Stitches and bruising

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Why might I need to have stitches after the birth?

Though the area between the opening to your vagina and your back passage (perineum) is stretchy, your baby may need a bit more room as he is born. If your perineum stretches so far that it tears, you may need stitches. Your midwife or obstetrician will examine you carefully after you’ve given birth to see if you’ve torn, and if so, how far. About nine out of 10 mums tear to some degree when giving birth vaginally. This may sound alarming, but most tears are minor. Though about 60 per cent to 70 per cent of tears need stitches, a third-degree tear or fourth-degree tear is uncommon. You’ll also need stitches if a small cut was made to your perineum (episiotomy) to help your baby out. About one in seven women has an episiotomy when giving birth. You may have an episiotomy if your baby needs help to be born with instruments such as forceps or ventouse, or if he needs to be born quickly. Though episiotomies tend to heal in the first two weeks after the birth, it can take up to six months for the area to heal completely. Occasionally, episiotomies tear after the cut has been made. As well as having a tear or needing a cut, you’re likely to have some bruising. A large bruise that is very swollen is called a haematoma. Small haematomas usually go away without treatment, but sometimes the fluid needs to be drained. Bruising and haematomas are usually caused by the pressure of your baby’s head passing through your vaginal opening. If your baby needed help to be born, the forceps and ventouse will probably leave you with bruises, too.

When does a tear need stitches?

Your midwife will check to see how far the tear has gone. There are four degrees of tear:

  • First-degree tear: a small, skin-deep tear that usually heals without stitches.
  • Second-degree tear: a deeper tear that tears muscle as well as skin, and usually needs stitches. If left to heal naturally, it will be more comfortable for you, though the healing process will take longer.
  • Third-degree tear: a deep and severe tear that affects the skin and muscles of the perineum, and reaches the muscle around your anus (anal sphincter). This always needs stitches.
  • Fourth-degree tear: a deep and severe tear that reaches further than the muscles of your anus. It may go as far as your bowel, and always needs stitches.

Occasionally a tear can happen near to where you wee (vulva). This may be left to heal naturally, or you may need to have stitches put in.

What makes a severe tear more likely during labour?

Only about one woman in every 100 giving birth vaginally has a third-degree or fourth-degree tear. It’s hard to predict if you are likely to tear, though you may be more prone to having a severe tear if:

  • It’s your first baby
  • Your baby is born in a back-to-back position
  • Your baby weighs more than 4kg
  • Your baby is born with the help of forceps

It’s not clear whether having an epidural makes you more likely to have a tear or not. Other things that happen during your labour may also contribute.

How is the stitching done after a tear?

If it’s a straightforward tear, you won’t need to leave the room where you’ve given birth. Your midwife will give you a local anaesthetic to numb the area and then carefully stitch up the tear, using a running stitch. Most maternity units recommend that the stitches are sewn in what’s called a continuous way, rather than an interrupted way. This will make it less painful for you afterwards. The stitches are dissolvable, so they won’t need to be removed later. If you have a severe tear, you’ll be taken to an operating theatre, so an obstetrician can stitch the tear. You’ll have an anaesthetic to prevent you from feeling any pain. This will probably be a local anaesthetic, via a spinal or epidural, which will numb the area. Sometimes a general anaesthetic is needed. You’ll have a fine tube (catheter) passed into your bladder to collect your wee. This will make it easier for your perineum to recover. You may have a drip in your arm to give you fluids. Painkillers will ease the pain once the anaesthetic has worn off. You will need lots of rest for the 24 hours after your stitches are put in, but you shouldn’t sit for long periods.

How can I help my stitches to heal?

Keep your stitches clean, to reduce the risk of getting an infection, and try these self-help tips:

  • Have a shower or bath at least once a day.
  • Change your sanitary pad regularly, and wash your hands before and after.
  • Keep doing your pelvic floor exercises, as this will help with healing, improve circulation to the area, and prevent leaking from your bowel or bladder.
  • Expose your stitches to the air. Take your knickers off for 10 minutes and rest on your bed, twice a day. Put an old, clean towel underneath you to protect the sheets.
  • Wear loose-fitting cotton knickers, and avoid wearing tight trousers. Wearing skirts or loose trousers will help the air to circulate.
  • Drink plenty of water every day, and eat fibre-rich foods, such as wholemeal bread, brown rice and fruit and vegetables, to help preventconstipation. You’ll be far more comfortable if you can poo easily.

