The "Husband's Stitch": Unnecessary Episiotomies and the Women Who Hate Them
Back in the day it was referred to as the “husband’s stitch.”
During labor, doctors routinely cut a 1-3 inch incision in a woman’s perineum– the skin and muscle between the vagina and the anus– to increase the size of her vaginal opening. After the birth, he’d stitch it up tightly in the hopes of improving a couple’s future sex life (or the husband’s, at least). But too often the procedure did the opposite, occasionally making mom feel so sore and uncomfortable she simply could not have sex, let alone good or frequent sex.
The official name for this procedure is an “episiotomy.” Routine episiotomies are no longer recommended, but many argue they are still performed too often. And women are getting pissed off about it.
Recently The Huffington Post ran a story about several women who felt their episiotomies were unnecessary, painful and harmful. One of the women was Babble blogger Rebecca Woolf, who has been a vocal opponent of routine snipping:
“My episiotomy was not slight. It was severe and not only did it take me weeks before I could pee without crying, but it took me a year before I stopped itching my crotch. It was like a yeast-infection on speed as it was healing. Not fun at all. Not only that, but it STILL doesn’t feel the same down there. He cut through the muscle tissue so the whole vag-area feels just very funky and sad.”
For several generations doctors thought a “clean cut” would be better than a “messy tear.” The cut was supposed to help women heal more easily, experience less urinary incontinence and enjoy a better sex life. In 2005 a large study found that episiotomies not only didn’t improve recovery times or pain after birth but increased the risk of deeper tears and pelvic floor problems. While most first time moms do tear during childbirth, most tears are superficial, 1st or 2nd degree tears, affecting only the surface of the body. Occasionally women tear into the muscle but an episiotomy always cuts through the muscle and they can lead to deeper 3rd or 4th degree tears, kind of like when you snip the edge of a piece of cloth can make it rips more easily. In 2006 ACOG changed their guidelines, discouraging episiotomies unless medically necessary.
“Medically necessary” typically means that the baby needs to come out right now and we don’t have time to wait for the perineum to stretch slowly and an episiotomy has fewer risks than pushing the baby back up and doing a c-section. (Sometimes an episiotomy is necessary and clearly reduces risks for mom and baby.)
But as this plays out, “medical necessity” ends up being a pretty subjective call on the part of the care-provider.
A 2005 landmark study on home-births published in the British Medical Journal tracked over 5,000 mothers in the US and Canada, and found the episiotomy rate for low risk mothers was 2.1% at home, vs 33% in hospitals. These are all low risk moms but very different rates of episiotomy, suggesting care-provider preference and context play a key role in determining whether you’ll get one.
You can see this today. In NYC, the current rates vary tremendously: At St. Luke’s Roosevelt Hospital where there’s a 64% epidural rate, 8.7% of women are given an episiotomy, that’s half the state average. Across town at Cornell, the episiotomy rate is 35% (double the state average), with a 97% epidural usage.
All of this suggests that the best way to avoid an episiotomy is to get a doctor who rarely performs them.
You can also get a doctor or midwife who has lower rates of other interventions that can increase the need for an episiotomy such as epidural, vacuum or forceps delivery, doctor-directed pushing (as opposed to mom-directed pushing) and pushing on your back. Childbirth Connection provides a comprehensive list of tips for avoiding an episiotomy.
If you want an epidural, as many laboring women do, you can reduce the risks of episiotomy by asking that medication be turned down for pushing so you can get in a more upright position and feel things a bit more to give you increased control. You can also hire a doula, as studies show fewer interventions are used when a doula is present.
But really the number one way to avoid an unnecessary episiotomy is to go with a doctor who doesn’t do them. Rebecca Woolf did this for her second birth and says she was up and taking long walks within a couple of days.
“I had a shitty experience that led to a really incredible one,” Woolf said. “For me, it’s just important to share [my story] with other people, so that other women will put up a little more of a fight than I did.”
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Ceridwen Morris (CCE) is a childbirth educator and the co-author of the pregnancy and birth guide From The Hips. Follow her blogging on Facebook.
photo: wikipedia
Luckily, with the three kids that I ahve had thus far I have not had or needed an episiotomy. I am staunchly against them. If the cranium on #4 is so big that I need one, let me tear, yo. I demand it. Don’t threaten me with the cut, that happened once, to which I replied “No, I got this.” And I did.
http://www.deathmetalmommy.blogspot.com
I had an e with my firstborn, and actually have some intermittent issues even today (25 years later) with two small horizontal bands of scar tissue from it. My gyn promises he can repair it but the idea of cutting there *again* freaks me out. I’m dealing.
As I share in my book, routinizing the episiotomy fits neatly into cultural anthropologist Robbie Davis-Floyd’s brilliant concept of hospital birth as a techno-ritual: it displays our culture’s tendency toward impatience while also expressing “the value and importance of one of the technocracy’s most fundamental markers — the straight line.” I also quote the opinion of a Dutch midwife who sees episiotomy as “the last word by doctors that ‘you really cannot do this without our help’.”
