What if i need stitches after birth?
This concern is one of the top “What ifs” that I run into as a doula. And here’s the low down.
You might need stitches.
I’m sorry.
It’s actually a lot more common than you might think. The American College of Obstetrics and Gynecology (ACOG) states that 53-79% of women need tissue repair after a vaginal birth. Flipping those stats around, it’s actually less common to NOT tear than it is to tear.
There are many solid ways to prevent tearing (check out this article for more info), and having a doula on hand to help with position changes and breathing is a huge help.
Today, we’re going to dive into the recovery.
First, we need to understand the types of tears.
Perineal tears are divided into four categories, called degrees. A first degree tear is only skin deep, while a second degree tear affects the muscle of the perineum. The vast majority of tears are first or second degree. They require a few minor sutures, but are so commonplace that I don’t even blink when a client of mine needs this type of repair. If you don’t have a functioning epidural, your provider will give you some lidocaine (in the interests of full disclosure, a shot of lidocaine in your vagina immediately after giving birth is no joke, but deep breathe like you were during contractions and the sting lasts only a few seconds before the numbing kicks in. Hang in there Mama, you can do it).
Third and fourth degree tears are much rarer, and more serious. A third degree tear reaches the muscles surrounding the anus, while a fourth degree tear affects the anus itself. Recovery will be a lot longer for a tear of this magnitude, but the initial steps are very similar.
Here are my top tips for recovering from stitches:
Use a peri bottle. It is your best friend. The last thing you want to do is put a lot of pressure on newly sutured and very sensitive skin. When using the restroom, rinse your vulva off with warm water (no soap!) and then pat dry very gently with toilet paper or a clean towel. Don’t wipe—you could tug on your stitches.
Sitz baths are your other best friend. Soaking your bottom in warm water will help keep the area clean and soothe that sore skin. Bonus if you throw in some epsom salts and/or herbs. There are lots of fabulous recipes around the internet for herbal sitz baths, or you can ask your doctor or midwife if they have a recommendation.
Dermoplast is a topical numbing spray that is used for burns or skin wounds. Spray your vulva liberally before using the bathroom. Urine is sterile, but can still sting when you’ve just had sutures.
Tucks Pads go hand in hand with Dermoplast. They’re typically used to treat hemhorroids (which you may also be struggling with). Soaked in witch hazel, they are cooling and help speed healing. You can put them right on top of whatever kind of maxi pad you are using post birth.
Speaking of pads, there are some great ice pack pads out there. If having some ice up against your recovering skin sounds heavenly, this is the way to go.
Last but not least, be conscious about how you’re sitting. Keep your legs straight and close together to avoid tugging on your stitches. Criss-cross applesauce is a no-no.
And now, the following:
(Pulls out a soapbox and steps onto it)
Let’s talk about the “husband stitch.”
This ridiculous invention (sorry, are my opinions showing?) is an extra stitch intended to keep the vaginal opening tight, which theoretically increases the sexual pleasure for men.
If this insanely abusive practice is mentioned whether in seriousness or in jest anywhere in your vicinity, I would consider it the reddest of red flags. We’re talking tarantula in the shower, alligator in the pool, cobra in the toilet, velociraptor in the kitchen type red flag.
(In case anyone was wondering why I put up with Alaska’s teenage-girl petulant weather dramatics, the fact that we don’t have snakes/giant spiders/alligators is high on the list. Also velociraptors, but I’m told those are hard to find anywhere outside of a Chris Pratt movie these days).
Why the red flag? Well.
First and foremost, women are autonomous human beings who have intrinsic value simply by existing, and can not, and should never, be boiled down to something that exists solely for the sexual pleasure of men.
Secondly, the practice itself is damaging the the pelvic floor and can cause intense and severe pelvic and sexual pain until reversed.
Thirdly, and absolutely the least important of the list, it doesn’t even work.
The only valid response to this is one an OB told me about. When the husband (THE HUSBAND, FOR THE LOVE OF ALL THAT IS GOOD AND HOLY) made a joking reference to whether or not the doctor was putting in an extra stitch for him, she didn’t miss a beat and told him to go ahead and drop his skivvies so she could get a good look at his equipment and determine how small she needed to make the area to fit him properly.
I love that doctor. If I knew who she was, I would buy her a coffee.
Putting away the soapbox, and returning to the issue at hand—the idea of tearing is never a pleasant one. I encourage you to talk to your provider and discuss all the preventative measures that you can put into place, and then utilize every single one. And then if you’re one of those 53-79% of women who have to manage some type of repair and recovery, you know what to do (and it is 100% not a husband stitch).
Christine Rogers is a birth doula and childbirth educator. She is the owner/operator of Draw Near Doula Services and serves in-person in Anchorage, Eagle River and the Mat-Su Valley region of Alaska, and virtually all over the United States. A mom of four, she works hard to ensure every client she serves has a positive and empowering labor experience, because no one should have to be afraid of birth.
Need a doula? Looking for childbirth education? Find Christine’s services online at www.drawneardoula.com/services. You can also follower her online on Instagram & Facebook: @drawneardoula or @christine_rogers_doula .
