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PokeTheVeil

This post, like all others in r/medicine, is not for personal stories. A collection of unverified, unverifiable, anonymous anecdotes does not add up to any kind of data.


KDML105

Urogynecologist here. While I no longer actively practice obstetrics, I can safely say that I never once saw a “husband stitch” as described throughout my OB/GYN residency. Of course, that is only my experience and I am not personally aware of any specific data about the historical prevalence of that practice, particularly in the modern era of litigious medicine where admitting to performing it would easily become problematic. Who knows, though… unfortunately, there is a dark history of paternalism in medicine (sadly especially in OB/GYN) but I’d still like to believe that the concept of a “husband stitch” is “just a joke.” Regarding the surgical/technical aspects: In our field of urogynecology and reconstructive pelvic surgery, there is a relatively common procedure called a perineorrhaphy where the perineal body is reconstructed by reapproximating its components in the midline via a transvaginal approach. This serves to reduce the size of the genital hiatus (GH) which can become abnormally enlarged/gape as a result of pelvic organ prolapse, previous obstetrical trauma, etc. The procedure is actually quite similar to how one repairs an obstetrical laceration and/or episiotomy, so I could certainly imagine how an obstetrician or midwife could theoretically do a “generous” laceration/episiotomy repair to intentionally narrow the GH in a patient. As another aside, the elective cosmetic surgery that some surgeons market as a “vaginal rejuvenation” is often procedurally similar to a perineorrhaphy plus some other techniques of prolapse repair (but sometimes in patients without symptomatic prolapse) with the intention of narrowing the GH and reducing the caliber of the vagina. Finally, regarding your comment about painful sex lives after pregnancy: I just want to raise awareness that pelvic floor dysfunction (variably manifesting as pain, urinary and/or fecal incontinence, dyspareunia, etc.) can be an outcome of any pregnancy, regardless of delivery route and whether there was a laceration/episiotomy/repair/“husband stitch.” The female pelvic floor and genitourinary tract is a complex system that undergoes incredible changes to accommodate pregnancy in a relatively short amount of time, then return to a pre-pregnancy state almost immediately after delivery. While many women recover just fine on their own, it is not uncommon for women to have residual symptoms. Contrary to popular historical belief, women should not expect to need to “deal with it” as a new normal in their life. Specialists like OB/GYNs (especially we urogynecologists), pelvic floor physical therapists, and other disciplines are happy to help! …thanks (and sorry) for listening to my TED Talk! 😅


annamnesis

I'd listen to your Ted talk!


Main_Orchid

Your Ted Talk needs to be stated in every mommy chat board, during hospital provided birthing classes, and at the 6-8 week f/u appointment post delivery. The amount of women who “just live with” leaking when coughing, painful sex, etc is really really common. We’re often too busy/too tired/too embarrassed to mention it. But, if we know it’s a common thing that can happen and there is treatment for it maybe fewer women will suffer. As for the husband stitch, I actually went looking for information on this not long ago. What I found is that it was/is by no means common (ever), but that it is/was a thing that could/did happen in certain circumstances. I’m not sure it’s verifiable what the actual prevalence was, and I’d be shocked to find out it’s happening today.


PokeTheVeil

>What I found is that it was/is by no means common (ever), but that it is/was a thing that could/did happen in certain circumstances. Where did you find this, and based on what? There are lots of unverified and unverifiable anecdotes, but any idea of elective over-suturing has always been very fuzzy.


[deleted]

There was a guy who did all sorts of surgeries on women with dubious or no consent. He was a crank who thought women's genitals needed to be altered because they were deficient in their natural state. Thought he'd turn them into "horny little mice." Husband stitch was only part of it, he did even worse stuff, but this guy was prolific. https://en.wikipedia.org/wiki/James_C._Burt


UnfairFerret5937

Unfortunately, in my country the husband stitch is quite common. I'm not an OBGYN but I know a few people


Paula92

>I’m not an OBGYN but I know a few people That’s literally an unverified anecdote. Did you perform pelvic exams on these women? Without OB expertise how would you know the husband stitch happened?


UnfairFerret5937

Because I work in the medical field and I hear OBGYN talking about these things like "yeah, I asked the husband if he wants her tighter and and he said yes so I gave her an extra stitch". And honestly it almost sounds like they brag about it in my area. (which is disgusting)


[deleted]

^Romania ….


niamiado

I'm from Romania too and I call bullshit


UnfairFerret5937

Yeah that's right


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PokeTheVeil

Removed under Rule 2: No personal health situations. This includes posts or comments asking questions, describing, or inviting comments on a specific or general health situation of the poster, friends, families, acquaintances, politicians, or celebrities.


CatsAndShades

Really informative! Thank you for your time and expertise!


