small tears--to stitch or not--share experiences please « Back to Group Discussions

[mamaharrison]

OK, with DD I had a second degree tear/canal carved through my lower vagina from her elbow as she was birthed with her hand at her head. So, let's be clear--I am not talking about that kind of tear here! I needed lots of stitches and got them!
However, I was surprised when I asked my MW her opinion recently about letting a small tear, one that may only need a few stitches, to heal without them and she was kinda horrified and insisted that stitches were always appropriate with anything more than a 'nic'. She went on to say how the tissue would be less likely to keloid and scar with stitches. I have had a completely different experience with this--everything I have ever had stitched has turned to keloid and has scarred terribly not to mention usually results in nerve damage to the tissue. However, the cut that needed stitches and I was unable to get sutured and healed on its own is my cleanest scar and doesn't hurt ever and it is on the tip of my finger--so lots of nerves!

I understand that it may be potentially more tender to forgo stitching and that without stitches and proper hygine infection would be more prevalent, but I feel intuitively that I disagree with this notion that stitches for a small tear promote less scar tissue and less damage to the area in the long run.....

what do you ladies think?

[Mamabeakley]

Well, I have no idea about the scar tissue issue but I would think that your knowledge of your own body history should trump your MW's preference in this case.

My personal experience was that I had a tiny tear with DS1 which got stitched.  The stitches did not dissolve properly and had to be removed (very painfully) at my 6 week appointment.  Then I had a lot of sensitivity and discomfort during intercourse for a long time, leading me to think that either I was stitched up too tight (and I don't think it would have been intentional - but the MW wasn't intimately familiar with what I looked like before the tear, so could have easily done it by accident) or the tissue where the stitches had been was extra sensitive.  (DS1 didn't rotate well on the way out so MW thought the tear was likely due to his shoulders being at a funny angle.)

I tore in exactly the same way with DS2, and opted not to have it stitched.  It healed perfectly and I had no sensitivity or discomfort afterwards.  (DS2 was born posterior, so that's why MW thought I tore that time.)

I did not tear at all with DD.  (I birthed her hands and knees as opposed to side-lying with the boys, and she was anterior.)

[mamaharrison]

Thanks mamabeakley. That is how I feel, too--almost exactly!

The Med wife I had definitely gave me the 'husband stitch' and sex was painful for over a year until I stretched back out. I felt like a different person and I didn't like it at all.

I think I will decline stitches if I tear. How long did it take to heal without them? Do you remember how many stitches you ahd with your first?

[annaka]

Good topic! All these things to consider that I never even knew about for my first baby. Wish I would have known back then.

For small tears, I'm all for letting them heal on their own. For DS a year and a half ago, the doc didn't even mention that I had a tear. About a week after he was born- once the other pain was diminishing- I asked DH to take a look and, sure enough, I had a small tear. It healed fast and I haven't had problems. I attribute it to a fast labor, and that once I felt the urge to push, I had him out way too fast. We'll see how this birth goes. Also, my theory is that if you have a slight/small tear and get stitches, and they are done tighter than necessary, that could lead to another tear in the next birth. (I do agree that stitches are probably necessary if it's a very large/deep tear.) In my non-professional opinion. :)

[tropicana74]

I am certainly no expert on this but here is my experience. With #1 I had a (very) small tear. She didn't tell me how small until she had already stitched me.....ONE stitch! Had I known I probably would have had her skip it but it was such a whirlwind in the birth room I was paying attention to DD not to what was going on between my legs. Anyway, that one stitch burned like a mother!@! But I will say that we were back to having sex after about 5 weeks and I never had any issues or gave it much thought after that. I think it could have gone either way.

With DS I had a second degree and strangely it did not burn afterward the way that my previous one stitch did....go figure. 

