You might find something on that in this book about the history of c-sections. It goes into a lot of detail about the changing field of surgery in general and how that intersects with the shift from female to male providers being in charge of birth. I wish I could be more specific but I don't have a copy of the book in front of me.

Good luck! It's a fascinating and disturbing history. I'd love to hear more about what you find.

This is interesting! I’ve already let my husband know that I’m relying on him to honestly communicate the amount of physical violence I will visit upon someone who tries a “husband stitch” on me. His fast talking will keep their body whole.

It's medical malpractice so you should also mention the lawsuits and complaints to licensing board that you will visit upon them as well.

Fair, but they have lawyers and money is fungible. Your meat suit bits are much less so.

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Was it better for her, though?

Usually a husband stitch means painful sex for the woman, sometimes to the point where they can no longer have sex or enjoy it.

Not sure if this is exactly the history you wanted, but here's a quote from Robert Caro's biography of Lyndon Johnson:

“During the 1930s, the federal government sent physicians to examine a sampling of Hill Country women. The doctors found that, out of 275 Hill Country women, 158 had perineal tears,” Caro says, citing the the results of a study that noted, “many of them third-degree ‘tears so bad that is difficult to see how they stand on their feet.’”

I'm not sure how/if you'd be able to find the original study, but it sounds like at least in this area of Texas the midwives weren't doing any stitching.

Like I said — and the downvoters seem to have missed it — this probably didn’t really happen, and if it did, I’m as appalled as you all are.

But, yes, my wife thinks better sex is better. (She credits the deepened emotional bond of sharing parenthood together. Which is totally probably the answer.)

Anything interesting about tearing up? 18 year old me was not expecting to rip everything upwards with my first so that was fun lol

We were in the Middle East during this particular birth (Abu Dhabi) but the surgeon literally said out loud, “and one stitch for your husband”. I was ignorant to the concept. It was much later when I realized what he meant. By then it creeped me out.

I heard from multiple women, that sex is better after baby, not sure what the reason is for this.

The downvotes are probably because you said that a husband stitch would make sex better if it had happened. That’s patently untrue for both parties

Henci Goer's book "Obstetric Myths Versus Research Realities" might be a good place to look for that kind of information.

The practice of using suture stitches on the perineum in case of tearing due to childbirth is very ancient: it was already recommended as early as in the XI century by Trotula de Ruggiero, a woman medic from Salerno. I don't know if she was the very first to do that, and if I had to make a guess I'd say no.

Omg me too! My clit felt like someone had put a cigarette out on it when her head crowned and I ripped at the top. I was fully expecting a tear on the bottom but nope. What an ordeal when the Dr who stitched me up wouldn't use any local anesthetic. I never made a sound when I was in labor or during delivery but I screamed when he began stitching without freezing me first. Did you get sewn back up?

I thought it was made up.

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Unfortunately, no. Here's an article about it

I didn't know that was a thing either. I had to get emergency reconstructive surgery as she shredded my vagina as well as tearing my clit. It took months to not be in constant pain. And now I have decreased sensation and difficulty climaxing.

But of course all the MALE doctors I've seen are all "wow I can't even tell you had a baby let alone had that extensive tearing".

I'm so thankful that everyone I worked with at my birth and recovery including all the or staff were women.

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That’s only when it’s extra or unnecessary stitches. If you’re unlucky enough to tear or need an episiotomy, trust me, you’ll want the normal stitches.

It is not from a husband stitch if that's what you're implying.

Only one stitch is called that, it's a stitch past the tear where it would have been naturally open. The stitches putting things right where there was tearing are a part of normal health care.

Source?

No, it's not made up. I requested one when I gave birth vaginally, and I would request it again. It did hurt for the first month or two after we resumed sex but it wasn't so painful that it prevented my enjoyment.

My doctor told me it's also called a crown stitch and described it to me before doing it. Instead of just stitching the "right" portion of the vaginal entry at the perineum, the crown stitch also stitches a little of the vaginal wall and brings it up to that "ring." (I don't know the name of the sphincter there.) Maybe I got lucky, but I would not hesitate to do the same thing if I were having a baby again.

can you explain why? you said it hurt. what are the pros?

