Having a baby is a rollercoaster. Lots of unexpected events can happen during and after birth and one of those experiences can be vaginal tearing and episiotomy stitches.
You may have a question (or 20) about this and since it's such a common occurrence, there's a ton of information out there to help.
Preparing yourself and your birth partner for the possibility of natural tearing or an episiotomy can help you make choices during labour, with the guidance of your midwife and doctor.
You'll also be better prepared for managing your wound and stitches after birth, as well as the recovery process.
The good news is that there are a number of ways you can care for your stitches at home to aid recovery and also make the entire process a little less painful and uncomfortable; leaving you to focus on spending precious time with your newborn instead.
That's where we come in. We've gathered everything you need to know about what to expect from tearing during labour and how to care for stitches after birth.
How common are perineal tears, cuts and bruises during birth?
Perineal tears, cuts and bruises are common.
It’s estimated that 9 in 10 first-time mothers who have a vaginal birth experience tears of some degree (which can include a graze, tear or surgical cut, medically known as an episiotomy) and approximately 60-70% of women receive stitches after giving birth [1][2].
The likelihood of tearing with subsequent births gets less common with perineal tears decreasing from 90.4-68.8% [3].
Tears range in severity from first-degree to fourth-degree, but thankfully the likelihood of occurring decreases with the severity.
Only 1% of women experience a fourth-degree tear during birth.
Can a perineal tear be prevented?
Nothing can be entirely prevented during birth, including the possibility of tearing — after all, you are pushing an entire human out of your vagina.
Are mothers superheroes, or are they superheroes? But, there are things that can help reduce the chance of tearing, including perineal massage.
The aim of perineal massage is to stretch the perineal tissue before birth and it can be done at home.
This is something you can do before the birth — in your third trimester — and your midwife will be able to guide you on the steps.
Some people also encourage controlled pushing during labour, which gives your skin time to stretch. Another method is keeping the perineal warm during the second stage of labour with a warm cloth. Finally, delivering in an upright (or non-flat) position is also said to help prevent tearing.
What is an episiotomy?
An episiotomy is where your doctor or midwife makes a small diagonal cut from the back of the vagina, directed down to one side in your perineal area (the skin between your vagina and anus) to help facilitate delivery [1].
An episiotomy doesn't typically cause problems afterwards but is only carried out if extremely necessary.
The procedure was much more common in the past but research has shown that it’s not always the best course of action during vaginal delivery [4].
There are a few different types of episiotomy incisions with the most common being a midline incision and mediolateral incision [5].
If your doctor or midwife performs an episiotomy, they will first give you a local anaesthetic so you won’t feel any pain.
Once the baby is born and you’ve delivered the placenta, a doctor will repair the cut with dissolvable stitches.
Why do you need an episiotomy?
There are a few reasons your doctor will perform an episiotomy but often it’s carried out to prevent the risk of severe tearing.
However, there’s no guarantee that an episiotomy will prevent more severe, natural tearing.
It’s something that you and your doctor can discuss based on your individual circumstances and your wishes. Other reasons include:
- If your baby is in distress
- If your baby is in breech position (which means their head isn’t coming out first)
- If there’s a need for assisted birth (including forceps or a ventouse).
What makes a tear more likely during labour?
A tear is more likely during labour if it’s your first vaginal delivery, with around 90% of women experiencing perineal trauma of some degree with their first baby.
You may also tear more if:
- You’ve been pushing for a long time
- You’ve experienced tearing before
- Your baby is over 8 pounds [6]
- You were induced
- Your baby is “sunny side up” (face up) during birth
Recovering from an episiotomy
After you’ve delivered the placenta, your doctor will repair the cut with stitches under anaesthetic so you won't be in pain.
These are usually dissolvable stitches so no need to worry about getting them removed.
If the tear is more severe, you may be taken to an operating room and given either a local or general anaesthetic and a doctor will repair the tear.
How long do stitches take to heal after birth?
The body is so clever when it comes to self-healing that your stitches should heal about 4 weeks after giving birth, often seeing improvement after 10 days or so.
Having said that, recovery does depend on the severity of the tear and, of course, everyone heals at a different rate.
You may experience soreness for longer than a month.