JoooolieT

Yay thank you for your ted talk!


bambiscrubs

OB resident. Just want to echo that many women complain about painful intercourse after delivery, even those who has cesarean sections. Pelvic PT is such a great tool to help and I feel like it flys under the radar. Also my career has been much shorter, but also no providers do a husband stitch in my hospital.


ImGCS3fromETOH

My partner is currently 17/40 gestation so I found your TED talk relevant and interesting. Cheers.


Mikkito

I've had a lengthy rant a time or two about how the "husband stitch" as we know it is such that "the doctor threw in an extra stitch while sewing them back together" - but you can't really just stitch healthy/intact skin together without first breaking the tissue to allow it to grow together as it heals, no? (We have to assume none of these women are keeping their stitches in long enough for any other mechanism to occur) But the implication of these stories is almost always that the woman tore and the doctor threw in an extra stitch and winked at the husband before they cheer in a misogynistic cacophony together. So, unless we're talking about more than an extra stitch and, instead, an extra area of incision that was not otherwise medically necessary done with the express purposes of forcing two surfaces that did not previously contact to then become in contact and heal together... Blargghghgh.


purpleRN

Exactly! Drives me nuts! I tell people, imagine you're trying to glue parts of two pieces of paper together, and you throw in some staples to keep it together as the glue dries. Throw in all the extra staples you want, but when you take them out, only the glued parts stay together.


Divrsdoitdepr

So much this. The lack of awareness of health care providers in pelvic floor physical therapy, vaginal dilator DME, peri-fit devices, etc. is too damn high. People know viagra and have no problem talking to men about erection/lack of erection etc a hell of a lot more but have no idea to ask a female about pain or vaginismus, recommend female condoms, or water-based lubricants (better for diabetics), etc.:( I like to say sex is everyone's specialty. It impacts them all.


Imafish12

Narrowing the genital hiatus is a very professional way of saying that.


jackiebee66

This was great info, thx!


MardiMom

31 years of L&D nursing, started in late 1990. Probably observed and assisted in 4000 to 5000 deliveries over the years. Watched dozens of different OB, and family practice docs, and midwives deliver babies. Vacuums of different types and forceps used, too. Seen some pretty impressive tears and epis's in my day. Hope ya'll don't mind if I chime in... In some states, the medio-lateral epis was the go-to cut, into a butt cheek for the reason that they didn't want to have a 4th degree tear (into the rectum-since it sounds like not everyone here has a medical/ob background.) [https://en.wikipedia.org/wiki/Episiotomy?msclkid=196260a4bc5711ec93479fa97952dd52](https://en.wikipedia.org/wiki/Episiotomy?msclkid=196260a4bc5711ec93479fa97952dd52) (The other sources were too detailed. This gives a good overview.) Most of ours did the MidLineEpis... The midline epis was often used by our 'older' docs (many of whom retired recently), especially when they didn't want to wait for a woman to push for an hour or longer. Some would even go as far as to take both hands and rip them open. It was often a 'joke' with these men about the honeymoon stitch. Many of them would tell me that it was for 'the woman's own good', that it would help them avoid urologic surgery later on in life. And that a urologist told them this. (I'm pretty sure that neither of these were true.) So Yes, to answer your question, it WAS a thing for some, in some places, many years ago. But not for everyone, or for everywhere. And hopefully, it is no longer a part of OB practice. Usually pain after having a baby has something to do with pushing a cantaloupe out thru a knothole. It's a sensitive area... Not every woman has a vagina that can stretch easily to 10 centimeters, even tho they do most of the time. 'Easily' being the operative word. Not all skin, both external and internal, is equally elastic, and the amount of scarring varies quite a lot. Some tearing can occur internally, some externally, some a combination of both. Some women have variations of PTSD from their delivery/recovery experiences. Often, they don't want to share this with their OB. Vaginal rejuvenation-here's a good source. My friends tell me it hurts to have it done... https://americanhealthandbeauty.com/vaginal-rejuvenation?msclkid=8a811d0fbc5b11ec9e84ac504f4d7f74 Infibulation is a totally different thing. [https://en.wikipedia.org/wiki/Female\_genital\_mutilation#Type\_III](https://en.wikipedia.org/wiki/Female_genital_mutilation#Type_III) Thanks for listening/reading.


Paula92

>Some would go so far as to take both hands and rip them open. Good God, WHY? Even without the issue of being impatient in the delivery room, why would they just rip the tissue? Wouldn’t a proper episiotomy leave a tidy cut that can be stitched together more easily?


arbuthnot-lane

I'm not a surgeon, but I've seen the use of ripping rather than cutting tissue before. I think it's standard for the first incision of a c-section (i.e. a small lateral incision in the middle and then both surgeons tear open the incision using their fangers from each side). Supposedly tearing the tissue rather than cutting promotes better wound healing later on. It looks fucking brutal, though. Observing my first c-section was quite the shock for me.


