HBMW doesn't suture tearing - would this be a problem? - Mothering Forums
Birth and Beyond > HBMW doesn't suture tearing - would this be a problem?
Ophelia's Avatar Ophelia 04:44 PM 08-19-2010
I'm pretty sure I want to hire a particular HBMW. She said she does not suture tears and says they heal better on their own.

I had 2nd degree tear from DS (he had to be hoovered out after a loooong back labor) which I dont' know that I have completely healed from 4 years later.

So I may be prone to tearing again (hoping for home waterbirth).

If you had at least 2nd degree tearing and did not have it sutured, was it a problem healing and a problem later? OR do they tend to heal OK on their own?

What if I got 3rd degree? If I didn't have it sutured at home, could I go to a regular clinic and have an MD do it within a week?

I just interviewed another HBMW who I also liked, who does suture.
Thanks!

nashvillemidwife's Avatar nashvillemidwife 05:28 PM 08-19-2010
Does she know how to suture if needed? Because she's right that most tears heal just fine on their own and many don't usually suture. I do know how to suture though, and will usually ask the client what she'd rather do. Most choose not to suture if they can avoid that extra trauma.

I don't know any midwives that suture 3rd degrees at home; that is beyond our training and requires equipment we don't own. Sounds like she's of the mindset that if it's bad enough to require sutures it's bad enough to get an expert to do it.
mwherbs's Avatar mwherbs 06:02 PM 08-19-2010
What do you want? And what is the plan if you want to be sutured? Will she do the repair, does she have someone who will come to you and do the repair? Or do you have to show up at the hospital in order to get a repair done? I have seen extensive tears heal up asap and you would not know anything ever happened and I have seen the smallest second degree just not heal up and cause irritation, same with stitching sometimes just painless post healing and other times the stitches seemed to drag on the healing time
So up to you
goldingoddess's Avatar goldingoddess 06:08 PM 08-19-2010
I personally wouldn't be comfortable going to a midwife who absolutely does not do any sutures, no matter the circumstance. On the other hand I wouldn't feel comfortable with a midwife who 'always' sutures. If I had had bad tearing at a previous birth I would probably want to find someone perfectly in the middle road between never and always suturing. Also, I think 3rd degree tears would require a pp transfer for repair, I could be wrong.
Ophelia's Avatar Ophelia 07:43 PM 08-19-2010
Quote:
Originally Posted by mwherbs View Post
What do you want?
I just want to be able to heal properly with hopefully the least amount of pain, if I do tear again

I am fine with not suturing if there is a good chance that a 2nd degree or less tear will usually heal fine on it's own w/o suturing, I just don't know enough about it to figure out what I would want.

Thanks!
dachshund mom's Avatar dachshund mom 08:57 PM 08-19-2010
I wouldn't. I had a 3rd degree, and while my mw can suture those, it was unusually bad and she wanted her backup DR to do it at the ER. It was not a plesant situation, having a 4 hour old baby in an ER with people coughing on her. My DH saw down there and said it was pretty terrible, so I wouldn't imagine you could leave that for a week. Doing it over, I'd probably try to convince the mw to do it and repair it later if needed.
nashvillemidwife's Avatar nashvillemidwife 09:06 PM 08-19-2010
Ophelia, in a case where she says she can suture if needed but she just doesn't usually, you need to ask 1) exactly how often do you suture and 2) how do you keep your skills sharp if you do it so rarely? I worked with a midwife who said she could suture if necessary. In reality, this meant that she carried a suture kit and some lidocaine in her bag. Once when I was ordering supplies I asked her when our sutures were set to expire. She said "they expire??" They were pretty much dessicated at that point.

Quote:
Originally Posted by dachshund mom View Post
Doing it over, I'd probably try to convince the mw to do it and repair it later if needed.
No offense, but if she's worth her salt she's not going to attempt to do something she knows she doesn't have the skills to do.
mwherbs's Avatar mwherbs 11:01 PM 08-19-2010
Sometimes in states where midwives cannot be licensed then midwives do not suture, as it can be seen as crossing the medical practice line, if so I can understand. But the thing is WHAT are the contingency plans?
sometimes clients have a family practice doc who would agree to doing in office suturing, and if it were me and I had to go to the hospital I would really try to see someone beforehand that I liked so I could call them and have them meet me at the hospital if need be.

