Introduction
Expectant women can have their pubic hair shaved using a razor (perineal shaving) on admission to labor wards. Shaving is one of the routine procedures of delivery in some countries around the globe (Mangram et al, 1999). Clipping using electronic clippers has also been common, especially for women undergoing caesarian sections. The two procedures have been in existence for several years, allegedly because they contribute to high levels of hygiene during childbirth. Some scholars and physicians argue that clipping is far much better than shaving. On the other hand, critics argue that these are procedures whose time is long gone, and have no clinical benefits.
Evidence-practice (Pros and Cons)
Hair removal is done by physicians as a necessary procedure when performing Pfannenstiel skin incisions. It is essential to improve hygiene, but several studies reveal that it enhances the risk of surgical site infections (SSI). In a 2011 Cochrane review of incidences of preoperative hair removal, three subsequent trials revealed an increased risk of SSI with shaving as compared to clipping (Tanner, Norrie & Melen, 2011). Shaving enhances bacterial growth through the microscopic skin abrasions that arise out of shaving. Thus, clipping is preferred to shaving in many instances.
Planning: How to Prepare For the Procedures (who, when, where, and why)
Doctors or midwives advise on shaving in case they anticipate an episiotomy in a vaginal birth, and hair clipping when the abdominal hair is extraordinarily thick during a caesarian birth. In a vaginal birth, shaving is done to remove the lowermost hair. A razor is to perform the procedure on an expectant woman just before delivery, or hours before delivery. This is done in the delivery room or labor ward as the woman awaits delivery. During a caesarian birth, a doctor or midwife clips only the topmost pubic hair using electronic or manual clippers to allow for skin incision. This occurs before the surgical operation in the labor ward or delivery room (Mangram et al, 1999).
Outcome (Final Verdict)
Studies reveal that when shaving and clipping are done a few hours before the operation, the risk of SSI is reduced. However, performing these procedures within 24 hours before the operation increases SSI by creating foci that enhance bacterial growth (Tanner, Norrie & Melen, 2011). Many studies have argued against hair removal by stating that it increases SSI rates, and thus no hair should be removed at all. There are no clinical benefits of clipping or shaving as the procedures later lead to multiple side effects on the woman. For instance, many women report irritation, multiple superficial scratches, burning, redness, and itching of the vulva after shaving. However, there are no significant problems associated with clipping. In other words, it is better than shaving in the aftermath. Thus, if doctors and midwives still insist on hair removal, then they should go for the option of clipping as compared to shaving using a razor. This will help to curb the side effects associated with shaving.
Evaluation
There is a wide range of options, which are better in reducing infections as compared to hair clipping and removal (Tanner, Norrie & Melen, 2011). The use of antiseptic agents on the incision site during preoperative preparation to prevent SSI is better than the use of clipping and shaving. There is no proof that clipping and shaving reduce 100% of the infections experienced during preoperative surgical operations. There is a wide variety of antiseptics such as alcohol-containing products, chlorhexidine gluconate, and povidone-iodine. These help to reduce SSI, as well as post-delivery infections.
Antibiotic prophylaxis administration also helps in reducing infections (Tita, Rouse & Blackwell). There is evidential clinical research of reduced infections following timely administration of prophylactic antibiotics. Redosing is essential during surgery and all these are effective ways of reducing SSI (Jacques et al, 2005). Doctors can also champion preoperative antiseptic showering just before the operation.
References
Jacques, P.S., Sanders, N., Patel, N., Talbot, T. R., Deshpande, J. K. & Higgins, M. (2005). Improving Timely Surgical Antibiotic Prophylaxis Redosing Administration Using Computerized Record Prompts. Surgical Infections, 6(2), 215-221.
Mangram, A. J., Horan, T. C., Pearson, M. L., Silver, L. C. & Jarvis, W. R. (1999). Guideline for Prevention of Surgical Site Infection. Infection Control and Hospital Epidemiology, 20(4), 247-278.
Tanner, J., Norrie, P. & Melen, K. (2011). Preoperative Hair Removal to Reduce Surgical Site Infection. Cochrane Database Syst. Rev, 2(1), 2.
Tita, A.T., Rouse, D. J. & Blackwell, S. (2009). Emerging Concepts in Antibiotic Prophylaxis for Cesarean Delivery: A Systematic Review. Obstet Gynecol, 113, 675–682.