How long should stitches hurt after birth?
Your stitches might be painful for 2-3 weeks. If it goes on any longer than this, be sure to tell your doctor that you’re still experiencing pain.
You may also experience bruising in the area, which typically gets better after a few days.
While pain associated with stitches after birth is normal, don't keep quiet if it's really bothering you and always let your doctor know if you're in pain.
What to do if your stitches are itchy?
Now, you might be thinking that pain is the worst symptom to come from stitches but there’s something else that can be equally as frustrating: itching.
It’s common for stitches to feel itchy following birth, this is medically called anogenital pruritus [7].
While this is common in the journey of postpartum recovery, there are certain things you can do to help reduce it.
Given this is a highly sensitive area, avoiding using highly fragranced soaps and scented pads can be helpful and choose clothing that won't irritate the incision area.
Taking antihistamines can also help with any itching.
What should you do if you feel a problem with your stitches?
You know your body better than anyone and if something doesn’t feel right, ask your doctor right away.
If you're experiencing any new symptoms that don't seem normal, it's worth mentioning to your midwife or GP.
You also want to make sure there’s no possibility that the stitches have reopened.
How to tell if your stitches are infected?
Perineal infection is something you need to bear in mind during recovery. As with most medical procedures, there is always a risk of infection.
If you do suspect an infection, it's important to tell your doctor about it immediately so they can treat it straight away.
The key things to look out for are red and swollen skin in the area, persistent pain, oozing from the area, unusual vaginal discharge and smelly discharge.
You should also be aware of a high temperature, abdominal pain, more bleeding than usual, an intense stinging pain whilst peeing that doesn’t subside, and any issues going to the toilet.
If you have any kind of severe pain, you should always consult a healthcare professional.
How to help heal stitches faster after giving birth
Keeping your stitches clean is a top priority for recovery.
It’s recommended to gently wash your perineal area every time you go to the bathroom, which is easily done with a peri bottle (a handy squirt bottle), before patting the area dry with toilet paper or a clean cloth.
Kin’s Postpartum Recovery Bundle contains everything you need to aid this recovery in one package — taking the guesswork out of the healing process.
The Peri Bottle, which is included in the Postpartum Recovery Bundle, is a must-have for cleaning your vagina and perineal area without painful pressure, while the Mesh Panties are soft, stretchy and breathable and won't rub on your stitches.
The Soothing Padsicles are great for providing an instant soothing effect, while the Healing Foam helps fight bacteria and reduces swelling and itching, which is incredibly important.
The Nourishing Cream is a luxurious belly butter blend that prevents and reduces the appearance of stretch marks whilst relieving breast discomfort and itchiness. Designed to address symptoms of postpartum depletion including hair loss, fatigue, and brain fog, the Postnatal Vitamin supports mothers at least 6 months after birth and while breastfeeding.
Exposing your stitches to fresh air throughout the day can help with healing and make sure you're always wearing a clean pad by changing it regularly — every 2-4 hours.
Your midwife or GP is also likely to give you a stool softener to relieve any pressure when you go to the bathroom and to help avoid constipation.
Making sure you're having a regular bowel movement is all part of a healthy recovery.
Finally, starting pelvic floor exercises when your midwife or GP gives you the go-ahead can help with healing, improve circulation and prevent bladder and bowel leaking.
How to soothe the pain caused by stitches after giving birth?
Pain associated with stitches is to be expected but harnessing a few handy products can help manage this discomfort.
Keep things clean with your Peri Bottle and ease the pain with the Soothing Padsicles. You can also use the Peri Bottle whilst you’re peeing to dilute your urine and reduce any stinging.
Kin’s Sitz Bath, which essentially turns your toilet into a spa for your bits, is also a recovery essential.
Soaking your perineal area in warm water along with the Sitz Salts can help ease itching and aid the healing process.
It's also a nice idea to relieve pressure off your perineal tears through the use of something called a valley cushion.
It's an inflatable or squishy cushion that puts pressure on either side of your bum to leave the vaginal area and wound free from pressure.
Finally, don’t forget regular pain relief! With the guidance of your doctor, be sure to regularly take painkillers to ensure you're as comfortable as can be.
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