Tears

Suturing

If you see that you have a tear, you will need to repair it or facilitate healing, depending on the location and degree.

You also need it done asap after birth as the two sides will begin to heal separately and won't go back together without abrasion or surgery after 24hrs. Aim to be sewn up or stuck together well before that, before 6 hours is best if possible.

• Hire someone (midwife or similar that you lined up before or after birth)

• Transfer (to your emergency department or OBGYN or midwife's office)

• Seaweed (this can be cut into wide strips, wet and used kind of like a steri strip, but the benefits are also healing ones. Raw and unsalted is best. Nori is better cut to size to hold the tear together, and used dry or lightly dampened, not soaked. Kombu is better fully soaked and then used more for its healing benefits rather than as an alternative to suture - apply in a large piece to your entire undercarriage)

• How to use seaweed + anecdote https://midwiferytoday.com/mt-articles/natural-alternative-suturing/ 

• Another article on how to use seaweed and some other suggestions on Facebook  

• Superglue (there are medical glues you can get used by vets eg VetBond, and doctors, or you can use normal superglue. Be very careful to only get it where you need it. Use glue sparingly as where the glue is will not heal as well. Do you apply glue to the whole tear, but do small spots or stripes working your way out from the inside of the tear to avoid trapping air)

• Amniotic sac (over the wound to stick it together and also has healing properties)

• Japanese suture clips (Explanation here - In His Hands stocks them!)

Healing

After stitches or self “suturing”, or even if you just have micro tears or a swollen vagina and vulva, you should take good care of your womb and sacred lady parts. They have just done an excellent job of working with you to birth your beautiful baby.

Tears can take 3-10 days to heal, or more depending on the severity, but you may be sore for quite a few weeks, especially with a tear that went into muscle, or left exposed mucosa lining that can get sore or aggravated with things like sex.

“Tearing is a normal part of the birth process, and the body usually heals well. The vaginal wall is a mucous membrane and heals very fast (like the mouth)” - Rachel Reed

• Immediate warmth (Japanese tradition says that this actually reduces swelling and promotes healing better than cold - apply warm wash cloths or sit on a well padded wheat bag or hot water bottle)

• If you have torn at ALL, keep your legs together - keep the tear together. It must adhere back to the other torn side. NO stairs, NO squatting, no twisting/bending down movements etc

• While you pee, use a peri bottle to squirt warm water on areas that sting, and after you pee to keep the area clean.

• Herbal; sit in a sitz bath or strain the soaked herbal water into the peri bottle

After every time you pee, you can reapply one or many of these healing items:

• Seaweed (soaked, patted dry, smeared with manuka honey, and applied across the perineum and vaginal opening)

• Manuka honey

• Witch Hazel

• Perineal spray

• Herbal peri bottle water

• Cold packs/pads, 20 mins at a time, in the first 24hrs only (many mainstream groups recommend Perineal pads frozen and condom poles for "down there". But not recommended in Japanese tradition.

• Warm packs can be beneficial from the first hour to well past the first week.

Keep a strong watch out for infection signs and act quickly if you suspect a uterine or tear infection. If you catch it quickly you can deal with it yourself by doing things like cleaning it better, taking herbal tinctures, and upping your Vitamin C dosage, but if you don’t, it will progress to antibiotics, and most of us don’t want that.

For you:

If your body is healthy and you are nourished, you can heal (in all areas!) after birth more quickly, and eating good food will also help you with other goals like breastfeeding and replenishing any blood lost.

• Nourishing food, preferably warm, eg soups

• Protein rich foods

• Broth

• Oils eg olive oil, fish oil, avocado 

• Vitamin C to prevent infection

• Foods with collagen

Considerations

• As a general rule, first degree tears (skin only) tend to heal well with rest alone. Staying primarily in bed with your legs together for several days helps.

• Second degree tears (skin and muscle) often heal well on their own, unless the tissue is torn in such a way that the tear does not lay together, such as a flap hanging down, or sides of the tear not matching up well. Second degree tears can take several weeks to heal, and are typically stitched by providers. Staying in bed, and avoiding activities that would separate the healing tissue, such as walking up stairs, or twisting movements like unloading a dishwasher or dryer are not advised. If you choose not to have a deep second degree tear stitched, there is a risk of painful intercourse if the skin did not heal together properly.

• Third degree tears (skin, muscle, and into the anal sphincter muscle) can occasionally heal without intervention, but depending on how severely the sphincter is damaged. (This muscle is what stops gas and faeces from escaping, so it's a pretty important one to have intact.) Repair within 24-48 hours is recommended by pretty much all providers. 

• Fourth degree tears (skin, muscle, anal sphincter, anal mucosa) extend into the anal cavity. With the sphincter fully torn, it must be repaired in order to have bowel control. The sphincter acts much like a rubber band that is wrapped tightly around the anus. If you cut a tight rubber band, the ends spring apart and will not find each other and reattach without someone intervening to tie/sew them back together. Because it is living tissue, the torn sphincter will usually heal back together if the ends are placed as they were before the injury. Because the tear extends into the anus, the chances of infection are considerably higher. It is not recommended to attempt to heal a fourth degree tear without sutures, and one could expect a lengthy recovery. Thankfully, fourth degree tears are extremely uncommon in physiological birth.

• Remember, if you choose not to suture a tear that has gone into sphincter muscle, you will almost definitely need surgery later. There have been a few posts recently of women in one of the freebirth groups posting and asking women to please consider stitches. They had been told “tears heal fine at home” but they were not made aware of the huge difference between 1-2nd degree, and 3-4th degree, and are suffering many months later for lack of simple education, because everyone commenting was uneducated themselves, or too positive. You deserve to be well informed about the effects on your body of stitches or lack of at every degree.

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• You have just birthed a beautiful baby, and you and your body deserve respect and TLC. Anyone who wants to assess (and suture) you other than yourself should be nothing but careful and gentle. If you feel that your care provider will not be that person for you, you have every right to request a different doctor. You have time to slow down and have a proper informed conversation about your tear and your choices (use BRAINS acronym) and to do so without them still between your legs. They can assess you, then chat before doing anything. I have seen many hospital birth stories where baby comes out, then placenta, then Dr heads down there and stitches poor mum up without anaesthesia! And without so much as a by your leave. You have rights.

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• Sex after birth: wait to be sure that your tear has healed and your postpartum bleeding has stopped. Take it slow and use lube. If you have pain, get curious about why, and slow down, rather than forcing yourself through it. Pain can be caused from a bunch of reasons, and not all will be tear related. Some pain might be be from pelvic floor, post birth vaginismus, or mental hangups. 
  Sometimes a few extra days healing will be all that you need. Other times it may take longer, or even some intervention to get you back to normal. 

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Have you torn and used something else to heal yourself? Send me a message in the chat bar so I can add it to the list of suggestions!