I had no idea you could tear up.

Lawdamercy.

Was this ever a real thing or just a joke?

An aside from your research topic, but to address the frequency: Having done a few rotations on ob/gyn l and d, I'd say ~95% or more of women have at least a grade 1 tear. I've only seen one birth out of ~50 that hasn't required stitches. Now you can get away without stitches, but the stitch hides some of the raw skin and prevents some of the pain during urination. There's a widespread belief that there's a "husband" stitch that occurs. Some background research into the prevalence of this notion would be interesting to look into as well.

There is a difference between a natural tear and an episiotomy done to prevent that tear.

A preventative cut to expand the vagina, so the tearing and rupturing is controlled, has nothing to do with the "husband stich"

So I found this post very confusing.

If a woman ruptures during birth, should the doctor just say, oh well that's nature?

Extra/unnecessary medical procedures are illegal, just adding stitches on the hope/guess that it might make the vagina smaller, is illegal.

So what is the point of this post?

That's definitely a very uncommon tear, relatively speaking, since that area is much more muscular.

Hi! I'm an ob/gyn.

I don't have an answer to your question, but I have commentary on the current state of perineal laceration suturing that I want to share here to keep some harmful misinformation from spreading.

First off, perineal lacerations are very common. It is very common to have lacerations with one's first vaginal delivery.

They get measured in "degrees." 1st-degree is very superficial, 2nd-degree involves the underlying structure of the "perineal body," and 3rd and 4th degree involve some or all of the anal sphincter.

That's an assessment of perineal lacerations that's very geared towards their significance for future pelvic organ prolapse (having the vagina bulge outward) and dysfunction with defecation. It doesn't include labial lacerations, lacerations that involve the clitoris or clitoral hood, or periurethral lacerations -- those all lack a grading system, and in my experience, get described subjectively.

/u/illraceyou96, /u/Fearless_Reaction592, /u/Snakandahalf -- non-perineal pelvic lacerations are understudied. It's recent that we have good data on what we can do to reduce the risk of perineal lacerations (perineal massage, for example), and I think non-perineal lacerations will be next. I'm going to talk a little bit about why.

Although misogyny is a constant force in our world, there are things that medicine likes and doesn't like to study. Medicine likes studies with clear differences between groups and outcomes: people either did or didn't get a medication, and you look at hospitalization rates after. Clitoral and labial lacerations are tricky because they are soft-tissue injuries happening after the very unpredictable interactions between a fetus/newborn and a vulva... and then the intervention is also very randomized right now, because there's a wide range of how aggressively physicians repair these kinds of lacerations.

So I think/hope that over the next 20-30 years, we'll see development of better ratings to measure labial/clitoral lacerations, which will be followed by proving that they correlate with subsequent risk of pain or sexual dysfunction, and then that will be followed by studies to see if interventions reduce their risk and/or if we can standardize management of them.

(This kind of standardization happened for cesareans in the last decade, for context.)

I've had the privilege of taking care of a lot of people who had unattended deliveries without repair of lacerations. I'd like to say without a doubt that repairing perineal lacerations is good. People who have unrepaired lacerations are at high risk of going on to have pelvic organ prolapse, which can cause issues with discomfort with activity, sexual dysfunction, incontinence, and constipation.

/u/biRdimpersonator brings up the "husband stitch." I've had the good fortune of only training in places with a high degree of compassion and patient-centered care, and during the ongoing takeover of ob/gyn by women. Medicine is becoming less patriarchal and paternalistic. I have never seen a "husband stitch." I have never seen anybody do anything more than was needed to return the vulva (close) to the state it was in before the delivery.

Most of my work is in abortion care. Some urogynecologist might come through here and correct me on the current state of research!

When my mom was having her nursing school rotations, she had to spend time in L&D, and recalls a birth she witnessed where the mother tore in 4 different places, including up to her clit. I just can't imagine.

Sorry, I don't know any source in English (or Spanish). I remember reading about this on the Italian edition of the National Geographic and from some other reputable sources, but I can't pinpoint them precisely.

Thank you!