Take care
finnegansmom's Avatar finnegansmom 11:10 PM 08-19-2010
I can't really answer the suturing/MW issue but my 2 cents a bout being prone to repeat are: I had a vacuum extraction with #1, after pushing for 5 hours. 5. He was only 8#1, but I tore like mad...I don't know or I guess choose to remember the degrees, but there were a ton of stitches and I was unable to have intercourse for 6 months. I was VERY scared with #2.... I switched practices to a very calm MW had a waterbirth, and birthed an almost 10# baby with not even a skid...nothing.

I would definately recommend the water birth, I think it helped me not tear...
BlackSheepPDX's Avatar BlackSheepPDX 12:24 AM 08-20-2010
I had a 3rd degree tear. My midwife did the repair at the freestanding/non-hospital birth center (she was also a HB midwife and would have done the repair at our home if we had chosen to birth there) within an hour or so after birth. My current HB midwives would suture on site at our home if needed.

I would not consider allowing something like that to go unrepaired. In general sutures need to be done within 24 hours of the injury or they don't close properly and have to be left to heal by secondary intention.

It is my understanding that yes, small tears will heal fine on their own, especially in the moist, well vascularized vaginal region, however I do not think you can do that with larger 2+ tears.

As a side note, when you say you don't know if you've completely healed, what are you referring to? I had some granular tissue that had to be removed about 6 weeks PP, and have had pelvic floor work done to help restore balance to the affected musculature. You may need some extra intervention if you don't feel "right."
dachshund mom's Avatar dachshund mom 12:25 AM 08-20-2010
Quote:
Originally Posted by nashvillemidwife View Post

No offense, but if she's worth her salt she's not going to attempt to do something she knows she doesn't have the skills to do.
I don't think it's an all or nothing situation where she doesn't know HOW to do sutures (though maybe it is in the OP's case). The situation was it was an unusual tear with hematomas and she didn't know the best way to go about repairing it and wanted the dr's help if he was available. They're my nether regions, and I'd prefer to have it done less than perfect than transfer to the hospital again, so I would hope she'd honor my wishes. In my case, my mw is a cnm with 20 yrs experience, and I trust her to do an at least adequate repair.
Ophelia's Avatar Ophelia 12:18 PM 08-20-2010
Quote:
Originally Posted by BlackSheepPDX View Post
As a side note, when you say you don't know if you've completely healed, what are you referring to?
Kinda TMI, but after sex if I stand up/walk around, it hurts, kind of sore. Not nearly as much as it did postpartum, but it's still there.
Veritaserum's Avatar Veritaserum 12:46 PM 08-20-2010
My midwife can repair anything but the really bad tears. It's one of the reasons I have a midwife. The thought of getting into my car and driving to the hospital to get sutured does not appeal to me at all. Now, if we're talking something that would only get 1 or 2 stitches, then I might just skip the suturing all together. Anything more extensive than that and I'd probably choose to stitch and would appreciate my midwife's ability to do that in my home.
MegBoz's Avatar MegBoz 12:57 PM 08-20-2010
Quote:
Originally Posted by goldingoddess View Post
I personally wouldn't be comfortable going to a midwife who absolutely does not do any sutures, no matter the circumstance. On the other hand I wouldn't feel comfortable with a midwife who 'always' sutures.
ITA

Based on what you wrote, it sounds like she really prefers not to suture. Or does she absolutely never suture?

I had a minor 1st degree tear & my CNM said she normally wouldn't have sutured it, but the bleeding wasn't stopping, so she put in 2 little sutures. I'd definitely rather have someone with the skills & equipment just in case of a situation like that.

Quote:
Originally Posted by mwherbs View Post
Sometimes in states where midwives cannot be licensed then midwives do not suture, as it can be seen as crossing the medical practice line, if so I can understand.
Good point, although here in Maryland, direct-entry midwifery is illegal. We have a few who practice anyway (one is licensed in Virginia as a CPM) & they both suture.
shoefairy3's Avatar shoefairy3 04:04 PM 08-20-2010
Quote:
Originally Posted by Ophelia View Post
Kinda TMI, but after sex if I stand up/walk around, it hurts, kind of sore. Not nearly as much as it did postpartum, but it's still there.
I had an episiotomy with baby #1 and it hurt like mad after sex forever and ever. Doesn't hurt anymore tho (oldest is 11 now) I can't remember how long it took not to sting anymore
Greenlea's Avatar Greenlea 04:32 PM 08-25-2010
My midwife does not suture, well can't suture really. However, she said it has been a long time since she sent anyone to the ER to get stitched up. She does massages, and goes slow birthing the head, etc. I would think a good MW would try to prevent tearing in her patients by doing this also.

