Stitches after Birth: Are they Overused?

This post originally appeared at Rebirththebook.com.
The following post is not meant to be medical advice, please discuss your unique situation with your medical team.
 
I wanted to take a moment to address stitches for perennial tears after birth. "Did you tear?" Is one of the leading questions I hear when discussing births, and understandably so as no one wants to go through labor, childbirth, and THEN face stitches. 
 
In my opinion, stitches are overly used on tears which could heal on their own without intervention. But, they're overly used because doctors and midwives know that for a tear to heal correctly, the new mom must be laying down in bed for two weeks in a position that allows for the tear to properly line up. Sounds a bit complicated, eh? 
 
First, let's address the tear lining up correctly because this is crucial. Picture a rectangular piece of cloth... now take a pair of scissors and cut it about one inch in the center. When that piece of cloth is lying flat on a table, the part of the cloth that is cut will still line up neatly. Many perennial tears that line up correctly when mom lays down will heal perfectly on their own with bed rest. If mom is running around after a toddler and trying to do the dishes, the extra movement can undo any natural healing and make the damage worse. 
 
Not all tears will line up correctly. In this case, stitches are the best option and will prevent mom from dealing with any future issues. A local anesthetic is injected, and self-dissolving stitches are placed to ensure proper healing and minimal scar tissue.  Though no mom wants this to happen, stitches prevent any major complications such as painful or difficult intercourse, pain sitting or walking, and excess scar tissue.
 
In my own life, I've had 4 babies and torn 3 times. I received stitches the first time and really was uncomfortable for weeks after. Part of it may have been more physiological than physical, but I never wanted to go through stitches again. My second birth was my smallest baby, and I did not tear. But, I did tear during my next two homebirth. 
 
My first homebirth was in Virginia. At that time, midwives weren't permitted to carry lidocaine to numb the area before performing stitches, so for them to be performed, mom needed to be taken to the hospital after birth. Nobody wants to do that. My wonderful midwife said she felt I would heal on my own if I laid down and rested, and I did. 
 
My second homebirth was in Connecticut, and the midwives are permitted to keep lidocaine on them so they can perform stitches in a home setting. My tearing was a bit more complicated and my midwife recommended stitches because she felt that rest and proper healing would be tough with 4 kids running around. I REALLY didn't want stitches so I declined them and agreed to lie in bed with my legs and knees together so the tear would line up properly and rest for 2 weeks. I did heal perfectly without stitches and was really relieved. 
 
The bottom line is that stitches can be declined if you discuss it thoroughly with your provider. Declining stitches poses the risk of not healing correctly or taking longer to heal, so be sure that you’re aware of your tear and your ability to properly rest before declining stitches. If I tear heals in separate sections, a person would be looking at much more complex surgical repair work than simply having stitches after birth so talk about it with your provider and postpartum support team before deciding! ​

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