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Thursday, February 01, 2018
The 'Husband Stitch' Nightmare: Isn't Just a Horrifying Childbirth Myth - firstname.lastname@example.org - Gmail
“Yeah, let’s go ahead and add in another stitch so we can make sure this is nice and tight,” Sarah Harkins’ family doctor said to her husband moments after she’d given birth to her daughter in 2005.
“I was so out of it physically, emotionally, and mentally. The doctor said it to him. Not to me… I was just lying there like a lump,” remembers Harkins, a New Orleans-based doula and lactation counselor.
Following a traumatic induction of labor, an epidural placed too late for relief, and a forceful extraction of her baby, Harkins was horrified to realize that the family doctor she’d carefully chosen to attend her birth was giving her a “husband stitch.”
A husband stitch, or daddy stitch, is an extra stitch given during the repair process after a vaginal birth, supposedly to tighten the vagina for increased pleasure of a male sexual partner.
The idea of the husband stitch has gained some recent attention following the publication of Carmen Maria Machado’s story “The Husband Stitch” and the responses to it.
Is it a myth? A hurtful joke? An urban legend? A combination of hearsay, misunderstanding, and chauvinist attitudes? To some, the very idea of a husband stitch is a silly notion, not at all based in the reality of care.
But the practice is very real.
There are no scientific studies that show how many women have been affected, nor is there a clear method for evaluating how prevalent the husband stitch truly is in obstetrics. But women share their stories as anecdotes, whispered as warning.
The proof is in women’s words. Or sometimes, it’s sewn into their bodies.
Angela Sanford, a 36-year-old mom from Fort Mill, South Carolina, received a husband stitch when she gave birth to her first child in 2008.
She didn’t find out until five years later, after years of “excruciating” pain during sex.
At an appointment for a Pap smear with a nurse midwife she’d never seen before, Sanford said that the first question the midwife asked her during her exam was “Who stitched you up after your first birth?”
“I explained and she said, ‘This is not right.’ I just started crying, saying, ‘Can you tell me what’s wrong? Because I know something is not right,’” Sanford continued. “And that’s the first time I ever heard the term husband stitch.”
Sanford’s midwife felt that she’d been stitched “too tight” by the hospitalist who had managed her first delivery, an unmedicated birth with two hours of doctor-coached pushing and a fourth-degree tear.
“He gave you what some people call a husband stitch,” Sanford recalled the midwife telling her. “I couldn’t connect in my mind why it would be called that. My midwife said, ‘They think that some men find it more pleasurable,’” she recalled. “My husband has been worried about me and fearful of hurting me. He would never have asked for this.”
The history of episiotomies, from popular to discouraged
For Stephanie Tillman, CNM, a certified nurse midwife at the University of Illinois at Chicago and blogger at The Feminist Midwife, the very idea of the husband stitch represents the persistent misogyny inherent in medical care.
“The fact that there is even a practice called the husband stitch is a perfect example of the intersection of the objectification of women’s bodies and healthcare. As much as we try to remove the sexualization of women from appropriate obstetric care, of course the patriarchy is going to find its way in there,” Tillman told Healthline.
What do you do when you’re confronted with the patriarchy just after giving birth?
Harkins, 37, remembers how she laughed at her doctor’s statement — at the thought of the “old, crusty Army doctor” overstitching her in order to give her husband more pleasure. “I couldn’t even process, but I kind of laughed, like what else do you do when someone says that? I had just had a baby. I didn’t think much about it because the whole birth experience was so traumatizing, but now that I think about it differently, the implications of that are just crazy.”
Husband stitches may have been more common when episiotomies were routine during vaginal birth. An episiotomy is a surgical cut made in the perineum — the area between the vagina and the anus — usually to widen the vagina to hasten birth.
From about the 1920s forward, the popular medical belief was that an episiotomy made a cleaner cut that would be easier to repair and heal better. The logic was also that getting an episiotomy would prevent a worse perineal tear. Tears during vaginal birth are graded from first to fourth degree.
“People were taught in the ’50s and ’60s that routine episiotomy was good for the woman,” Dr. Robert Barbieri, chair of obstetrics and gynecology and reproductive biology at Brigham and Women’s Hospital in Boston, told the Huffington Post. “What they thought is that if they did a routine episiotomy, they’d have a chance to repair it and that during the repair, they could actually create a better perineum than if they hadn’t done it. The idea [was] that we could ‘tighten things up.’”
It’s estimated that over 60 percent of women experienced episiotomies in the United States by 1983.
But starting in the 1980s, high-quality research on episiotomies was released, demonstrating that routine episiotomies cause the very issues they were thought to prevent, leaving many women with more severe tissue trauma and other negative long-term outcomes, including painful intercourse.
In 2005, a systematic review in the Journal of the American Medical Association found no benefit to routine episiotomy use. A 2017 Cochrane review “could not identify any benefits of routine episiotomy for the baby or the mother.” Today, the American College of Obstetricians and Gynecologists recommends that clinicians “prevent and manage” delivery lacerations through strategies like massage and warm compresses rather than making cuts on the perineum.
