Postpartum
Here's How To Tell If Your Vaginal Stitches Aren't Healing Properly After Childbirth
Ouch.
As if childbirth wasn’t enough to deal with, there’s all the afterbirth stuff nobody talks about that you have to contend with, too — like tearing. Either by an episiotomy or by chance, you could get a gash during delivery that requires stitches. And since you (and your vagina) have gone through a lot during labor, it might not be easy to know if everything is alright down there postpartum. If you’re concerned, there are signs of infection in after-birth stitches to watch out for that mean they aren’t healing properly.
It happens to the best of us, but if you tore during delivery or had an episiotomy, you’re going to need stitches. And while having a tear in your perineum might make you wince just thinking about it, it’s imperative to make sure that it heals properly. Thing is, you just might not know what to look for. “It can be really hard to determine because immediately postpartum, there’s a lot happening in the vaginal area,” Dr. Kiarra King, M.D., FACOG, OB-GYN, tells Romper “The mom will have some bleeding occurring because of normal postpartum changes, so it’s not an easy place to look and see what’s happening.”
The good thing is, though, that most people will never have to confront an infected tear — with basic care, they tend to heal up very well. However, when the tear is deep, as with a third- or fourth-degree laceration, the healing process can be much more complicated. A 2015 study published in the Obstetrics and Gynecology journal found that 3.3% of people giving birth had a third-degree laceration and 1.1% had a fourth-degree laceration. And those rates increase during a second pregnancy if a tear occurred in the first, according to a 2014 study in BJOG.
How long do after-birth tears take to heal?
Ultimately, the healing process will depend on how well you take care of the vaginal stitches. Make sure you keep the area as clean as possible after going to the bathroom (that’s where that spray bottle they give you in the hospital comes in handy), cleaning yourself well so you can decrease the chance of infection.
If you happen to have a more severe perineal tear, how long will it take to heal? "Repaired vaginal lacerations or episiotomies take a long time to heal, like any injury. The stitches usually take three to seven days to dissolve," board-certified OB-GYN Dr. Mary Jacobson, chief medical director at Alpha Medical, tells Romper. "Be patient and give the repair six weeks to heal — and expect several weeks of soreness and tenderness during the healing process. If your vaginal repair isn’t healing properly, you may have an infection."
No matter what kind of vaginal tear you have, here are some signs that your stitches aren't healing properly.
Signs of infection in after-birth stitches
1The stitches smell
While you can expect to bleed for up to six weeks post-birth, the smell of blood will be different from stinky stitches. If your stitches smell bad, that's a sign of infection you absolutely shouldn't ignore. “Foul-smelling or green infected looking discharge that is new is a sign you might have an infection,” certified nurse midwife Michelle Barcus tells Romper. Jacobsen notes that this is one of the first signs you should reach out to your doctor.
2Excessive redness
Excessive redness or swelling in the vaginal or perineal area is another red flag indicating infection. "Significant swelling in the area" is a sign you should call your doctor, according to Jacobsen. Barcus explains that "swelling that is getting worse and redness to the tissue area surrounding the stitches" are signs you should see your provider right away. Basically, anything icky or weird from this wound might merit a call. Even if you just think there might be something icky or weird about it — call your provider. While you're probably busy with the baby, it's equally important to take care of yourself.
3Your stitches hurt — like, a lot
You shouldn't have to put up with excessive pain after birth — ever. While some aching and soreness is normal, let your doctor know if the pain is serious. But how can you tell what’s normal healing and what’s not? “If they deemed your vaginal exam to be normal at the hospital before discharge, then I would use that as a baseline,” advises King. “But if you get home and have extreme pain that is not relieved by the pain medication you’ve been provided, that would be the time to give the doctor’s office a call.” If you describe your symptoms, they might tell you it’s part of the healing process, but they also might have you come in for a quick exam to ensure everything is OK.
4Your stitches have gaps and breaks
You should always keep an eye on your stitches to make sure that there aren’t any breaks or gaps. You’ll need to use a mirror so you can get a good look down there to ensure that they’re healing properly. “If you're looking for signs and symptoms of the sutures actually breaking down, you might feel increased pain in the lower portion of the vagina, or you may see a suture come out when you're urinating or having a bowel movement,” Dr. Vonne Jones, M.D., FACOG, OB-GYN, tells Romper. “Sometimes patients say that they hear a pop where they feel like a split happened, and then they'll notice a difference in their discharge because of it.”
5You have a fever
One sure sign your wound may not have completely healed despite treatment is if you develop a fever, according to Jacobsen. This can be another sign of an infection, so you'll want to reach out to your doctor ASAP. "You want to monitor for any signs of infection, such as new onset fevers (>100.4 [degrees Fahrenheit])," says Barcus. If you’re feeling feverish, call your OB-GYN, since it might not be immediately obvious if you have an infection.
6You have fecal incontinence
One of the less fun parts of the postpartum phase is all the gassiness you might experience. But if you have to scurry to the bathroom to go number two, or if you're leaking fecal matter when passing gas, your laceration might be worse than anticipated, and stitches might not be enough. A fourth-degree tear, by definition, can impact your rectum. "Be sure to do your Kegel exercises daily in order to prevent urinary and fecal incontinence as you age," Jacobsen says. "Kegel exercises strengthen your pelvic floor muscles. Your pelvic floor muscles support the uterus, bladder, small intestine, and rectum."
If at any time something seems wrong with your stitches, you’ll want to contact your OB-GYN right away. They’ll be able to identify immediately if there’s a potential infection or something has gone astray with your stitches and provide proper medical treatment. Soon, you (and your vagina) will start to feel like yourselves again.
Studies cited:
Friedman, A. M., Ananth, C. V., Prendergast, E., D'Alton, M. E., & Wright, J. D. (2015). Evaluation of third-degree and fourth-degree laceration rates as quality indicators. Obstetrics and gynecology, 125(4), 927–937. https://doi.org/10.1097/AOG.0000000000000720
Edozien, LC, Gurol-Urganci, I, Cromwell, DA, Adams, EJ, Richmond, DH, Mahmood, TA, van der Meulen, JH. (2014). Impact of third- and fourth-degree perineal tears at first birth on subsequent pregnancy outcomes: a cohort study. BJOG2014; 121: 1695– 1704. https://doi.org/10.1111/1471-0528.12886
Experts:
Dr. Kiarra King, MD, FACOG, OB-GYN
Dr. Vonne Jones, MD, FACOG, OB-GYN
Dr. Mary Jacobson, Chief Medical Director at Alpha Medical
Michelle Barcus, certified nurse midwife
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