In the dark corners of the mommy blogosphere, the “husband stitch” has become a sort of maternity ward Slender Man. The much-feared extra suture, supposedly used to tighten the vagina after childbirth, has long been the rumored result of handshake deals done between husbands and doctors–presumably behind the backs of sedated new mothers. A vestige of medical evolution, the “husband stitch” has become the stuff of internet message boards, cautionary tales, and nightmares. It is the ultimate intimate betrayal and a demon energized by understandable insecurity.
“Right after birth I heard those three cursed words; the husband stitch,” one Redditor recently recalled in a post best read aloud by a campfire. “What bothers me the most is that every nurse and receptionist I talk to from my old practice (where the doctor who stitched me up works) speaks and acts as if all of this is in my imagination.”
“I haven’t been able to run, use a tampon or have sex for 15 months,” another anonymous woman posted on The Bump after she was stitched “ALL the way up” due to severe tearing. “PLEASE learn from my mistake,” she urged readers.
Those two stories, which allude to the same uncomfortable situation, are both credible but also alarmist and likely confusing to both would-be mothers and would-be fathers. Known as the “daddy stitch” or “husband’s knot,” the “husband stitch” was given its stickiest name by Sheila Kitzinger in her 1994 book The Year After Childbirth: Surviving and Enjoying the First Year of Motherhood. What was she describing? A procedure to “preserve the size and shape of the vagina, either to enhance a man’s pleasure in intercourse, or to increase the frequency of female orgasm.” Was what she described a common occurrence? Probably not, but that’s where things get both complicated and interesting.
The American Congress of Obstetricians and Gynecologists does not deny that the “husband stitch” procedure–essentially a flourish on the end of a postnatal repair of vaginal tissues and muscles surrounding the anal sphincter–happens. However, its representatives claim that the practice “is not standard or common.” Lakeshia Richardson, a gynecologist and obstetrician, admits to having sewn a few herself, but only after strongly advising patients against it. “A very few times patients have been very persistent about it and I have performed it with written consent,” Richardson told Fatherly. “I explain that you could wind up having pain during intercourse because of this extra stitch. I do not recommend it.” The question that remains frighteningly unresolved for many mothers is whether or not there is a conspiracy of silence about the husband stitch, which is rumored to be a sort of favor doctors do for new dads (presumably after a plastic-gloved high five).
Speaking of which, the average baby’s head is about 11.4 centimeters in diameter, and it’s expected to pass through the average vagina, which is only 2.1 to 3.5 centimeters in diameter during birth. Sure, a delivering woman’s body releases hormones to help loosen ligaments and muscles to make way for that giant baby head; contractions do their part too, and the cervix gets credit for dilating, but it’s by no means a perfect system. Spontaneous vaginal tears still occur anywhere from 44 to 79 percent of the time and can range from superficial first-degree tears that don’t require stitches, to third and fourth-degree lacerations that go through the vaginal tissue, perineal skin and muscles, and sometimes all the way through anal sphincter and tissue underneath it. Pooping on the table isn’t nearly as graphic of a possibility, by comparison.
But there’s an alternative to letting the body literally rip itself a new one. In the 18th century, Irish surgeon Fielding Ould put forth the theory that cutting a woman giving birth is better than letting her vagina and the tissue between that and the anus, the perineum, tear naturally. Ould dubbed the procedure an episiotomy, and recommended it only when labor had been dangerously prolonged and there was no other way to save the mother and child. Episiotomies fell into relative obscurity until nearly two centuries later, when Northwestern University obstetrician Joseph DeLee put them back on the map in a 1920 meeting of the American Gynecological Society at which he reportedly compared labor to falling on a pitchfork. Though many of his colleagues disagreed with him, DeLee claimed that episiotomies were a preventative measure to manage risks of blood loss, perineal tears, and head trauma for the infant trying to get through, and his thinking caught on. By 1979, 63 percent of vaginal births in the U.S. involved episiotomies. Naturally, a significant number of new mothers would have needed these slices stitched up — not for the pleasure of their husbands, but to close their wounds.
In the 1980s, however, episiotomies came under fire. Kitzinger, known more for her advocacy against the pathologization and medicalization of childbirth than the husband stitch, published research that routine episiotomies were doing more damage than they should, and a 1984 study, published in the British Medical Journal, showed no benefits to routine episiotomies. A 2005 systematic review published in the Journal of the American Medical Association revealed that episiotomies did not help with incontinence or pelvic floor relaxation, and women had more painful sex as a result of the procedure. Finally, a 2012 randomized control trial of more than 5,541 women, showed that those who did not have episiotomies experienced fewer cases of perineal trauma, needed less suturing, and had a lower incidence of complications overall.