My first baby had a very large head. I had an episiotomy, and stitches to repair it (nothing extra). Everything went well.

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"A very singular character was Trotula, a noblewoman from the Norman family of De Ruggiero from Salerno, active and famous around 1050...she was the founder of the modern Obstetrics and Gynecology, and wrote the book “De mulierium passionibus ante, in et post partum” (The sufferings of women before, during and after delivery). Among other indications, she wrote “it is necessary to stitch perineal lesions due to delivery”, a very modern thought."

It was - and is - a very real thing.

Husband stitches are an urban legend. If sex hurts after childbearing, it's more likely to be vaginismus or some other pelvic PTSD. Postpartum physical therapy can often resolve it.

This is gold. Med Student here. I was never sure how to broach the husband stitch matter with my OBGYN attendings, usually during deliveries the perineal repairs have made perfect sense! For all the reasons you mentioned. Where it's gotten a bit more grey for me is where I was a part of a particular vaginal reconstruction+prolapse repair surgery (the former was an add on by the patient) with an awesome urogyn I've learned under (she is a great surgical educator, actually let's me cut and stitch and enjoys teaching) , but I still remember one comment of "don't worry about how the tissue looks here, it'll feel the same and neither will notice, it doesn't have to be aesthetically pleasing. Her husband and her are gonna love this." It was very frank and I enjoy that about her sense of humor. I was at a bit of a loss though about what to make of that on a grand scale as it did remind me of the "husband stitch." At this point I'm interpreting it as something the patient wanted for their own sake? Kind of like how some men opt for penile lengthening/entension surgery? (Although that's less common) I'm no expert on this topic I'm just trying to parse the situation with the now very negative, rightfully so, perception of the husband stitch. I understand a major difference here is of course the patient being the one to make this choice. Ie there's a respect for autonomy here. (At least from what's visible on our end)

I should clarify too, I only participate in procedures or surgical operations with patient permission as to how exactly I'm participating*

Is it super painful or something, why is it so offensive? If I was getting stitches and the doctor said adding another would improve my wife's sexual experience, I'd be like 'lets do it'.

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It causes the woman tremendous pain during intercourse. Many women who have had this done to them are unable to have pleasurable sex ever again without additional reconstructive surgery.

I got a digital version, I will let you know what I have found as soon as possible. Thank you!

Hi there! Glad you're engaging with this.

> but I still remember one comment of "don't worry about how the tissue looks here, it'll feel the same and neither will notice, it doesn't have to be aesthetically pleasing. Her husband and her are gonna love this."

Yeah, that comment makes me wince a bit, too. I'm trying to picture a posterior repair surgery and where somebody might say that and really mean it. Maybe a bit of puckered vaginal mucosa? It might have been a surgical situation where she had sorted the underlying support structures and it left the mucosa looking a little odd...? I'm making this up.

I think that if your impression of this urogyn was otherwise positive, and she was otherwise compassionate and patient-centered, you can forgive a comment that didn't land right and we can give her the benefit of the doubt.

I remember a very sweet 60-year-old patient whose husband was absolutely doting. They were such a sweet couple in pre-op, and he was so warm and positive... and then as we were about to wheel her away he said "va a estar coma una quinceñera, si?" (And it'll be like it's her sweet sixteen, right?) (Except fifteen not sixteen.) And we all winced and groaned... but she laughed! And when I checked how she felt about it, said she was happy for him and looking forward to that, too.

So it's important to remember that, even if you're trying to have perfectly feminist and respectful language, your patient might not... and that's okay! Meet them where they are. Don't reflect negative ideas back at them, but engage with the positive in what they're saying.

> At this point I'm interpreting it as something the patient wanted for their own sake?

I think so. Or something that your attending has heard many times from patients. No urogyn wants to do a repair that winds up uncomfortably tight. Even if the doctor isn't compassionate, that's a miserable patient that keeps coming back unhappy! Who wants that? We're surgeons. We like to get things done right once and have them be fixed and that's it.

> (she is a great surgical educator, actually let's me cut and stitch and enjoys teaching)

I think that it's good for you to keep in mind in public forums that people are reading your words without an understanding of supervision in medical teaching.