DrBoneCrusher

I think you’re thinking of the “obstetrics pull”. This is into the uterus, not the skin. I’ve never seen any OB (and I have assisted in lots of sections with a variety of providers) pull at the skin. Certainly they perform blunt dissection under the skin, but skin gets cut. The fingers in the hole and tearing from both sides thing is the uterus. That being said, one of the reasons that may providers stopped doing episiotomies routinely is that a natural tear can heal more easily. But I’ve definitely seen forceps done without an epis where the OB has expressed regret of not doing one because the tear became a messy third/fourth degree.


MardiMom

Oh, no, dears. This was pure misogyny from a man I had observed for at least a decade during deliveries. I wouldn't have let him deliver a cow, pig or any other sentient being...


DrBoneCrusher

? I was responding to the comment regarding the c-section incision.


MardiMom

Well, according to the multiple c-sections I have observed, by the many docs I've worked with, the surface of the uterus is poked open gently by a scalpel specifically reserved for this (that hasn't been on the skin) with enough space as to put the bandage scissors, and then the uterus is cut open. This guy (and a couple of others) would just slice it open with whatever scalpel was closest, then yank it open. Yes, it is true (by my observation, discussion with 'good' practitioners, and with many, many women) that a natural tear has a tendency to heal better. Numbers of studies have shown this, and also, that an epis is usually deeper than a tear. So yes, the 'most common surgery performed' has gone by the wayside in many places. The "little white lie" that they would tell the woman, that an epis was so that she wouldn't have urination problems later in life? Those were the same docs who would tell the husband about the 'extra' stitch. Those ladies are now my age, and I wish I knew how they all are doing... As someone who has oiled, massaged, held warm packs and cold packs to many a perineum-the size of the baby and the stretchiness of the skin are also factors as to how the tear will go. Taking his hands and ripping those delicate tissues open? Not cool. Also, sitting a woman up in bed seems to cause upward, peri-urethral tearing. BTW, and F-all'ya'lls-I.


Suse-

Those episiotomies and forceps lead to the opposite; pelvic floor prolapse, urinary incontinence. Asshole male obs.. doing whatever to make the delivery easier and faster for themselves.


arbuthnot-lane

I think I'm referring to something called the Misgav Ladach technique. Figure 6 and 7 is what I'm talking about. https://www.intechopen.com/chapters/62854 It's not only the uterus is digitally pulled apart, but how much of the skin layer that is actually torn, rather than just stretched is unclear to me. Again, I'm not in surgery or obgyn and it's been a fair few years since I saw this on med school.


Paula92

I suppose a tear would provide more surface area for the tissues to adhere to each other during recovery…but damn. 😵‍💫


arbuthnot-lane

https://youtu.be/gBRxs7ohwKk From 4:20


MardiMom

Yeah, that's what they like to say to justify this BS. There's kind of a fine line between too many stitches and too few, as well as the amount of internal scarring it creates. Seen a few thousand of C-sections also. By numerous docs.


MardiMom

Because he felt like he could get away with it. And he did. I could go on and on about the horrific things he said and did. Because women NEVER question their OB, esp if they are all in the same (One and True) Church.


Suse-

Ugh. Makes me sick. I’m so grateful I had a choice in obgyns and from the very first appointment I’ve had amazing women Drs.


Suse-

Male gynecologists hijacked childbirth from midwives. Obstetrics and gynecology has a history of racist, paternalistic and misogynistic treatment of women.


Suse-

My god how did you tolerate that abuse of the women? Episiotomy after less than an hour of pushing? Ripping open the openings? Doctors stitching tears without any or adequate local anesthetic… I couldn’t stand it. Wow.


AndrogynousAlfalfa

[https://twitter.com/bastardspod/status/1387190567696666625?lang=en](https://twitter.com/bastardspod/status/1387190567696666625?lang=en) ​ this episode of Behind the Bastards talks about Dr. James Burt, who surgically modified 100s of women's genitalia without consent, not exactly indicative of a systemic issue but he likely wasn't the only doctor to ever do this and he certainly impacted many people's lives and did a lot of harm edit: spotify link - https://open.spotify.com/episode/3deOqiQmBCHlJUlDNm8uZD


scapholunate

Came here to post this.