Also, the water really does help if you plan on a water birth. I had one with my son, at 8 lbs, 4 oz and had no tearing. I am hoping for that again.
liberal_chick's Avatar liberal_chick 10:05 PM 08-25-2010
I had a 2nd degree tear that didn't heal correctly (it healed totally open, like a "V"), so b/c of my experience I wanted someone this time who could suture if need be. Well, b/c of VBAC/HBAC rules for licensed MWs in my state, I was unable to find a different MW. So I'm going to go to the hospital for sutures after the birth if I need them. It sucks and I'm not happy about it, but it was literally this MW or the hospital and I hate the hospital enough to cross my fingers and hope I don't tear.

I got my tear repaired by a GYN at 9 weeks PP and it was worse than childbirth. Awful, awful, awful.
RedOakMomma's Avatar RedOakMomma 12:00 AM 08-26-2010
I've had a 3rd degree and a 2nd degree tear, and knowing the number of stitches that went into both, there's no way I'd just let a 2nd degree tear heal on its own.

I'm very glad I was stitched up immediately after birth by someone (my OB) who knew what he was doing...the healing hurt, but there has been no lasting pain.

Given how many women on this site complain about pain from their healed tears, I wouldn't let just anyone repair a tear. I'd want a skilled MW comfortable with sutures or an OB who is familiar with repairing that area of the body after a birth.

IF you do tear, I'd probably ask to visit a back-up OB and have it stitched up. Very soon after the birth.
MsBlack's Avatar MsBlack 09:48 AM 08-26-2010
Quote:
Originally Posted by RedOakMomma View Post
I've had a 3rd degree and a 2nd degree tear, and knowing the number of stitches that went into both, there's no way I'd just let a 2nd degree tear heal on its own.

I'm very glad I was stitched up immediately after birth by someone (my OB) who knew what he was doing...the healing hurt, but there has been no lasting pain.

Given how many women on this site complain about pain from their healed tears, I wouldn't let just anyone repair a tear. I'd want a skilled MW comfortable with sutures or an OB who is familiar with repairing that area of the body after a birth.

IF you do tear, I'd probably ask to visit a back-up OB and have it stitched up. Very soon after the birth.
The thing is, around here I read just as many stories from women with tear-healing problems who birthed in a hospital, as from those who birthed at home. Not that I've done any sort of formal survey of posts (wouldn't that be a big job), but I'm thinking that I hear more sad stories of lingering pain or other issues with healing, from the women who got sutured, as opposed to those who didn't. Whether or not my guess about this is right or wrong, suturing itself--even by the most skilled OB/surgeon, is not a guarantee of faster or better healing, is not a guarantee of pain-free sex or anything else. And plenty of stories of difficulty healing written here, are from women who did get sutured.

For myself, I'd want to know first, that I was doing all I could to prevent tearing if possible--or at least to prevent a serious tear. SEcond, I'd want to know that my mw could *help* me prevent tears during birth (or at least, severe tears). 3rd, I'd want to know that my mw can assess tears well enough, has good advice about promoting healing, and the good sense to assess my healing throughout the pp time. Only if she assessed that the tear really might benefit more from sutures than from natural healing (and serious or complicated tears usually do benefit from suturing), would I choose to go the hospital for OB suturing.

And if I'd ever done that (never had to), I'd consider it a small enough thing after a successful hb...not something to fret about too much. Soon enough, home again and babymooning, after all I don't mean to make it a 'non-issue', when for some mamas it's a real issue of whatever size to them--just saying that it might help to put in perspective. Because it's true--going in for sutures need not be the end of the bliss of your birth, and how you handle that is very much up to you. And it's also true that suturing, even by the best of the best, does not mean you will always heal fast and perfectly--it is unpredictable, and many factors play a part.
Twinklefae's Avatar Twinklefae 09:57 AM 08-26-2010
Quote:
Originally Posted by RedOakMomma View Post
I've had a 3rd degree and a 2nd degree tear, and knowing the number of stitches that went into both, there's no way I'd just let a 2nd degree tear heal on its own.