If you had a severe tear, you’ll be advised to take a five-day course of antibiotics to guard against infection. You’ll also be given laxatives to make it easier to poo without straining your stitches.

How can I soothe the tender area?

If your stitches are very uncomfortable while you’re waiting for them to heal, try these tips:

  • Put a cold gel pad or frozen pack of peas on your perineum. Wrap it in a clean flannel to protect your skin, and don’t leave it on for longer than half an hour. Wait an hour before re-applying it.
  • Pour a jug of warm water over the area while you wee, or use a plastic squeezy bottle. This will dilute your wee, reduce the sting, and keep your perineal area clean. Gently dab your stitches dry with toilet paper, using front to back strokes. Don’t use a hairdryer on the area.
  • Don’t use tampons until you have completely healed, and the area has been checked by your doctor.
  • If it’s uncomfortable to sit, try sitting on a Valley cushion. Ask your midwife for one, or hire one from theNational Childbirth Trust.
  • In the early days, sitting in cool water can help to reduce the swelling. As things ease, you can have a warm bath, perhaps adding a few drops of lavender oil or tea tree oil to the water. There’s no evidence that it helps with healing, but you may find it comforting. Sit in the water for around 20 minutes, twice a day. Pat your stitches dry with a clean, soft towel.
  • Take painkillers. Paracetamol is a good option for easing perineal pain. You can try ibuprofen if you need something stronger, though if your baby was premature, or had a low birth weight, ask your GP before taking ibuprofen if you are breast feeding. Your doctor may prescribe more powerful painkillers if paracetamol or ibuprofen aren’t enough for you.
  • Take it easy. Being up and about is good for your circulation, but if you develop a heavy, dragging feeling in your perineum, take the weight off your feet for an hour or so.
  • Dab witch hazel on your stitches with a cotton pad, or apply a witch hazel compress.

When should I see a doctor?

Most tears or episiotomies heal well. The bruising usually gets better within a few days, and your stitches should heal within three weeks to four weeks of your baby’s birth. After two months you should be pain-free. Even if you had a severe tear, you’re unlikely to have any problems a year after your baby’s birth. Your doctor will ask if you have any concerns at your postnatal check. Make an earlier appointment if you’re worried. You should ask for help if:

  • Your stitches become more painful or smelly, as you may have an infection.
  • You have to rush to the toilet to poo.
  • You can’t control your bowels when you pass wind.
  • Weeing gives you a burning or intense stinging pain, and you need to go more frequently.
  • You have a severe pain in your lower tummy, or around your perineum.
  • You have a high temperature.
  • Your sanitary towel is soaked with lochia or blood, or if you pass large clots.
  • You have any other worries or concerns.

If the thought of resuming your sex life makes you feel anxious, you could talk to your doctor or health visitor. It’s only natural to feel concerned about sex if you had stitches and bruising, and being worried about how your stitches have healed can make you even more fearful. Share your feelings with your partner, and tell him if you are worried about having sex again.

Can I avoid having stitches in the first place?

Massaging your perineum in the weeks before your due date may help it to stretch better during the birth. This may make you less likely to need stitches, have an episiotomy, or have a tear. Your antenatal teacher may teach you how to do this during your antenatal classes. Using a warm compress on your perineum during labour may also mean you are less likely to need stitches.

Will my stitches cause problems in the future?

A small number of women have long-term perineal pain or problems with controlling when they poo. Up to a quarter of women who had stitches after the birth may have pain during sex, or bladder problems. But you can help to prevent this by regularly practising your pelvic floor exercises, and seeking help if things don’t improve. With the right treatment, most problems that arise from having stitches can be helpe or cured.

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