The new guidelines have impacted delivery in the United States. In 2012, only 12 percent of births involved an episiotomy, down from 33 percent in 2002.
Episiotomies still happen and can be clinically indicated in some situations, like when a vacuum or forceps are needed. Often, though, the decision about whether to do them comes down to training, preference, and comfort of the obstetric provider.
“There are still providers who do it routinely and they, for whatever reason, think it’s a cleaner and better approach for people, despite all of the research otherwise. They practice how they want to,” Tillman contended. “Essentially, it’s a form of power over women’s bodies to say ‘Medical management can do this the right way and your body can’t.’”
Research supports this, too. A 2015 study in the Journal of Maternal-Fetal & Neonatal Medicine found that “the attending provider adds a significant independent effect to the episiotomy risk model.”
In the United States, there is substantial variation in episiotomy rates based on geographic location, hospital, and even the type of insurance the patient has. White women were also found to be more likely to receive an episiotomy than black women, according to a 2015 research letter in the Journal of the American Medical Association.
Another study, looking at the use of routine episiotomies in Cambodia, found that the belief that “women would be able to have a tighter and prettier vagina” was a reason given by providers for routine episiotomy.
For some women, it’s not their medical situation that will decide whether their genital tissue is cut while giving birth, but social and cultural variables well beyond their control or even knowledge.
Lasting pain from the extra stitch
Regardless of whether a tear happens on its own or as a result of an episiotomy, it’s not even possible to make a vagina tighter with stitching, according to OBGYN Jesanna Cooper, MD.
“A ‘husband stitch’ would not affect overall vaginal tone, as this has much more to do with pelvic floor strength and integrity than with introitus [opening] size,” Cooper explained.
It is possible, however, to create a tightness on the perineum and outer vulva with stitching, although it’s debatable if sexual partners can feel it or not.
Perhaps the husband stitch is a holdover from a time before doctors understood vaginal tone and believed they were returning women to prime sexual function after birth.
Today, the goal of a vaginal repair is not to tighten the vulva or vagina, but to bring the skin back together enough to facilitate the body’s own healing process.
In the heady hubbub after birth, it’s not uncommon for women to feel totally out of the loop in regards to what’s going on near their vulva.
Although the onus is on the provider to get clear consent and to explain what is necessary for the repair, women may not pay close attention or remember how they were stitched until much later, when pain or other issues occur.
“I was just happy that it [giving birth] was over,” Harkins said. “'In the moment, I wouldn’t have used the word ‘violated’ because my brain just couldn’t process violation at the time. Now that I’ve had time to process, I have a clearer sense of what I went through and what was done to me — the injustice, to wound me in my privates, at a time when I was most vulnerable.”
La Marque, Texas, mother Tamara Williams, 27, found out she’d been given a husband stitch after her 2015 birth when her boyfriend mentioned it. He thought she’d heard the birth center midwife say “she’d throw in an extra stitch for him,” winking.
He didn’t know what to say or do when the statement was made, and Williams was on such a “baby high” she has no memory of it. But knowing it was done to her is hurtful, despite the good relationship she still maintains with her midwife. Williams experiences continued pain during sex, even after giving birth to another child.
Moving past the daddy stitch
Although both Harkins and Sanford felt violated by their husband stitches and suffered pain and dysfunction as a result, both women also express a desire to give their providers the benefit of the doubt in regards to the care they received, perhaps demonstrating the profound power differential in the birthing room and patients’ strong desire to continue to trust their providers.
“Part of me wonders if he did it on purpose or not. How hard is it to do it too tight? Maybe it’s an easy mistake to make. I’m not a vagina expert. I’m an optimist, so I try to think the best of what they intended,” Sanford said.
But with the husband stitch, it’s complicated to know what was needed, what was intended, and whether a postpartum body is the subject of a joke or a procedure.
Neither Cooper nor Tillman have ever seen another provider put in an unnecessary stitch, although Cooper says she has heard “husbands ask for an ‘extra stitch for him’ when his wife’s perineum was being repaired.”
She finds the ethical implications of a maternity care provider ever doing one distasteful. “An OBGYN should be there for his or her patient and not for a third party’s interests. We serve women first and foremost. An ‘extra stitch’ goes against surgical principles of healing,” Cooper stated.
Although it has and likely still does happen occasionally, the practice of the husband stitch is rare and hopefully getting rarer in American birth spaces. It’s possible the push for care to become more evidence based will lead to the husband stitch dying out completely.
Whatever it is — an urban legend, a vestige of outdated medical practices, a vanishing rarity — it is a traumatic reality Angela Sanford still lives with.
“I felt betrayed because something unnecessary was done to my body that I didn’t ask for,” Angela said. “It was a harmful decision made without my consent. That’s not what you should get when you are in the hospital to have a baby.”