KURENME BIRTH CLIPS: A JAPANESE MIDWIFERY ALTERNATIVE TO SUTURING By Eriko Shinohara, Utako Yamamoto, Mitsuyo Ito, Keiko Takahashi, and Yuki Arakizeki Birth clips, originally called “kurenme” in Japan, are small, simple metal clips used for treating perineal trauma. In Japan, midwives are not allowed to suture, except for in emergencies, thus Japanese midwives have used birth clips to treat perineal tears for many years. Some midwives in the United States keep birth clips as part of their suturing kits, but don’t know how to use the clips since the instructions are not in English. This paper explains how to use birth clips appropriately and effectively. PREVIOUS RESEARCH There is no research that examines the use of birth clips for perineal trauma, but there is research that examines the effect of its alternative: suturing shallow perineal trauma. Two randomized controlled trials (RCTs)–one from England and one from Sweden–compared the effects of suture versus non-suture for first- and second-degree perineal trauma. In England, an RCT (n=74) reported no significance differences for perineal pain in either group, although the fusion progress was better in the suture group.1 An RCT (n=78) in Sweden, on the other hand, reported no significant differences between the healing processes of sutured and non-sutured minor perineal trauma, defined as first- or second-degree trauma with no bleeding, where the cross section of the tear meets, and where the depth and length of trauma is less than 2cm by 2cm. The trial concluded that women should have the choice of whether to have suturing or allow for the body’s own healing of the perineal trauma.2 Therefore, when the laceration is shallow, there is no clear evidence to support suturing the shallow perineal trauma. USE OF THE BIRTH CLIP IN JAPAN In Japan, midwives usually use birth clips if there is no bleeding from the tear and the cross sections of the tear meet. To contain perineal trauma during labor, midwives encourage slow descent and crowning of the fetal head, which allows for adequate extension of the perineum. Most lacerations, in this setting, are shallow first- and seconddegree tears, so use of birth clips is sufficient. However, if the cross section is misaligned, the trauma is extensive, or it is not limited to the perineum, then sutures are necessary. In Japan , in cases when suturing is warranted, a physician is called to do the suturing. In most cases, Japanese midwives use one birth clip for trauma, however sometimes two are needed. After 48 hours, the clips are removed and the tear continues to heal. In the birth center, after placing the clips, midwives tell clients to keep their legs together, not to cross their legs, and to wait for the natural process of healing. When the clients return for two-week and one-month check-ups, the healing is apparent. In Japan, like in other Asian cultures, rest is very important in the postpartum period. Usually the recommendation is to rest for three weeks after giving birth. Women usually stay at the hospital or birth center for four to five days after giving birth. Even after discharge, family–particularly the woman’s mother–or friends support the woman for several weeks to enable rest. The low activity levels make for fast healing and no lasting effects from a tear that has been treated with birth clips. In Western countries, women are discharged from facilities after birth more quickly and postpartum activity level is higher than in Japan. Midwives using birth clips, should advise women to care for their own perineal health by limiting the amount of postpartum activity, so as not to put a burden on the perineum for a few weeks. In the United States, midwives can purchase these clips online for between $2 and $5 per clip. Search for “Japanese Suture Clips” on birth supply websites. Note that birth clips always need to be sterilized before use. ! Eriko Shinohara is a midwife and assistant professor at Tokyo Healthcare University, Tokyo, Japan. Eriko can be contacted at firstname.lastname@example.org. Utako Yamamoto, Mitsuyo Ito, Keiko Takahashi, and Yuki Arakizeki are midwives at Yamamoto Birth Center, Yokohama, Japan. The authors have no afﬁliation with birth clip manufacturers or retailers.
https://montaneenterprises-my.sharepoint.com/:b:/g/personal/mwinmt_birthwithlove_com/EbqH-ad_VTtPgoxXmPAEeG0B9lfoSUznXGCq5QBqKdknVA?e=m9Au9n this is the link, had directions too!
This is Ollie...while it mentioned here to sterilize, I have been told that it can't be done in a sterilizer, you need to drop them in hibiclens before use only. Comments:I am with Cheyanne. Really like the clips for the right tear. We have had access to them here in Az for a while since the midwife who found them lives here. I have found that I like to leave them on for 4 days if the woman will tolerate it. Just feel like I get better healing that way. Always use at least 2 clips and occasionally 3, but I have found 1 will not do it. They are handmade out of silver and can be sterilized and used more than once although I would not use them more than a couple of times so they stay sharp. Sometimes they turn black and then I toss them. Also I have found that they do not work well for women with a lot of adipose tissue. They seem to sometimes pinch them open and they will fall out. Never had that problem with thin women. Once you see them, you will see that they are slanted a bit so you can put them in and they will lay flat against each other. I tell women that they get a baby and some jewelry... few complaints. Pam White
#2 I'm definitely intrigued. I'm wanting to learn more and will likely order some to experiment with.
But since you asked, here are a few concerns...The clip looks as if it might hurt to use it. But if women are tolerating it for 2 to 3 days (or longer according to some) after only the initial anesthesia it must not be too bad. And again, it would save them both the tissue trauma from the stitches the anesthesia injections and, depending on how much is given, blowing up the tissue with the lidocaine, or whatever is used. Even with my questions the clips are officially on my list of items to purchase as I am in the process of returning to midwifery practice after some years mostly away from births.
It hurts going in, they suggest using a topical lidocaine/cetacaine, the one who has used them says it only hurts for a moment and then they report no discomfort later, they fold down near the skin.
I'm wondering if they work like the self-piercers that can be used for earlobes. It feels somewhat uncomfortable at first, then it gets numb, perhaps from the continued pressure.
When purchased do they come with any further suggestions or instructions on their use? I intend to purchase them regardless but more information, even anecdotal, is always welcome.
No, but I welcome any info you come up as I try to keep the page informative. In Japan they are sold as an animal suture, but since the mws can't suture, they use them. I intend to use them the next time I need to suture.
I'll let you know if I run across anything else. Meanwhile, I appreciate your carrying them and offering information as others share with you.