, S. (2001). A natural alternative to suturing. Midwifery Today, 32-33.

Mota, R., Costa, F., Amaral, A., Oliveira, F., Santos, C. C., & AYRES‐DE‐CAMPOS, D. I. O. G. O. (2009). Skin adhesive
versus subcuticular suture for perineal skin repair after episiotomy–a randomized controlled trial. Acta obstetricia et
gynecologica Scandinavica, 88(6), 660-666