Stitches and Tears After Vaginal Birth: Comprehensive Care and Recovery

Many women need stiches after a vaginal birth because of tearing or an episiotomy. There are quite a few causes that determine the severity of your tear and how many stitches you will need. These may include if this is your first delivery, if this second stage of labor was prolonged, if instruments were used, your birthing position during delivery, the baby’s size and position, and more.

Understanding, treating, and caring for these occurrences is essential for a smooth postpartum recovery.

Understanding the need for stitches after vaginal birth  

Episiotomy vs. Natural Tears: An episiotomy is a deliberate surgical incision made in the perineum, the area between the vaginal opening and the anus. Healthcare providers might perform this procedure with the intention of enlarging the vaginal opening, facilitating a quicker delivery, or preventing severe natural tears. Historically, episiotomies were more common, as they were believed to offer a more controlled and predictable healing process due to the clean, straight nature of the incision. On the flip side, natural tears occur spontaneously during the delivery process. These tears arise from the pressure exerted by the baby's head on the vaginal tissue. In recent years, there's been a shift in perspective within the medical community. Many experts now believe that allowing the body to tear naturally, if it's going to happen, might result in less postpartum pain and fewer complications than an episiotomy. In essence, while an episiotomy offers a more controlled incision, natural tears align more with the body's organic response to childbirth. Both scenarios come with their own sets of advantages and considerations. It's crucial to discuss these aspects with your healthcare provider.

How Many Stitches Might You Need? The number of stitches that are needed after vaginal birth varies widely based on the severity and location of the tear or the need for an episiotomy. There isn't a fixed number, as each situation is unique.  

Treatment and Repair of Vaginal Tears: The treatment approach for vaginal tears depends on their severity. First-degree tears might not require stitches at all, while second- to fourth-degree tears will. These stitches typically dissolve within six weeks. Most tears are treated in the delivery room, but larger ones with significant bleeding might need attention in an operating room with better equipment. In severe cases, the anal sphincter might also need repair using dissolvable stitches.

Caring for stitches and tears

Most individuals find relief from tear-related pain within two weeks. However, larger tears might take longer to heal. It's essential to monitor for signs of infection during the healing process. Here are some of the things you should consider to care for tears and stitches after vaginal birth:

Importance of Hygiene: Maintaining cleanliness. Practices such as washing hands before and after using the toilet and changing sanitary pads frequently can prevent infections. Using antiseptic solutions to clean the tears and stiches as recommended by your doctor can also be beneficial.

Rest and Recovery: Rest plays a pivotal role in healing. It's advisable to avoid strenuous activities and seek assistance from loved ones when needed.

Using Ice Packs: Ice packs (cold packs) can alleviate inflammation and pain in the perineal area. They should be worn for about 10 to 20 minutes and are typically disposable to prevent contamination. In addition to single-use cold packs there is a wide selection of cold packs that are for multi-use.

Exposing Stitches to Fresh Air: Allowing your stitches to breathe can expedite the healing process. Consider spending a few minutes daily without underwear.

Stool Softeners: Stool softeners can ease bowel movements, reducing strain on the stitches. They can also alleviate pain during postpartum recovery.

Home Care for Vaginal Tears: Post-delivery, you might experience discomfort as your tear heals. To ease this, consider the following:

• Use a peri-bottle to wash after using the bathroom.
• Gently pat dry the vaginal area instead of wiping.
• Apply ice packs or special sanitary pads with cold packs.

Change your pads regularly (every 2-4 hours for episiotomies).

• Avoid constipation by drinking plenty of water and using stool softeners.
• Take sitz baths regularly.
• Sit on a donut pillow, especially if you had a severe tear.
• Avoid exercises or movements that irritate the perineal area.

Increase your fiber intake to avoid constipation and discuss consuming stool softeners.

• Use over-the-counter pain medications such as Ibuprofen.
• Use hazel witch spray to alleviate pain.
• Line sanitary pads with witch hazel pads.

Always consult your healthcare provider before taking any medications, especially if breastfeeding.

Activities to avoid

Sexual Intercourse: Engaging in sexual activities immediately after giving birth can be painful and might complicate the recovery process. It's advisable to wait until complete healing.

Strenuous Physical Activities: Heavy lifting or excessive movement can strain the stitches and delay recovery. It's best to take things slow and allow your body to heal.

Signs of complications

Infections and Odors: A foul-smelling discharge or excessive bleeding can be signs of an infection. It's essential to monitor any changes and consult with a healthcare provider if needed.

Severe Pain and Discomfort: While some pain is expected, severe pain or increased discomfort near the stitches is a cause for concern.

Contact Your Healthcare Provider if your stiches become painful or have an unpleasant odor or it you experience symptoms like fever, chills, have issues related to urination, or you lose control over your bowels.

What can be done to avoid stitches during a vaginal delivery

While it's not always possible to prevent them entirely, several strategies can help reduce the risk the chances of vaginal tearing and having stiches. Prenatal perineal massages, especially in the weeks leading up to childbirth, can increase the elasticity of the perineal tissues, making them more flexible during delivery. You can do perineal massage on your own, with a partner, or a perineal massage tool. Adopting certain birthing positions, such as squatting or being on all fours, can also help in reducing pressure on the perineum. Controlled and guided pushing couple with breathing techniques (hypnobirthing), often under the direction of a midwife or doula, can allow the perineum to stretch gradually. Warm compresses applied to the perineum during labor is shown in studies to increase blood flow and elasticity, further reducing the risk of tearing. Lastly, staying well-hydrated, maintaining good overall health, consuming the right foods and vitamins, can keep the skin and tissues more resilient. It's essential to educate yourself about your options in an in-person child education class or an online childbirth education class, and more important, discuss any concerns and potential preventive measures with a healthcare provider to ensure a safe and informed birthing experience.

Sources:
https://my.clevelandclinic.org/health/diseases/21212-vaginal-tears-during-childbirth

https://www.verywellfamily.com/when-will-my-episiotomy-stitches-dissolve-2758693