[stegenrae]

FWIW, my mw with DS2 had a looong history of both being a NICU and L&D RN as well as being a DEM for a couple decades when I got her. I had a labial/clitoral tear and she only  mentioned in passing that I tore, but didn't need stitches. (It was a pretty significant tear, btw.) I recall a brief conversation with her that, in her reading of the research (*which I, myself, have NOT done*), stitching is almost always unnecessary, as natural healing will take place with proper hygiene anyway, except when the tear is significant (like your 2nd degree or worse, I guess). 

With DS1, I was at a birth center, and he was caught by a CNM, but the doc arrived about 10 minutes later and did all of my checks. Despite a respectable perineal tear, she chose to let it heal naturally, too. (So I'm offering the experience with an MD, and for a "typical" tear here.)

My current CPM doesn't stitch, but will refer to specific docs to stitch 2nd degree tears where needed. I asked about the time delay, and she said a day or two won't make much, if any, difference in healing, but that the birth high that can be a natural pain reliever won't be in effect, and that part would suck. 

No idea how that applies to anything you're considering...just thought that I've had all 3 "types" of midwives and a doctor all agree with what your instincts are telling you.

...BUT I don't have a history of keloids. DH does, though, and like you, the things he let heal on their own haven't keloided (I've decided that is a verb) nearly as badly as the couple he'd had stitches on, though that's purely anecdotal.

[Mamabeakley]

I think it was 2 or at most 3 stitches.

And I think the tear with DS2 was completely healed within 1 - 2 weeks.  Good excuse to sit still for that length of time!  I'd rather not tear this time, but if I do will not stitch unless it's serious.

[Lilac11]

Interesting answers!  I have to rethink what I'll want in the case of a small tear!

I had "one" (not sure how many that actually was!) stitch with DS.  MW said it would bleed less that way.  She did it quickly with no anesthetic.  I had no postpartum pain after a few days (after the regular swelling, soreness went down).  Stitches dissolved no problem.  But sex was uncomfortable at first, and gradually got better over a few months.  I was also quite dry vaginally (due to breastfeeding hormones) for a few months too so I think that couldn't have helped.

[segolilymama]

I have been fortunate to have 3 babies with no tears (knock on every piece of wood in my house...). However, I have always known that for anything minor I would not accept stitches. Everything I have read advises against stitching whenever possible, for exactly the reasons you mentioned, mamaH. Just say no ;)

[kel]

ditto to sego

[mamaharrison]

Raegan--Thank you for your details of all scenarios! I agree the keloided is a verb, too and I don't want my body doin' it--haha ;) So am I correct that your labial/clitoral tear wasn't stitched and healed well?

thanks to all other mamas, too! I definitely feel the same as you--will not be getting stitched this time--hopefully won't tear at all ; ) Being stitched changed my sex life completely for years--it was bad news!

[stegenrae]

it healed well, but did not heal together. (and I imagine that's why I had to sit on a boppy for a little longer than average (seriously--THAT is what Boppys are made for--like a hemorrhoid donut with a cutout for girl parts!) The tear actually increased sensation, so I'm not complaining, yk? It just looks crazy. ;)

[mamaharrison]

good to know ; )

[sassyfirechick]

Oh no, I wish I knew all of this when I had DD!  I had a 2nd degree tear which my MW stitched up (I call BS on the post labor birth high - I felt every single stitch and that was after a topical anesthetic!). According to DH I had a 'lot' of stitches, I reallty felt like it took forever and while I felt the burn of the tear happening it didn't hurt as much as the stitching did.  I actually asked for less/looser stitches, DH jokingly wanted more.  Well here we are almost 14mos later and I still haven't had sex bc it's so tight that not only do I end up in tears bc it won't stretch - at all- but i get surface tears on the scar tissue that sting and burn and are pain in and of themselves.  Poor DH, he's been tolerant but I know it's stressful for us both.  I really wish I hadn't gotten stitched up.  I had a great sex life before, now I dread it bc it's not the least bit pleasurable - mamaharrison, years plural??  I want more kids but clearly if DH can't get in there that poses a problem!  I think a trip back to my MW is in order, since at last visit she said everything looked wonderful and was healed.