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Perineum Stitches – Are They Always Necessary?

I don’t do perineum stitches as much now as I did as a new midwife.

I see the magic of the vaginal mucosa too often!  Healing time is surprisingly quick and the result dramatic. The mucosa in the vagina is like the inside of your mouth.  So let’s reconsider the need for perineum stitches.

How often have you bit down on your cheek maybe even to the point of tasting blood and then a few hours later or the next day your tongue pokes around to find a whole new layer of skin already growing on top! Magic! The vaginal mucosa does the same thing; works incredibly fast to heal itself.

I have wanted for some years now to make a photo journal of before and after to show how the perineum heals itself. It would be a fascinating resource for student midwives, doctors, nurses, perhaps even mothers who have a fear of tearing, to see this inherent health in action.

So far I haven’t had any volunteers for my project, but to be fair I haven’t asked.

Perineum Stitches: An intervention…

To the mother & baby. Doctors love to finish perineum stitching 10 minutes after the birth at which point mother & baby will be staring at each other with awe, beginning their visual relationship together.

The baby may be already initiating breastfeeding and they may both be sitting in an oxytocin bubble that we have no business to disturb unnecessarily.

The model of midwifery that I learnt we wouldn’t consider disturbing these precious moments unless a clear indication; wanting to get home or back to the office not being one.

Causing more trauma to the tissues.

Injecting local anaesthesia, and the back and forth sewing with the needle often leaves the tissues more traumatized then before you started. More pain, less even alignment of the tissues, longer duration for healing, may all be the result.

There are times when perineum stitches are unavoidable of course: if the tears is bleeding, if it is deep into the muscle layer, or if it involves any structures around it like the anal sphincter, or if the mothers time or lifestyle doesn’t permit her the care and rest period required for organic healing.

Attentive perineum care to support self-healing requires the following:
  • Daily sitz baths
  • Using Calendula diluted tincture to rinse after peeing
  • No toilet paper only water to wash (our toilet paper has too many chemicals today, not only can it be irritating, small fibres can get left behind in the wound)
  • Paying extra special attention to hygiene after passing motions, afterwards can be a good time to do sitz bath
  • Keeping knees together throughout the day. All movements in and out of bed, up and down stairs, should be done with awareness of closed knees. It is helpful to imagine having a rubber band or a tube-top around your knees. Cross-legged breastfeeding will have to wait!

Sitz Bath How To

Find something to sit in. In some countries you can purchase a specific plastic insert for the toilet but if you cant find one it doesn’t matter, a plastic, shallow, wide rimmed bucket from the market work great. Or some mummies even use the older kid’s bathtub.

images-5 images-6

The sitzbath chairs from yesteryear were amazing! See here

Sitz Bath Recipe for Perineum Tear

The following recipe is soothing for mummy regardless of having a tear or not. It supports healing of hemorrhoids and is also a good treatment for persistent candida.


Lavender essential oil (or flowers)

Handfull of Epsom salts

Calendula tincture (or flowers)

1 or 2 cloves of garlic peeled and smashed

Tea tree oil and grated ginger

If you don’t have all those ingredients use the ones you have. For example just garlic, lavender and ginger will work great!

Depending where you live in the world and what access you have, additional awesome herbs to add include: Comfrey, Rosemary, Uva Ursi.

Boil a pot of water and turn off flame; throw in all the none essential oil/tincture ingredients. Cover and let steep for 20mins. Uncover add cool water to comfortable temp, pour into basin, add a few drops of essential oils and calendula tincture and sit with bottom submerged for 15-20mins

Do once or twice daily

Note: stitch free healing works best for woman who are anyways healthy, have good nutrition = good tissue integrity and are able and willing to put in some extra effort and mindfulness into perineum care.

You can also use this medicated water in several other ways:
  • Make a squirt bottle and rinse the perineum after peeing
  • Make a compress (soak a clean washcloth in the mixture and place at perineum for 15-20 minutes)
  • Some woman choose to soak natural cottons menses pads in the medicated water and then freeze them, this provides a wonderful cooling affect (for women following eastern heating rituals this will not be appropriate).

Other foods that support perineum healing naturally include honey and seaweed!

I started using Calendula tincture when I was in India, calendula is a big yellow or orange flower with natural antiseptic properties. In North America the flowers are quite prevalent, so it is more commonly used in that form. However in India it is most commonly found as a homeopathic tincture.

I’ve seen such awesome results with it that I still buy it by the caseload whenever I am in India to give to mothers wherever in the world I am working. It is also super for clearing candida, cleaning babies umbilical cord and many other first aid uses.

Here’s a good article with lots more information about calendula.

As midwives we do best when we remember, and then support, the body’s inherent wisdom that is always looking for homeostasis, for healing.

Jireh takes over his mums sit bath and loves to reenact his little brothers birth!

Would you like to know more about what choices you have giving birth?  Check out my informative, free videos that teach you about your choices while giving birth.

  • I love this article for so many reasons. The biggest fear of labor I had rested in the thought of my perineum tearing. I had no other anxiety around my first home birth besides that. Did u tear? Yes. Was it bad? Yes. Was it as bad as I originally imagined in my head? Absolutely not. What was originally my mental birth block became turned shortly into a beautiful healing ritual between my husband and I. Our lovely midwife recommended applying raw honey and Kombu seaweed to the tear every night since we opted out of receiving stictches from her after a second degree tear. If my body could grow and birth a baby, then it most certainly could heal a little piece of skin flap!! So there we were, new parents, alone with baby, every night….I looked forward to the time when my husband would gently inspect the area, apply a dab of honey with a swab followed by a comforting patch of cold seaweed….ahhhh it was like 10 minutes of spa treatment. Seriously. Three years later, I look back on that experience not as a painful one, by as one of pure bliss and gratitude for the body’s amazing ability to heal itself. If I knew then, what I know now, 99.9% of any anxiety around tearing would have been eliminated.

    • Janelle what a beautiful inspiring story thank you so much for sharing. Tearing is such a common fear and it does us all so much good to hear stories like yours. I am so happy you had a midwife who supported your body’s natural healing ability!