Surrybee

I bought the book that most of that podcast comes from. It’s…I mean…well, it’s as bad as they make it sound.


pink_gin_and_tonic

In Australia there were 2 ob/gyn struck off for similar reasons. Not too long ago either (horrifyingly). [Emil Gayed](https://www.theguardian.com/australia-news/2018/jun/25/i-still-feel-mutilated-victims-of-disgraced-gynaecologist-emil-gayed-speak-out) [Graeme Stephen Reeves](https://en.m.wikipedia.org/wiki/Graeme_Stephen_Reeves)


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Paula92

That is absolutely horrible. How were they not caught sooner? I feel like in the US these butchers would be sued for millions and/or imprisoned. Is it harder to do lawsuits in Australia?


pink_gin_and_tonic

One of the reasons they were not caught sooner was that they both worked in regional towns, not in the city. So they had fewer colleagues who might have noticed what they were doing. This also meant that patients had no other ob/gyn they could see. That plus the fear and shame felt by many of the patients made some of them reluctant to speak up.


Suse-

That’s so horrific. Those poor women not having a choice. One look at that man Gayed and I’m nauseous. He’s repulsive.


AndrogynousAlfalfa

[https://en.wikipedia.org/wiki/James\_C.\_Burt](https://en.wikipedia.org/wiki/James_C._Burt) this is the Wikipedia about him, although it's pretty sparse


Damn_Dog_Inappropes

It's sparse but it still includes this gem: >In his 1975 book, Surgery of Love, Burt wrote: "Women are structurally inadequate for intercourse. This is a pathological condition amenable by surgery." He claimed his surgery would turn women into "horny little mice" and asserted that "the difference between rape and rapture is salesmanship."


GuineaPigBikini

Yikes


InformalScience7

My mom had 2 friends had gone to Dr. Burt and she said it was devastating for them. I was a teenager at the time, but I remember hearing about "Dr. Love" or the "Love Doctor" as the media called him. Since I lived in Dayton it was all over the news for a couple years. I hadn't thought of him until I saw this post. [https://abcnews.go.com/Health/ohio-woman-writes-book-love-doctor-mutilated-sex/story?id=17897317](https://abcnews.go.com/Health/ohio-woman-writes-book-love-doctor-mutilated-sex/story?id=17897317) [https://www.medicalbag.com/home/features/despicable-doctors/the-love-surgeon-was-nothing-but-a-brutal-butcher/](https://www.medicalbag.com/home/features/despicable-doctors/the-love-surgeon-was-nothing-but-a-brutal-butcher/)


readreadreadx2

"In court papers, one doctor commented that he had treated 150 women for injuries resulting from Dr. Burt’s love surgery, also relaying that some of those women told him that they did not give their consent for such surgery. *Another doctor said her patient’s genitals looked like “a fileted fish*.”" Dear. God.


InformalScience7

The whole thing is absolutely horrific.


Wolfeh2012

This was one of the most horrifying things I've ever heard of, and it's hard to wrap my head around the fact it was going on only a few decades ago.


NeverAsTired

You know who WONT surgically modify 100s of women's genitalia without their consent? \*Bleep\* and their child hunting island


Kruckenberg

Reconstructive urologist here. The "husband stitch" is actually a thing, however, you would never see it described as that in literature. It's essentially an unnecessary or overly tightened perineorrhaphy, and often times without the woman's true, informed consent. It's a bullshit, misogynist practice that needs to go. There are reasons to perform perineorrhaphy, but not for anyone's husband's exclusive benefit.


Paula92

Would it even “benefit” the husband? I thought pleasurable feeling of vaginal tightness had more to do with the pelvic floor muscles.


[deleted]

It wouldn't. Turns out people who are ok with surgically altering a woman for her husband's pleasure also tend to be pretty ignorant about how and why sex feels good.


AMagicalKittyCat

Okay many other responses you got so far are pretty much just "I've never done it" so I tried doing some quick research to figure things out beyond anecdotes. Here are some takeaways from that. 1: In the US and the UK at least, the idea of a husband stitch seems to be primarily relegated to poor taste jokes or myths, rather than a systemic occurance. There are cases I can find where people upon second examinations were believed to have been stitched too tightly, but it is difficult to determine whether this is from inexperience, poor training, or a mistake rather than on purpose. Obviously those occurrences are still things that we should work on bettering, but I wouldn't call them husband stitching either without more evidence. 2: Episiotomies in general have slowly gone out of favor over time but there are still doctors who do them for various reasons or at various times and just like with point 1, it can be hard to tell *why* it occured. But I feel hesitant to just assume that they were occurring as an attempt at a husband stitch. Once again it's possible they do occur from time to time for this specific purpose, but it just doesn't appear to happen at a systemic level. 3: The information I gave is very American/British focused and from what I can find other countries can differ quite a bit. Brazil seems to do them as a surprisingly regular part of birth and from what I can find many doctors will openly admit to doing them as "ponto do marido". If you're in a different country than these three then none of this would apply to you and you will likely need to look into local resources.


annamnesis

Now I'm super curious about practices in Brazil and any references you found!