I'm very glad I was stitched up immediately after birth by someone (my OB) who knew what he was doing...the healing hurt, but there has been no lasting pain.

Given how many women on this site complain about pain from their healed tears, I wouldn't let just anyone repair a tear. I'd want a skilled MW comfortable with sutures or an OB who is familiar with repairing that area of the body after a birth.

IF you do tear, I'd probably ask to visit a back-up OB and have it stitched up. Very soon after the birth.
:

I had a second degree tear, which was admirably stitched up. And anyone who says their midwife or doctor 'goes slow birthing the head' - you do know that YOU are the one in control of that right? I was told multiple times to ease up pushing, but the urge was so strong that apparently I told the doctor something that was a UAV, rather than the "I can't" I intended.

And since I then tried to have intercourse 3 weeks pp, and tore them all open again, I am living with an essentially unsititched second degree tear. It's not fun or exciting or something I would recommend for anyone.
MsBlack's Avatar MsBlack 10:24 AM 08-26-2010
Quote:
Originally Posted by Twinklefae View Post
:

I had a second degree tear, which was admirably stitched up. And anyone who says their midwife or doctor 'goes slow birthing the head' - you do know that YOU are the one in control of that right? I was told multiple times to ease up pushing, but the urge was so strong that apparently I told the doctor something that was a UAV, rather than the "I can't" I intended.

And since I then tried to have intercourse 3 weeks pp, and tore them all open again, I am living with an essentially unsititched second degree tear. It's not fun or exciting or something I would recommend for anyone.
I'm so glad you pointed this out--it's important. The best way, IMO, for a provider to 'help' a woman birth the head slowly, is to work with her to slow herself down a bit. It can be SO HARD to resist bearing down when the uterus is demanding that from us! Yet I've seen many times how women can breathe through that urge--at least *just enough* to slow down the baby's emergence, to allow a bit more time for perineum to stretch, and help prevent the kind of tearing you had.

Yeah--if a woman is bearing down actively through that burn of crowning, the mw or doc cannot really slow the birth of the baby's head. At least, they can't do that without causing harm! Far more effective if they, or your other support people, can help you blow through that burn without bearing down. The uterus is still pushing the baby out--but descent is slowed just enough usually, if mom can blow through instead of bearing down.

Also sounds like you maybe didn't get good, firm advice about when to start sex, pp--? Mamas need to be taught how to check out their yonis after birth, so they can know when they are really ready for intercourse...no one should accidentally re-injure a tear, because of not knowing enough about the issue.
Twinklefae's Avatar Twinklefae 10:38 AM 08-26-2010
I still don't know if I would have been able to stop pushing - as we discussed in another thread, I wanted to push SO badly.

And I was told to wait til 6 weeks - I just didn't, and paid the price. (It's not painful or anything, just awkward.)
honeybee's Avatar honeybee 01:52 PM 08-26-2010
This was a major issue for me with my first homebirth. I had a 3rd degree tear in the hospital with my first. I had a fp, and the tear was bad enough that even though she *could* have stitched it up, she called in the on-call OB. I did not have any lasting problems from the stitches, and I was glad she knew her own experience level.

So, the "what happens if I tear?" question was one of my main concerns when interviewing hb midwives. I interviewed a CNM who was just beginning her hb practice. She used to teach nurse-midwives how to suture at a large teaching hospital. She told me it was very likely I would tear again, but not to worry because she could stitch me up.

The other two mws I spoke to were experienced hb mws. They both said they rarely saw tears, and it was unlikely I would tear that badly again. They could both do some suturing, but in general it was better to let small tears heal naturally. If I ended up with a bad tear again, they would call in the suturing CNM as backup. Before the CNM was available, the clients would need to go to the hospital for stitches.

FWIW, I had a fast birth with #2, and the midwife arrived after his head was born. I did not have time for any kind of perineal massage, nor could I "breathe" through contractions. My body did all the pushing. BUT, I was also in the position that was most comfortable for me, hands and knees, and there was a natural pause after his head was born. I had a very small tear that healed up fine on its own.

I'm comfortable with a mw right now who does not do suturing. If I tear badly and we need to go to the hospital, so be it. A minor tear is better off healing at home, and if I had a major tear that needed major repairing, I'd rather go in to see someone who has lots of experience with suturing.