While episiotomies can be necessary and life-saving in rare instances, the research was clear—as a routine procedure, it made no sense to cut the perineum prophylactically.
But as episiotomy rates fell to 24.5 percent in 2004 and 11.6 percent in 2012, a new bugaboo appeared—the husband stitch. A number of studies published in Seminars in Plastic Surgery and Culture, Health & Sexuality legitimized the husband stitch as a real procedure. “After an episiotomy—the cutting of the woman’s genitals to enlarge the vaginal opening for the baby to emerge—the doctor will sometimes insert an extra stitch pulled tight, also known as a `husband stitch,’” study authors Virginia Braun and Sue Wilkinson of Loughborough University wrote in the Journal of Reproductive and Infant Psychology. As a result, the subversive stitch was becoming increasingly understood as a risk that came with any repair. The husband stitch, in essence, became a medical (and frequently sexist) boogeyman that could appear after any rough birth.
Much like the boogeyman, Abby Brown, a certified Nurse Midwife at Community Midwifery Care, says imagination might be part of it. She says that she’s most familiar with the husband stitch as “an urban legend on parenting boards.” Other physicians that spoke with Fatherly agreed.
But Kitzinger was herself a victim of one particularly unsettling husband stitch experience when she gave birth to her daughter in 1956, according to her autobiography A Passion for Birth: My life: anthropology, family and feminism. “It was there that the obstetrician, after injecting me with a general anaesthetic, dared to ask my husband (man to man), ‘How tight do you want her?’” She wrote. When her husband did not know what to answer she was “duly sutured and then handed back to him with these words: ‘I’ve sewn her up good and tight.’ I was furious. He had given me the French equivalent of the American obstetrician’s ‘husband’s stitch’.”
Medically speaking, an extra stitch just doesn’t make any sense. The vaginal opening, or the introitus, has little impact on a woman’s (or man’s sexual) experience. Sexual pleasure depends more on the pelvic floor muscles—something that can be addressed through other interventions including surgery, but not a simple stitch. Richardson speculates that doctors in the past likely did administer extra stitches without consent because they believed they were helping the couple—especially when episiotomies were so routine, and before research demonstrated that those efforts were not only unrelated to the size of the vaginal opening but likely to do more harm than good. Those stitches, Richardson says, failed to accomplish what kegels could. “You can’t really say legally where a repair should stop,” says Richardson. “It’s an approximation.”
Meanwhile, the increasingly profitable vaginal laxity market has given moms concerned about what birth has done to their bodies another option—vaginal rejuvenation. It’s never done immediately after birth, and for good reason. There’s too much swelling and edema in the vaginal area to do anything cosmetic before it heals. But vaginal rejuvenation can cost up to $8,000 and is not typically covered by insurance for the same reason that it won’t improve sex much—it’s cosmetic. “The musculature internally is still very lax which I don’t think would increase either partner’s pleasure during sex,” Brown explains.
At the same time, it is clear that what was once very real and flawed procedure has evolved into something more mythical today, blurring the lines between fact and fiction. Many women who give birth, especially for the first time, will require some stitching whether they have an episiotomy or not, to limit incontinence. And many, perhaps due to message boards and hushed rumors, will assume they’ve fallen victim to a husband stitch. When in fact it’s less likely that anything unethical has happened, and more likely that they happened to overhear the phrase “husband stitch” thrown around by inconsiderate bystanders during a messy birth.
Richardson suspects most patients who think they have a husband stitch are probably wrong. And regardless of the outcome, they’re likely to blame the husband stitch. If they are fortunate enough to have a successful recovery and great sex, Richardson says, it’s the husband stitch that saved the day. If they struggle, it’s also the husband stitch.
In the end, the husband stitch is neither a myth, a joke, nor a procedure—but a strange three-headed monster involving all three. Most doctors referencing it and people asking for it are likely joking, and it makes sense as to why. Even births without complications are stressful and it makes sense that a joke like this could catch on, as a way for guys to cope, break the tension, and perhaps bond and build trust with doctors. But there are better ways to accomplish this without referencing a procedure of no medical value that some doctors still perform if pressed. Best case scenario, the person delivering your kid is going to think you don’t know how sex works. Worst case scenario, it backfires with a pointless stitch that could cause your partner more pain.
Even if it’s coming from a good place, the best way to reduce the risk of someone not getting a joke is to stop telling it. And maybe the husband stitch bit is ready for retirement, as it hasn’t aged well. At this point, a bedpan as a hat would be a better opener–so to speak.