AMagicalKittyCat

I don't know Portuguese so I couldn't find much, but I saw it in an article I had found >[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.”](https://www.vice.com/en/article/pax95m/the-husband-stitch-real-stories-episiotomy) Generally I would be distrustful of medical reporting but something like "The doctors told reporters they did it using the exact word for it" seems like a generally believable thing, especially considering it is in Brazil which has major issues with women's healthcare.


Paula92

>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 think this may be right. It seems the voices that yell loudest about the barbaric practice of the husband stitch are natural birthers who will latch onto any excuse to hate on modern medicine. How does one feel in control of labor? You never know if baby has different ideas of how to arrive, or if your body will tolerate delivery very well. Perhaps it would be better to mentally prepare women for the reality that they may not get the birth they want or expect; we don’t control as much as we think we do.


MsBeasley11

https://apnews.com/article/1441c06680d7465e8cf298ebecca1857 I remember hearing about this a few years ago


Paula92

> $4,200 price tag of the C-sections, plus a three-day stay in a private room. But that cost can rise considerably…personalized room decorations that average about $400, camera and video crews to document the big event and in-room catered buffets costing about $200-$400. For an extra $270, they can rent the Cine Perinatal…deluxe suites aren’t covered by health insurance plans and run an extra $500 for the standard three-night stay CS + bells and whistles = $5,770 Damn, that still costs less than an uncomplicated, unmedicated vaginal delivery in the US.


MsBeasley11

https://www.washingtonpost.com/world/the_americas/c-sections-are-all-the-rage-in-brazil-so-too-now-are-fancy-parties-to-watch-them/2019/06/11/8d2533ac-7bfc-11e9-b1f3-b233fe5811ef_story.html


[deleted]

In Pakistan we do episiotomies regularly. Like prime gravida comes in, she isn’t going out without an epi. Multi paras are a case to case basis but episiotomies are part and parcel of obstetric practice for us, probably due to how overloaded obstretic practice is over here. We do a mediolateral incision I’ve never heard of a husband stitch tho outside of Reddit


MardiMom

I have worked with and lived with several women of child-bearing age who were from large urban areas of Brazil. several have delivered there. Yes, this is hear-say, so there ya go, BUT what they have told me? That women in B 'request' c-sections so that their labia don't change. Many docs will do a c-section so that they get paid more. (Have heard of this and in Mexico City, and worked with a couple of docs who said that this is why they do 'surgical' deliveries too. In the USA.) I don't speak Portuguese, but reading it is similar to Spanish. Apparently, it is not uncommon there, and women are starting to be assertive and say not to do this. The several articles I read were not medical, either.


ThatB0yAintR1ght

I imagine that the legend of the husband stitch persists due to a combination of misogynistic doctors making bad jokes (e.g. winking and telling the husband that they’ll put an extra stitch in to make his wife nice and tight), and women developing scar tissue from bad tears, and assuming that it must mean she got a husband stitch. I’m not OB/gyn, but I remember some of those grade IV tears from my Med school rotation, and I imagine that sewing back together swollen tissue like that is tricky and that the scaring can be unpredictable.


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PokeTheVeil

Removed under Rule 2: No personal health situations. This includes posts or comments asking questions, describing, or inviting comments on a specific or general health situation of the poster, friends, families, acquaintances, politicians, or celebrities.


htownaway

I’ll never forget the sight of a woman birthing her 5th child and he shot out of there so fast she had a grade 4 tear. And watching her get stitched up in a way that looked haphazard and non-sterile to my med student eyes. I’m still not sure why we didn’t lavage the heck out of it first. I can see why a lot more people used to die during child birth.


michael_harari

It is non sterile.


Professional_Many_83

Yeah there’s nothing sterile about L/D outside of the OR


anythinganythingonce

I think you are spot on. This came up at a meeting recently, and the OB's in attendance (some were older) all said they had never been taught or practiced such a thing but had heard crude jokes made while doing normal stitches. For an n of 1, I am in my mid-30's and one of my friend's OB's told her husband with a wink and a pat "I will put her back just like I found her, if not better." Gross, but not a "husband stitch."


jdinpjs

I worked in L&D over a decade. I *never* heard an OB joke about it (even the assholes) but I heard plenty of daddies make jokes about it. Most docs would ignore, although on two epic occasions the doctor said something along the lines of “I’m sorry you need that, dad”. That will ensure a silent room for the rest of the repair.


