After the birth of my child, I was wondering about the history of perineal stitches and when this practice became widespread. This subject seems to be adressed in 'From social to surgical: Historical perspectives on perineal care during labour and birth' , Hannah G. Dahlen et al., (Woman and Birth 2010), (https://scholar.google.nl/scholar?q=From+social+to+surgical:+Historical+perspectives+on+perineal+care+during+labour+and+birth%27&hl=nl&as_sdt=0&as_vis=1&oi=scholart - pdf cannot be downloaded on phone), but on closer inspection the authors only write about the history of the episiotomy (a medical incision of the vagina/perineum), specifically that it was first written about in 1742 by Sir Fielding Out. I do believe that stitches logically follow a episiotomy, but stitches can be done without an episiotomy (when the perineum tears), but I cannot find anything on that historically.
One of the main subjects of the article I mentioned is the transition from the traditional (early) modern midwife to the 'man midwife'. Could it be possible that these early modern midwife stitched, since medical stitching goes back thousands of years (https://en.m.wikipedia.org/wiki/Surgical_suture). I would like to learn more on the subject.
Thank you in advance!
TrustedAdult t1_izt18gv wrote
Hi! I'm an ob/gyn.
I don't have an answer to your question, but I have commentary on the current state of perineal laceration suturing that I want to share here to keep some harmful misinformation from spreading.
First off, perineal lacerations are very common. It is very common to have lacerations with one's first vaginal delivery.
They get measured in "degrees." 1st-degree is very superficial, 2nd-degree involves the underlying structure of the "perineal body," and 3rd and 4th degree involve some or all of the anal sphincter.
That's an assessment of perineal lacerations that's very geared towards their significance for future pelvic organ prolapse (having the vagina bulge outward) and dysfunction with defecation. It doesn't include labial lacerations, lacerations that involve the clitoris or clitoral hood, or periurethral lacerations -- those all lack a grading system, and in my experience, get described subjectively.
/u/illraceyou96, /u/Fearless_Reaction592, /u/Snakandahalf -- non-perineal pelvic lacerations are understudied. It's recent that we have good data on what we can do to reduce the risk of perineal lacerations (perineal massage, for example), and I think non-perineal lacerations will be next. I'm going to talk a little bit about why.
Although misogyny is a constant force in our world, there are things that medicine likes and doesn't like to study. Medicine likes studies with clear differences between groups and outcomes: people either did or didn't get a medication, and you look at hospitalization rates after. Clitoral and labial lacerations are tricky because they are soft-tissue injuries happening after the very unpredictable interactions between a fetus/newborn and a vulva... and then the intervention is also very randomized right now, because there's a wide range of how aggressively physicians repair these kinds of lacerations.
So I think/hope that over the next 20-30 years, we'll see development of better ratings to measure labial/clitoral lacerations, which will be followed by proving that they correlate with subsequent risk of pain or sexual dysfunction, and then that will be followed by studies to see if interventions reduce their risk and/or if we can standardize management of them.
(This kind of standardization happened for cesareans in the last decade, for context.)
I've had the privilege of taking care of a lot of people who had unattended deliveries without repair of lacerations. I'd like to say without a doubt that repairing perineal lacerations is good. People who have unrepaired lacerations are at high risk of going on to have pelvic organ prolapse, which can cause issues with discomfort with activity, sexual dysfunction, incontinence, and constipation.
/u/biRdimpersonator brings up the "husband stitch." I've had the good fortune of only training in places with a high degree of compassion and patient-centered care, and during the ongoing takeover of ob/gyn by women. Medicine is becoming less patriarchal and paternalistic. I have never seen a "husband stitch." I have never seen anybody do anything more than was needed to return the vulva (close) to the state it was in before the delivery.
Most of my work is in abortion care. Some urogynecologist might come through here and correct me on the current state of research!