Like, I know that we're talking, say... putting a single stitch in the exit site of a retropubic sling in an incontinence surgery... not doing the imbricating stitches of a posterior repair. And I suspect that the cutting is the trimming the excess mucosa once it's been freed up from the underlying tissue, not making the opening incision on a cesarean. i.e., appropriate times for uncertain hands, where errors can be easily guarded against or corrected.

But how will your words sound to somebody who has their surgery next week and is really nervous?

Thank you for your answer and source! Very interesting.

Thank you!

I know there is a difference, but so far I only found sources on episiotomy and the stitches following that procedure, but no sources on stitches after natural tears.

I have said nothing about husband stitches, although I read about the practice (or urban legend) while googling the subject of pereneal stitching. I also have never said that doctors should let tears happen (and leave untreated?), so count me equally confused.

Perhaps the women didn't want any more kids and this was one way to discourage their men from wanting to have sex.

It doesn't matter how it looks, neither will notice it. That's fine for vaginal intercourse. What about if the couple routinely partake in cunnilingus?

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 .

I am not a historian or history buff, so this is some anecdotal stuff that might help in your research. in brazil (and I believe other Latin cultures) there's a practice called "the husband's stitch" and it is exactly what I sounds like. the dr will do one or more stitches than needed after episiotomy or perineal tear, in order to make sex more pleasurable for the husband's, completely disregarding the woman's comfort and safety. a lot of people who had this done report extreme pain and sometimes can't have penetrative sex at all afterwards

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.

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.

What's right for you isn't right for anyone. Also, the literature doesn't support husband stitched as it messes with the way the vagina unfolds during sex.

Secondly, husbands would ask for this when their wife was under andI and couldn't consent to the "procedure". The entire basis for the "husband stitch" is misogynistic.

It is just as barbaric as FGM.

I wonder if something was lost in the shift from midwifery to male-dominated hospital births. Maybe our ancestors' midwives had knowledge of childbirth and recovery that's been lost to time or is only just being rediscovered.

Source?

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I was speaking from personal experience, but here's an OB's take:

https://blogs.webmd.com/womens-health/20180316/an-ob-weighs-in-on-the-husband-stitch

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.

A blog on web MD is an opinion not a fact. Secondly, you're speaking of anecdotal evidence. One perspective among millions of perspectives on the topic.

That's not statistically significant and, quite frankly, it's disturbing that you think those are valid sources.

I guess I just bristle at the phrase "husband stitch" because it's reductive of a biological system that does not get nearly enough attention in medicine. Sex can hurt for five gagillion reasons after childbirth and more doctors need to recognize that, screen for it, and treat it.

Oh gosh, that sounds so horrendous. I know more now.

What an interesting question! I was wondering about this myself. I hope when you gather more information you’ll come back and update!

Hard to believe they wouldn’t be in constant pain and discomfort

> But how will your words sound to somebody who has their surgery next week and is really nervous?

For what it's worth, I understood what they meant. Not necessarily the particulars but I knew that they meant under full supervision, after years of rigorous teaching and with very minor and routine procedures.

If you're never given the opportunity to practice, you'll never learn. I'd rather trainee doctors practice during their placements rather than only ever observe and then be thrown in the deep end when they qualify.

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.

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.

Well I’m an OBGYN and I’ve worked in tens of hospitals with hundreds of other obstetric doctors and none of us do it. It’s an urban myth, a bad joke.

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Fwiw I had the same female OB deliver my two kids about 20/22 years ago. Both labors once progressed moved fast. In both cases my OB cut me to let the babies out so I wouldn’t tear horribly. I never thought much of it bc from any other mom I spoke with my labors were incredibly fast.

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!”.

I'm not familiar with how to do specific sections of your comment as quotes, so sorry is a bit disjointed! I firstly totally agree that it may have been some non optimal word choice. She's truly awesome and her patients love her!

I know I suffer from some occasional wicked "foot-in-the-mouth-itis" we all do.

And I should clarify now that you mention it... this isn't r/medical school.

