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When to suture a tear...?

Last post 03-31-2009 11:24 AM by midwifea. 1 replies.
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  • 03-31-2009 9:29 AM

    When to suture a tear...?

    When i had DD i tore a little.  The tear was at about 5 o'clock if you imagine the vagina as an elongated oval clockface, and ran down ad slightly towards my thigh.  I have a very short perineum (under 2cm) and almost no labia minora so the tear itself was actually small and uncomplicated (not through labia) but still deep enough considering how much room i have down there to tear (just under a cm long, so nearly 50% of the perineum, though not straight down).  I hope all of this is not too TMI for you all! 

    I had 2 midwives, one said it was into muscle and she would stich it, the other said that even though it was into muscle it wasn't very severe and not bleeding badly and that she would be concerned about me having infection or discomfort from the stitches for more than a few hours (because i was at home and having a midwife call every day, rather than on a ward where i could buzz one if the stitches were infected or pulling) so she wouldn't stitch it, they both gave me their cases (very calmly, i got no impression it was a very dangerous situation or that they minded either way) and let me decide.  I decided to leave it, and it healed fine.  Because it was into muscle it healed "open" - it closed a little bit, though not completely and the skin just grew back over the part which hadn't quite closed itself.  I never had any particular pain from it, it never hurt me during sex though once (and only once, 3 months post partum) i caught it with my diva cup and it stung for a second or two, my pelvic floor is better than it's ever been.  From my POV it healed perfectly, but recently a midwife i talked to about it was relatively shocked that they had "left me with a 2nd degree tear".

    She works in a hospital all the time (never does homebirths) so i wonder if that's a more medical viewpoint or a true one?  I had read plenty on tears before having DD so i knew exactly what i wasn't having stitched (also glanced in a mirror which was baffling 40minutes after birth!) ad felt calm in my decision. 

    So, wise ladies, when does one suture?  When does one suggest?  When does one insist?  Was i mad to refuse stitches and lucky to come through, or is my case a normal outcome for my situation? 

    I'm looking forward to learning a lot more from you all!


    Me 32, DH 41, DD 2006, DD 2010, DS 2013
  • 03-31-2009 11:24 AM In reply to

    • midwifea
    • Top 10 Contributor
    • Joined on 02-12-2009
    • Kailua Kona, HI
    • Posts 475

    Re: When to suture a tear...?


    It sounds as if your homebirth midwives were/are confident, capable, and reasonable in their actions. They assessed your tear individually, taking into account your anatomy, your environment, your capabilities. Then, they gave you all the information needed to make an informed choice about your own healing, and, it sounds as if you healed beautifully.

    When assessing whether or not a tear needs suturing there are many things to consider, not just defining 1st or 2nd degree.  Is mama going to rest and stay down?  Are her tissues and healing capabilities normal?.  Would other modalities assist the healing process better than a needle and thread?  Does the tear flap or gap when mama is in a reclined, knees up position or does it stay approximated?  How is the bleeding at the tear sight? (ie. weeping, even with compression)  All these things go into the evaluation.

    I saw some pretty horrific yoni infections from sutures in Central America.  IMO docs love to stitch, it's what they were taught to do!  They stitch up every little nick on a yoni and sometimes that creates more problems.  I always try to ask myself at a birth, now what would my ancestors do?

    That said, anecdotally, I remember one mama, she had a really good Y shaped tear on her pelvic floor that did not want to approximate.  As hands off as I am I wanted to stitch this. I gave her all the info and a mirror and we talked about the reasons it should be stitched,  In the end she decided, no stitches, she was adamant.  I was really nervous about this but respected her choice.  It took a while, plenty rest and herbs but eventually it healed on it's own.  She jokingly referred to her yoni as a 'frankenyoni', but it did heal.

    I think the hospital midwife who was shocked has just never witnessed the other side, so to speak.




    "The Voice

    There is a voice inside of you
    That whispers all day long,
    "I feel this is right for me,
    I know that this is wrong."
    No teacher, preacher, parent, friend
    Or wise man can decide
    What's right for you--just listen to
    The voice that speaks inside."
    — Shel Silverstein
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