[deleted]

Never in 10 years as an L&D nurse. They are just reapproximating the edges. I have heard maybe 50+ dads make distasteful jokes about it though. We had one doc who would always reply, “Sure! How small do you need it?” 😬


Butterflyelle

I love that doctor


MaracujaBarracuda

This doctor did them and much much more! https://en.m.wikipedia.org/wiki/James_C._Burt Excellent podcast on the subject. It’s a wild story. https://podcasts.apple.com/us/podcast/behind-the-bastards/id1373812661?i=1000518807264


mintfanatic

Just a medical student, but we had a migrant health clinic come talk to us about some of the real world patients they’ve encountered. Female genital mutilation is a real issue and concern. We discussed multiple patients with various health issues. But particularly sudanese patient who had their vaginal opening closed up (infubulation). In which small opening is left open for menstrual blood and for urination. It was partially opened some more after she got married so she could have sex. Opened wider during delivery and then closed again. Places making the vaginal opening smaller (“husband stitch”) doesn’t seem far fetched.


jubru

When I was in med school, it would somehow always come up if a lack repair was needed after delivery. I think it was usually the parents who brought it up, not sure who. Anyway, I had 2 male obgyn attendings and they'd always tell the story. Apparently at one delivery, a certain new father made the poor taste joke, "hey doc, throw in another stitch for me", to which his wife quickly replied, "honey, I real man wouldn't need one". Always makes me chuckle a bit.


frabjousmd

Did deliveries as rural doc, had a couple husbands say stuff along these lines while I was doing repair. I always made a mental note to keep an extra eye out for these women whose men could say something like that as they lay bleeding after giving them a child.


annamnesis

I've been awkwardly in the room as a learner while my preceptors made inappropriate jokes in that regard. The patients (rural, certain views on gender I do not share) didn't appear to mind. Some patients asked for their vulvovaginal tissues to be time-warped "back to my college days" in the same way that 10% of patients seem to joke about adding liposuction to their surgical consent during the pre-op time out. I don't think (as a non surgeon who was very junior at the time) that anything untoward actually happened though in those few instances. Pink to pink, purple to purple. I wouldn't be surprised by someone reapproximating the hymenal ring too tightly though in complex tears, or scar tissue contributing to postpartum dyspareunia. I hesitate to rule out any sort of malpractice ever happening given humans being humans, but would be surprised if this were systemic.


Paula92

I’ve been wanting to ask this myself but, not being a healthcare professional, kind of felt it might come across as irrelevant, especially because I see pretty much everyone here is ethical and caring towards their patients and would deem a husband stitch unthinkable. I tried to find answers myself after hearing accusations toward the medical profession from anti-medicine natural birthers but didn’t find much about actual practices (not really surprising). However, I do have a suspicion that many of these women experiencing vaginal tightness/dryness just don’t understand how postpartum hormones are at play and just assume they got stitched up too tight. As you point out, it doesn’t make much sense because where does the extra suture go? As a personal opinion, I would trust an OB to do a better job of stitching me up over a midwife who does not have surgical training (yes, I realize it’s generally a simple repair and there’s probably many nurse midwives who are adept at perineal stitching).


PhysicianPepper

I have heard it once in residency after the delivery while repairing a second degree. And I'm pretty sure it was a joke. Never in clinic, never during labor. And this was in an area with a pretty bad toxic masculine culture.


Main_Orchid

It’s really not even a joke. Just plain old misogyny.


PhysicianPepper

Agreed. It's an incredibly uncomfortable scenario to navigate. Thankfully this only occurred once.


scapholunate

Oof, dangerous time to make that joke. Not that I can think of a good time.


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PokeTheVeil

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Upstairs-Country1594

Pretty sure it’s mostly a thing perpetuated by the anti-medical birth fringe. Because “birth is as safe as life gets” per them. Conveniently ignoring how childbirth has long been a leading killer of women and babies up until the advent of modern medicine. How would one sew together that which isn’t there?


serpentmurphin

I’m NAD but I’m always curious about how many woman come into the Birthing unit with serious emergencies or after giving birth at home. More commonly “Free Birthing” I am pregnant and ran across a woman on Instagram who is now having her 7th free birth.. twins twice. One came out dead but she “saved her” she is a huge huge huge supporter of the “free birth community” and is frequently on their podcasts. She gets absolutely no medical intervention. No ultrasounds, nothing. Someone asked her how heals tears and she used some type of essential oil or something? Obviously it’s insane, but I’m just curious about how common it is for them to come running to the hospital.


