swisspea t1_iztpipz wrote
Reply to comment by Skyblacker in A question on the history of perineal stitches after giving birth by Endorion
Untrue. I was stitched “too close” after I had my first, and it was only a first degree tear to begin with. While I absolutely believe this was not an intentional “husband stitch”, it was observed by my postpartum midwife and I needed some massage to break up the scar tissue from that botched job. Luckily I’m fine now, and have had two uncomplicated births and easy recoveries since the .
sfcnmone t1_iztrd1h wrote
The classic (but I’ve never seen it in 25 years of L&D work) “husband stitch” was put deep into the underlying muscle. A 1st degree tear is so shallow that it doesn’t effect the muscle.
Someone could tie a first degree tear stitch too tight, for sure, in an attempt to make the woman’s vulva “look right”, whatever that means.
Skyblacker t1_izttbzu wrote
Or maybe the vulva is just so swollen and torn right after birth that stitching it back into place is more of an art than a science.
sfcnmone t1_izu7hcl wrote
Oh well yes I’ve done “some” stitching and yes it is absolutely an art. In fact, deciding whether to put any stitches at all into shallow tears is an art. Midwives tend not to sew shallow tears (1st degree) as long as they aren’t bleeding, because the stitches are often much more uncomfortable than unsutured “skid marks“. Not to say that vulval tears are particularly pleasant no matter what!
This doesn’t really work well for deeper tears, where the muscle or small sphincter are torn. That’s really the point of OP’s question.
My observation, from delivering a couple of thousand babies, is that first time teenagers almost never have deep tears, and first time 35 year olds almost always have tears, and so probably there were fewer tears hundreds of years ago.
Skyblacker t1_izubiqq wrote
I've also read that pushes during natural birth tend to be shorter (less than 10 seconds each) than when coached through an epidural, and it's long pushes that increase the odds of pelvic dysfunction afterwards.
I actually ran that experiment myself during my last birth. While coached, I watched the clock behind my doctor and deliberately did not go over 10 seconds per push. It made a difference!
After a previous birth, I fainted. But after this one, I still had enough energy to be hungry and demolish a cheeseburger from hospital room service. After another previous birth, I had hemmeroids that felt like continuous contractions. But this time when the epidural wore off, I was just sore like I'd overdone squats at the gym.
Were there other factors? Maybe. And I admit that this is anecdotal. But I do believe that shorter pushes made the difference between fainting from exhaustion and screaming in pain, to being merely worn out and sore.
And up until the advent of the epidural (which I love overall, don't get me wrong), shorter pushes were the norm.
sfcnmone t1_izupxtc wrote
Yes I absolutely agree. Sometimes women without epidurals even sleep right through a “pushing” contraction.
Sounds like you’ve got this thing figured out. I had a patient once who said “I think I’ve found my sport!”.
swisspea t1_iztwlb3 wrote
Oh gosh, that sounds so horrendous. I know more now.
Skyblacker t1_iztquhs wrote
So the issue was scar tissue. That's what I attributed my pelvic pain to after my first childbirth, until a pelvic floor therapist diagnosed vaginismus instead. She assigned pelvic relaxation exercises that might have been adjacent to massage.
I just think the phrase "husband stitch" is reductive and fails to acknowledge the complexity of pelvic floor dysfunction and treatment.
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