I do have a friend who had a 2nd degree tear during a hb, which she allowed to heal naturally. But she also didn't get out of bed for several days and made sure to give the area lots of air. It's a judgement call, and probably depends on how much help mom has after the birth.
nikirj's Avatar nikirj 02:14 PM 08-26-2010
Your window to repair a tear after the birth is about 4-6 hours, just FYI.

A third degree is very unlikely to heal properly without suturing, and these repairs also take longer, so I wouldn't hesitate to transfer for that. First and seconds are a different story and that all depends on what the tears look like and how immobile you can be.

Not being able to (vs. not liking to) suture would throw up a red flag for me about a MW's qualifications. I'm not saying to dismiss her out of hand, but in my area where choices are plentiful it would probably be an automatic "no" for me.
Tithonia's Avatar Tithonia 04:17 PM 08-26-2010
I realized early on that this was my biggest lingering fear about going with my current MW, who doesn't suture. I apparently had a 2nd degree tear with my first birth, although I actually never noticed it. (Didn't notice tearing, didn't bother me when they stitched it up, never bothered me afterward.) However, when I thought about it further, I realized that I'm pretty sure I wouldn't have torn if I had had my current MW for my first birth. My MWs then did directed pushing (which I was not articulate enough to argue with or question at the time, although it was not at all what I wanted and felt like I was working against my body), and had me lie back for the actual birth. I guess they were trying to help things go slowly (that's what my husband remembers them saying, anyway), but I've read since that that position puts a lot more pressure on the area that's most likely to tear, which I totally believe.

So I'm actually really not worried about it this time, since I have chosen a context and MW which will allow me to do things my own way, listen to my body, and minimize the chance for tearing again. If for some reason it does happen, I'll deal with it then...
MsBlack's Avatar MsBlack 05:45 PM 08-26-2010
Quote:
Originally Posted by nikirj View Post
Not being able to (vs. not liking to) suture would throw up a red flag for me about a MW's qualifications. I'm not saying to dismiss her out of hand, but in my area where choices are plentiful it would probably be an automatic "no" for me.
Wow, that is a pretty strong statement, Nkirj. I appreciate you qualifying that by saying that for you, given your region of plentiful (and legal) mws, no suturing could be an automatic no.

I guess I reserve my 'red flags' for safety concerns, not something like suturing...a midwife, IMO, most needs the qualifications that serve safety. Other qualifications are nice, too--such as LLL leader or LC status, to name one--they're just not my measure of 'general qualification for practice'.

Of course, my region is not legally (or medically) supportive of hb mws--and far fewer practice here, so that definitely colors my perceptions about what is important in a mw, and what is less important.
homemademom's Avatar homemademom 09:09 PM 08-26-2010
For me, being capable and competent at suturing would be part of what I looked for in a midwife. I don't want to have to see a doctor for anything short of an emergency, so if I tore enough to require sutures, I would want it done well and done at home.
homebirthing's Avatar homebirthing 07:27 PM 08-27-2010
I am in Minnesota too and I am apprenticing with a midwife that doesn't suture. You can always go in if you feel like it needs more then herbal care to heal.

I feel the same as most of you do as far as suturing. While I still need to learn more about it, when I am hired as a primary midwife, I make sure that I have another midwife on board who can come and suture for me if the mother requests it.

Honestly though, most tears DO heal beautifully if cared for herbally and with baths and rest. But I do think ultimately it is the mothers choice.

Happy birthing!
Sarah
mwherbs's Avatar mwherbs 11:41 PM 08-27-2010
I actually read a small study on this today, they either sutured or did not sutured tears that were 2 cm by 2 cm. And then at the 6 week evaluation they had evaluations done by providers who did not know if mom was sutured or not the results were about equal with maybe 20% either way not perfect.
Ophelia's Avatar Ophelia 12:15 PM 08-28-2010
Thanks for all the information! I did go with the MW that I had wanted, that doesn't suture. We discussed supporting the perinium, herbal care, etc. so I felt comfortable after talking with her. If I have to go to the hospital to have stitches (if I can't go to a regular clinic or it is middle of the night), then I will do that but hopefully we can do what we can to prevent it in the first place. Really good to know that if I do need to be stitched it has to be soon after birth.
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