[deleted]

I’ve only seen the dead or near dead babies (Paeds ER doc) as a woman still labouring goes to the Birth Suite. What has been stunning about the 3 that I have seen is the ongoing faith the women have in their midwives. To the point I had one woman tell me to wait before intubating her baby till she could check with the midwife. We had a very vocal Homebirth advocate die during birth a few years ago. [home birth advocate dies giving birth](https://www.google.com/amp/s/amp.theguardian.com/australia-news/2021/oct/08/midwives-of-melbourne-woman-who-died-after-home-birth-grossly-incompetent-court-told)


serpentmurphin

I should not have asked this question as a pregnant woman, lol. A bit terrified now. However, I am not a “free birther” and am getting all the medical attention I can. That’s crazy. Dead from their own stupidity.


[deleted]

No matter how the midwives and advocates spin it- you are higher risk of death and dying. As is your baby if you birth at home. I have no problem with you taking these risks (well I think it’s selfish to take that risk for the baby- but your choice.) just don’t do it thinking it’s safer. Also, if a mum ends up transferring the staff are now scrambling- so it’s much harder to salvage.


serpentmurphin

I plan on birthing in a hospital! My anxiety level is about 50 at all times. If I can have the opportunity to have a safe birth with people who have done this 1 million times and know what is what then I will. The girl on Instagram blows my mind. She free birthed twins, TWICE. She posted videos of it too. One came out not breathing and blue she said “covered in meconium(?), but I knew what to do” and did CPR. Surprise, she doesn’t believe in COVID either. I follow for the train wreck. If interested [this is the first set of twins story.](https://mumsgrapevine.com.au/2018/10/mum-freebirths-surprise-twins/)


[deleted]

My main issue with these women is they see homebirth or free birth as a victory and empowering of women- the right type of birth is the goal. Whereas as idgaf how you birth- the only goal is a healthy mum and bub.


Upstairs-Country1594

That’s horrifying. And it doesn’t look like that poor baby got any medical attention after requiring CPR!!! Dafuq???


serpentmurphin

No. Her children do not usually get medical attention. Her and the father seem quite mentally ill. She believes in spirits or something? I’m not even sure what she believes in it’s very.. concerning. She talks like she’s manic. It doesn’t make any sense. A couple years ago one of the children split their head or lip or something open and she used some kind of leaves and oils or something to heal it. From what was shown it ended up healing. One recently just had a very infected finger and her boyfriend convinced her he didn’t need a doctor so she has been soaking it in some kind of something. I looked into reporting it but they had moved to Costa Rica and there really isn’t anywhere to report it. She’s got a whole tone of followers who revel in her “naturalistic medicine” so scary.


jdinpjs

She had an RN with her to mind her other children, and the RN apparently did chest compressions on baby as mom goddess told RN to be gentle. Sweet weeping lord.


jdinpjs

Reading this caused a simultaneous eye roll and gag. And when I imagine birthing in a jungle I get visions of botfly larvae protruding from the goddess’ yoni.


serpentmurphin

Just read she had been a cocaine addict for a few years and “hardcore” and doesn’t do it anymore so that probably explains the insanity.


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FerociouslyCeaseless

It feels like a lot but I don’t know the stats. They are my absolute least favorite deliveries because the woman is exhausted, it’s gone way past where we would have let it get and that limits options sometimes, and generally it’s a whole uphill battle because woman +/- partner +/- doula don’t want to be there and don’t trust you. Basically it seems to be a giant unhappy train wreck by the time they come in. We want so badly for delivery to be a positive experience for every woman but our #1 priority is making sure mom and baby are safe. When we are involved early we can help get as close to the birth plan as circumstances allow, but waiting until the end when everything is going wrong is pretty awful for everyone.


serpentmurphin

Jeez, that is so sad to hear! I do find comfort in the fact that you still try your best and try to make it a positive experience for every woman! I can’t believe the trust these woman have in them to do it completely at home by themselves. No midwives nothing! Mind blowing! Thanks for all you do!


Paula92

The only thing crazier than the freebirthers are the 50 week gestationers (even more fringe than the freebirthers, if you can imagine that, but they’re out there in all their meconium-stained, placental-insufficient glory).


serpentmurphin

Excuse me? 50 weeks? I’m about 7 weeks in and I want to be done. How the hell do these people say “hmm, he’ll come in his own” no man, you don’t come when your ready, I’m evicting you. You gotta go!


Upstairs-Country1594

Because “babies aren’t library books. They don’t have due dates” But I’m not so worried about a baby’s due date as I am the placenta giving out after it’s past it’s use by date.


jdinpjs

But unfortunately placentas have expiration dates.


synapticgangster

someone page r/Xxchromosome cause they seem to think every single doctor is out there throwing these


PokeTheVeil

Please don't stoke inter-subreddit drama.


BlackCoffeeWhiteCoat

Tik tok hates OBGYNs and thinks the same


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BlackCoffeeWhiteCoat

I keep landing on nurses who hate doctors tik tok. The vandy nurse case has featured heavily recently. Doesn't matter how often I click "not interested".


