Perineal Tears, To Stitch Or Not To Stitch?

When it comes to discussing perineal tears, there seems to be so much misinformation, so let’s chat.

First of all, we must touch on the fact that there a several different degrees of tears.

An intact layout of the exterior genitalia, as a baby crowns.

First degree

Second degree

Third degree

Fourth degree

WHY do Tears Occur?

Sometimes tears are unavoidable, especially small tears. Some babies come out with such force and pressure, pulling the perineum tight in response, and can cause the skin to rip. In the moment, during a natural birth, will you feel it? Maybe, but you will probably be more focused on the fact that a child is emerging down your birth canal and about to come into the world to greet you, you won’t notice until afterwards, if you check, or if you go to pee and it burns on your perineum.

This study discusses how episiotomies, larger babies, an assisted vaginal delivery (with forceps or vacuum), an epidural, and induction, potentially being factors in tears.

This study reiterates how instrumental vaginal delivery can increase prevalence of tears, as well as length of transition (longer transitions were more so associated with tears, but we cannot help but wonder what caused those long transitions, but they don’t mention that).

Preventing Perineal Tears

• STAY UPRIGHT, listen to your body and allow baby to descend naturally, without coached pushing or purple pushing, let FER take over
• Gently apply a warm compress on your perineum as baby descends. If you can do this yourself entirely this is optimal. There’s no need to push on babies head, pull on your perineum, or enter your vagina like some providers do. As baby is naturally and successfully descending, simply place gentle pressure with a warm wash cloth (can add oil as well if desired) on the perineum
• There is no indication the pre-labor stretching, massaging of the perineum, or kegels work to strengthen or loosen the perineum, so this is truly unnecessary. See a pelvic floor therapist if you are concerned about the firmness or lack thereof of your perineum during your pregnancy, a pelvic floor therapist may will have some good tips to protect those pelvic floor muscles!!

Can Perineal Tears be Managed Without Stitching?

There are many reasons why someone might want to avoid stitches. This includes the infamous “husband stitch,” prolonged healing, improper healing, lack of sterility, pain, swelling, pelvic floor impact, and more. Not to say that NOT getting stitches does not come with risks, because that choice does come with risks, too.

If you have a first degree or second degree tear, you may choose to heal naturally!

• Comfrey root (found here), an herb that contains natural Allantoin (which also helps form the umbilical cord and the baby's bladder in the womb), is an amazing all around healer and helps bind skin. Mixing this with warm, raw manuka honey (found here), turmeric (found here) and witch hazel (found here) can make a soothing, anti-bacterial, anti-fungal natural stitch to encourage your body to heal quickly on its own. Apply warm Nori wraps (found here) and/or gauze over the area to gently seal, and prevent mess and stickiness all over your underwear/postpartum pad.

Be sure to cleanse well with a peri bottle mix after every bathroom trip, and re-apply to prevent bacteria growth. This does not always work for every individual and even after making this choice, it’s very possible to decide to get stitches. Should you change your mind, you can always go to the local ER to request stitches. Or, you may decide to get stitches right away, that’s fine too!!

A common misconception is that a hospital transfer is required for stitches. Nope! If you have a midwife, she can stitch you, too!! And luckily, tear repair is not something that you have to absolutely rush to the ER for right away even if unassisted. You should give a hustle if you have a severe tear, but for a tiny tear, enjoy those golden hours with your babe and then go, and do not admit baby, then check out once you’ve been stitched. There’s no reason to be admitted for 48 hours for stitches, because they will dissolve in a few weeks anyways, but if you want to stay, you can do that too.

An example of perineal stitches: