Identity

The 'Husband Stitch' Leaves Women in Pain and Without Answers

The infamous post-birth procedure—in which doctors suture the vaginal entrance narrower than necessary without the patient's consent—is just one of the ways in which women are mistreated during and after childbirth.

by Mary Halton
Apr 26 2018, 3:17pm

Photo by Cameron Zegers via Sotcksy. 

“If you are reading this story out loud, give a paring knife to the listener and ask them to cut the tender flap of skin between your index finger and thumb. Afterwards, thank them.”

So goes one of the most memorable passages in Carmen Maria Machado’s short story “The Husband Stitch.” Now perhaps better known for making flinching readers aware of its namesake than anything else, Machado’s story is a dreamlike but searing account of birth. It resonates because, above all, it has something dark and familiar lurking at its heart—the idea that the primary purpose of a woman’s body is to pleasure men.

For the (blissfully) uninitiated, “the husband stitch” refers to the procedure of suturing the vaginal entrance narrower than necessary to repair trauma post-birth, with the presumption that this will enhance the sexual pleasure of a penetrating penis.

Machado’s tale has been causing waves since it was published in 2014, making many people aware of its namesake for the first time, but the story of the husband stitch didn’t begin there.

The “unnecessary suture” was first defined in print by natural childbirth advocate Sheila Kitzinger in her 1994 book The Year After Childbirth, though it remains unclear the extent to which the practice has taken place historically. Today, most accounts of the stitch begin and end with men requesting it from a doctor after their partner gives birth.

Such scenarios are familiar to California OB-GYN Dr. Janna Doherty, although she says she would never perform the stitch. “I have probably had [the] request 10 to 15 times over the course of 18 years,” says Doherty. “Typically, it is said in a 'joking' manner, and... responses from the laboring women range from dirty looks at the partner to laughing.”

Mary H., a 32-year-old woman living in San Diego, says her former partner was blessed with such a sense of humor. When Mary H. was giving birth in California in 2002, “My husband jokingly said, ‘Hey, throw an extra couple stitches in there for me,’ and the doctor (and everyone in the room) laughed,” she recalls. “The doctor told him, ‘Don't worry, she'll be great.’”

Her son wasn’t breathing when he was born, so she was very distracted after the birth and isn’t sure what happened next. “Within a few weeks, as my stitches should have been healing, I was not great,” she says. “They never felt healed. When I would have sex, my perineum [the tissue between the vagina and the anus] would tear back open each time. For days, it would sting when I went to the bathroom after sex.”

Mary H.’s problems persisted until the birth of her next child, when a different doctor told her that her previous suturing “wasn’t done right.” At that point, she suspected the doctor may have actually gone through with the extra stitch.

Possibly because the “husband stitch” isn’t officially defined medically, there are no clinical studies of it. Searches on PubMed and ScienceDirect (two large research databases) yield just one paper, which investigates Brazil’s high episiotomy rate (94 percent in 2004). Doctors interviewed by the research team openly refer to the use of the “ponto do marido”—husband stitch—as “intended to make the vaginal opening even tighter after delivery.”

The stitching afterwards was agony, much worse than labour. I didn't expect the after problems either.

Anecdotally at least, the procedure doesn’t appear to be a widespread practice in the US and UK. But it also appears to be more than just a myth, with painful stories often appearing on childbirth forums and one source recalling that the practice was brought up in a childbirth class given by a Northern California hospital in 2014. Also, a recent report on Healthline about the topic included multiple accounts by women who say they were stitched too tight post-birth.

In the UK, Jodie, a 30-year-old Glasgow woman who requested that her real name be kept private, had a postnatal experience similar to Mary H.’s. After she gave birth, another doctor told her she had been “stitched too tight,” she tells Broadly. She was given pain medication for the discomfort she still experiences sitting and walking six months later.

Jodie feels that her procedure was simply botched due to a level of clinical disregard or improper training. (Dr. Doherty says that lack of adequate experience may well be a factor, although graduating OB-GYNs in the US at least should be experienced enough at suturing to provide the necessary care.) Jodie struggled to get acknowledgement from care providers that she understood her own body and how it should be healing, she says.

Regardless of their doctors’ intentions, Jodie and Mary H.’s situations share a common root issue, which likely contributes to suspicions and fears surrounding the husband stitch: The fact that people often do not feel in control of or adequately informed about what’s happening to their bodies when giving birth. It’s an issue that also finds basis in the very procedure that necessitates suturing—the episiotomy.

First coming into regular use in the 1920s, the episiotomy—an incision in the perineum between the vaginal opening and the anus—was used to aid in assisted deliveries (forceps or vacuum births) and believed necessary to prevent natural tears. For decades, it was treated as a matter-of-fact procedure that was practically obligatory for someone having their first baby.

This approach began to come under scrutiny in the 1980s, with studies showing mounting evidence against its benefits, and clinical opinion increasingly turning against it. UK medical guidelines now state that episiotomies should not be treated as routine, and the American College of Obstetricians and Gynecologists (ACOG) advises that there is no situation in which it is essential. However, doctors still reserve the ability to decide whether or not they think an episiotomy is necessary.

“A lot of good data has come out recently showing that episiotomies lead to more damage (more tearing into the rectum) than allowing for natural tearing along tissue planes,” Dr. Doherty points out. She herself does fewer than six a year.

For Suzie Kitson, who works in a UK midwife-led unit where assisted deliveries are less common, the distinction feels obvious. “To me, the only indication for a midwife supporting a normal vaginal delivery to carry out an episiotomy is prolonged fetal distress,” she says. “I can count on one hand the number I’ve done since qualifying.”

The episiotomy rate has greatly decreased over the last few decades. But for many who do receive them these days, the issue is of not being properly warned about receiving the procedure beforehand or informed about what to expect from the healing process afterwards.

After Jodie’s baby was born with the aid of forceps in 2017, she recalls being told her perineum tore a little and that she only needed a small stitch. “It wasn’t until two days after, when I was given my hospital records, it was noted I was actually given an episiotomy,” she recalls. “I didn’t know what that was, so I had to Google it.”

In California, Cari had a vacuum-assisted delivery when her daughter hadn’t been born after two hours of pushing. She also says she had no idea she’d had an episiotomy until afterwards. “No one said anything. I only heard about it from a nurse, a day later, who gave me care instructions for keeping the site clean… Given that it didn't seem to spare me from a couple of deep, natural tears, I'm not sure what the point was.”

That lack of clarity can leave people short of answers when longer-term problems arise. Many of the women mentioned in this piece, such as Mary H., experienced pain during sex (dyspareunia) for prolonged periods after their episiotomies. They felt the procedure had been done for the right reasons, but were given little to no information beforehand. Instead, they received vague advice afterwards, like, in Jodie’s case, a warning that “things down there won’t feel normal for at least a year.”

“I still have no idea, how deep or long those cuts were, if there are any side effects I should be looking for, or what happened to me."

Emma Boyden, who had an episiotomy when her baby was born in Wolverhampton, UK, in 2012, found that “The stitching afterwards was agony, much worse than labour. I didn't expect the after problems either. Sex was very painful for a couple of years afterwards, and can still be uncomfortable now.”

For California mother Jeanine, “healing, or what I assume was healing, took longer than I thought the first time. Lots of, frankly, painful attempts (including different positions) at intercourse. The second time we didn't even try for several months.”

And because dyspareunia is not studied widely—especially in a postnatal context—the healing process can feel even more mysterious, leaving people uncertain of what to expect from sexual intimacy postnatally.

While Emma believes that her episiotomy was done for the right reasons, she also describes birth as “handing my body over,” which does not seem to be an uncommon feeling.

A study of first time births in Pennsylvania between 2009 and 2011 found that women who experienced an instrumental delivery—which frequently requires an episiotomy—were less likely to report feeling involved in making decisions about their labor. Black women were found to be the most disenfranchised, a finding that aligns with recent reports about extremely high maternal mortality rates of Black women in America.

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Renewed discussion around the husband stitch is perhaps the surface expression of this deeper issue: That many giving birth do not feel in control of what will happen to them during labor, or sure of what to expect afterwards—the perception that to give birth is to hand over your body and perhaps be returned something different, that you don’t quite recognize.

“I still have no idea,” Cari says, “how deep or long those cuts were, if there are any side effects I should be looking for, or what happened to me. And there's no way to find out, either.”

Some surnames in this article have been omitted or abbreviated for privacy.