Oh, but yes we can. I didn’t have one with my second!
Marcy Axness
author, “Parenting for Peace: Raising the Next Generation of Peacemakers”
In the last six weeks of pregnancy, we practiced perineal massage. I strongly recommend it as a way of preventing episiotomies and tearing. And I would echo the above sentiment – use a midwife.
I’ve had 4 kids in 3 different hospitals and never once had anyone even allude to an episiotomy, much less suggest it.
My episiotomy was 43 years ago, but I remember it like it was yesterday. Fifty-one stitches and a year of pain. When standing, I thought my insides would fall out. Hard to stand and even do dishes. It wasn’t corrected until my second child 15 months later. My second child I begged for a c-section, to no avail.
I had an old fashioned doctor who gave me an episiotomy, and yes, without my asking for it, but truthfully, I didn’t mind. It made my labor go very quickly (once she crowned) and he did such a a beautiful job stitching me back up, I have had no trouble with it and I can’t even tell I ever had one. I have had compliments on how, well, ‘tight’ I am from my partners (and now husband). It itched for about two days while it healed. No biggie.
I would have much rather had that then the doc let me tear in god knows how many places and ruin my labia, etc. I am very happy with my vagina, post baby.
I had two children 12 years apart. My doctor told me on my second child it would be like having my first all over again. Wow! I didn’t expect to hear that. The first delivery was hard and I didn’t want to experience another episiotomy but I did. Then years later the doctor wanted to do a hysterectomy and he said that episiotomy would have to be done I said NO WAY! No surgery for me.
I had an e with my first … I was tearing and the doctor helped it along so it would be a clean cut…. I tore slightly with my secondand for my third I ended up with 3rd or 4 th degree tear after a natural pain med free delivery … I’d much rather the E over tearing!
I had an episiotomy with my son, my first child. I spent the next 9 weeks healing, and am still dealing with issues from it a year later. I hated it, and it caused more pain and issues than any other part of my healing. I know that my son needed to come out quickly, but I would have preferred to tear, honestly.
I was 19 when I had my 1st baby.. I was cut only because my son was almost a 9 lb baby.. I had him and they sewed me back up w/o numbing me 1st.. This hospital didnt have birthing rooms so we had to go to the OR.. I was home in 4 days and starting healing… I itched never burned and our sex life was never painful.. Our last 3 babies where vaginal deliveries like the 1st w/o any complications … It does sadden me that some women have had so many problems after recieving one…
I have had two for the two births I had. With the first one as the doctor went to cut, I ripped. I healed up in a few weeks long before the six weeks checkup. The second one was a diagonal cut and it did hurt worse but healed relatively fast as well. I have suffered no ill effects from these and it has been over 26 years since I had it done. Maybe I had doctors that could sew one up better. I do know that my daughter did not have to have one either time and I guess she was glad not to.
My ob/gyn is against doing them, so I’m very thankful that it was never an issue!
I had my first child at 18 & I ripped from one end to the other, I have to say that was very painful. When I had my second child 6 yrs. later the Dr rubbed the area & still had to cut me but I have to say I would rather be cut any day over being ripped. I strongly believe that every women is different in every situation.
I have had 4 four babies…I had obgyn’s with all four, my third baby is the only one I was cut for but she was also the biggest baby! All 3 other times it wasn’t an issue! no tearing or cutting!
I had my daughter with a midwife in a birthing center. I had an episiotomy with her because she started to come out so fast that I started tearing, upwards. The midwife numbed me and did a terrific job of stitching me up. So much so, I’ve had OB/GYNs comment that they couldn’t even see the scar. I had a normal recovery with it and no long-term effects.
Now, with my son, I also had a midwife, but in the hospital. She did not want to do an episiotomy, nor did I want one again. But once again, the boy decided to come out fast and I tore like the dickens, upward and sideways. The midwife stitched me up, but I still feel where I ripped (seven months later) and sex can be painful at times because of it.
Each woman’s experience is different, but I’d rather have an episiotomy than tear like I did, based on my experiences.
I had my 1st daughter at 17 she weighed 9lb 5oz with a 14 inch head so my Doctor gave me a Episotomy he had me spray myself with demaplast & set under a heat lamp 15 min 4 times a day, but I had no problems from it. My 2nd child a son weighed 8lb 6oz a month and a half over due, and dilated 7 1/2 the wholw time & induced daily for the last month everyday and no baby the baby started showing signs of distress they were going to c sec the next morning but I went into labor that night. 1hr and 45 min later after having him going down the hall I hqd to be packed & stitched unpacked and cked to see if the placenta had been left (it wasn’t) and packed again. But no problems from that either thank God. And no more after that.