I'm not doing the surgery or anything high stakes during the procedure. We're talking closing laparscopic port sites, parts of open incisions (after the attending has got them started or gotten the key bits done) and certainly not doing anything major with knife. And all under active guidance from the surgeon. Not to worry anyone 😅. We start with watching and work our way up gradually as we prove ourselves competent as patients would, as I imagine, hope.

Speaking from the USA perspective:

Don’t threaten the person operating on you for something they won’t do anyway

Fair point, I'm not sure! But I should mention It wasn't actually that profound. You'd kind of have to be looking for it and that was DURING the surgery. I'd imagine with healing it would be neglible. Possibly some scarring? It's not my area of expertise, but I imagine it would improve with time and be worth it from the patients perspective the vast majority of the time.

It could have been purely poor word choice? However I do think there was truth to it in that it would be hard to notice in the first place.

1. Where did I say it was right for everyone or even encourage ANYone to get one? Yet here you are, being hypocritical by chastising me for something I had every right to do simply because I didn't have a bad experience with it.
2. I'm a woman. Please do not tell me that I am being misogynistic. That's as bad as women who don't allow men to hold doors open because it devalues a woman's ability to open her own door. Sometimes people can choose to do things for someone else for reasons that have NOTHING to do with with their "value" as a person.

Wow do you remember what this had to do with LBJ?

Thank you for saying this! Glad to hear it’s not being done. I hope that is reassuring to people reading this and worrying about it.

Speaking from the reads American women's experiences on reddit and facebook perspective:

I don't think pre emptive threats are the way to go either but it's definitely still a thing in places over there.

If I was a woman giving birth I would want to specifically mention it to the obstetrician to feel them out and make my stance on it super clear. Why leave something like that up to chance.

> There are no scientific studies that show how many women have been affected, nor is there a clear method for evaluating how prevalent the husband stitch truly is in obstetrics.

Speaking as an obgyn who trained in an extraordinary diverse set of regions:

This practice has been long abandoned in the United States so much so that just about every obgyn and midwife knows the comeback, “sir, how small do I need to make it for you to fit?”

Where does this practice still happen? Certain geographic parts of the world where women’s rights are largely suppressed and where women are overwhelmingly exposed from the medical profession.

The moment you bring up legal threats with your obgyn, what you can expect is:

1. The possibility of them rightfully dismissing you from their practice as there is an assumed hostile patient-physician relationship which impairs their ability to treat you with an objective and standardized quality of care

2. Increased risk that they and other medical personnel will limit their exposure to you for fear of being implicated into your threats. In lay terms: you will get less contact with the medical team because they are scared of you making them in a law suit

3. Damaged rapport which can have any other number of fallout impacts even if as small as a less amicable relationship

4. Any threat of physical violence will also, often, but you a one way escort by security out of the hospital and ban from L&D and post partum. I have been punched, tackled, but, had patients try to stab me and nurses get that even more than doctors. I don’t screw around with safety and neither should any other medical personnel.

Obgyn cases account for 7 out of the 10 highest lawsuit payouts in US history. We all get sued and it’s often for tongs that are not in or control.

A simple: “please no husband stitch” will get you all the reassurance and care you need, and this can be addressed on your first visit, last visit, or any of the ten months of contract between conception and delivery.

I didn't, actually. I just said what I was thinking and how I equated the procedure to other commonly done "procedures ". It wasn't a personal attack.

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TrustedAdult, thank you for taking the time to put this information together. It's very insightful and extremely informative.

Some things referenced in your response I wasn't even familiar with, so I did some research and I'm now way more educated. Once again thanks.😊

I think it’s in a chapter that focuses on how hard life was for people, particularly women in the region of Texas that LBJ represented.

Is there a term for lacerations that happen inside the vagina during child birth? Is that part of the scale or not because it's not the perineum?

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I will check it too. Thanks

I was thinking about it too. It is very interesting.

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Like I just said, I don't think pre emptive threats are the way to go either

While I appreciate your comment I think it would be more productively directed at the woman upthread who is talking about actually PHYSICALLY threatening her obstetrician before she gives birth.

I'm an old Australian man living in Australia so Im not part of this situation. I was just trying to point out to her that malpractice is generally illegal since it keeps happening to redditors.

Come to think of it not sure what country she's from either.

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