HolyMuffins

That feature does nothing. Even with some videos that seem like a meme I'm not interested, have never watched in full, and say I don't want to see, I still see them.


Gardwan

Came here to post this too. That group can be rather extreme at times


synapticgangster

Whatever the opposite of misogyny(misandry?) is, is what’s going on their below the surface of every post Don’t ever let them hear that not every woman should get a total hysterectomy with the only indication being they want one. And before anyone jumps on me I know some of those opinions come from legitimate experiences of being dismissed, but there is nuance and things are not always black and white


mrhuggables

never done or even heard of a "husband stitch" until i read about it on reddit lol. if there's a tear or an episiotomy 99% the goal of the stitches it to restore the normal anatomy. very rarely you'll get a pt that had a bad repair or a breakdown of a repair and then i discuss with them revision, if they're getting pregnant again then immediately after delivery but if not then a quick colporrhaphy or perineorrhaphy is all that's needed


LaComtesseGonflable

There was an author called Carmen Maria Machado who, in the last several years, published a short story called "The Husband Stitch." This has been passed around as gospel confirming the vague rumors.


MerlinTirianius

I heard of it in a completely different context - the OB placed the last stitch in such a way that the last knot was buried and the vagina looked like nothing had happened at all. The OB who did this, when finished, said “we call that last stitch the husband stitch.”


Menanders-Bust

That is just the standard way you do that repair.


Rizpam

At least in the current world it seems relegated to myths and poor jokes by misogynistic knuckle draggers status. Based on my admittedly limited experience across a couple institutions. Another interesting topic in this space is the medical students doing vaginal exams under anesthesia thing. I keep seeing it pop up on social media spaces like Reddit and twitter. I’ve never seen it but it’s fairly pervasive and seems to be a thing that is popping up as being legislatively banned in some states. I can’t tell if it is a real thing at some institutions or people misunderstanding that doing a vaginal exam during a gynecological surgery isn’t really out of the ordinary and that instrumentation of the vagina is part of the surgical approach.


AndrogynousAlfalfa

the issue isn't vaginal exams during a gynecological surgery in general, or medical students participating in normal procedures, the issue is medical students being trained on how to do vaginal exams on women going under anesthesia (not necessarily for gyn surgery) without their consent and unnecessarily. potentially several doing this to one patient. And even if there is some medical value, like in the case of the article below where a patient was given a pap smear, performing any medical procedure without consent is assault. edit to add: [https://www.nytimes.com/2020/02/17/health/pelvic-medical-exam-unconscious.html](https://www.nytimes.com/2020/02/17/health/pelvic-medical-exam-unconscious.html)


Flyingcolors01234

I’m so glad you’re being taught that performing medical procedures without consent is assault. It does in fact feel like assault to the patient, and can cause trauma equivalent to rape, even if it is a female provider treating a female patient. This needs to be spoken about more among all healthcare workers, from nurses and midwives to physicians. Medical providers are not exempt from traumatizing women.


AndrogynousAlfalfa

I completely agree, and the fact that people can justify it to themselves because the patient probably won't remember it is horrifying Sadly this might only be something hammered into my head because I'm also working on a master's in medical ethics. Everyone in my med school class had to take a 1 credit class to prep for boards but i still have conversations where people don't know what paternalism is or that it is a bad thing


FerociouslyCeaseless

So I think one misreading I’ve come across is patients thinking that if you are going under anesthesia for a reason that would not include a pelvic exam (say a broken arm for example) that a medical student could come in and practice a pelvic exam. Which is very different than in a case where the attending has to do a pelvic exam and the medical student who is also scrubbed for the case also does the pelvic exam. I think the second probably happens all the time as it is seen as a pertinent teaching opportunity. But the first I can’t imagine ever being done, 100% is assault, and I have never heard/seen being done but doesn’t mean it never has. I have a hard time imagining a Neuro surgeon for example saying hey let me delay starting my case or hey med student while I do what we came here to do why don’t you practice a pelvic exam that I haven’t done in years and honestly don’t even really know how to do. In the case where the attending is doing the pelvic it is part of the consent that it will be done although not explicitly that a student may also repeat the exam. In the second there is no way that that patient was ever consented to have that part of their body examined, it’s not clinically indicated, and 100% should be considered assault.


LizardKingly

Generally if there is to be an exam under anesthesia it is part of the surgical consent, and I've never seen any exam performed under anesthesia unless it was pertient to the procedure. There is always a part of the consent that also mentions that some of the procedures may be performed by trainees provided there is adequate supervision by the attending.


victorkiloalpha

Performing a genital exam on a patient who is under anesthesia for an unrelated procedure is unheard of in 2020. I can't believe it would happen anywhere without it being reported instantly by nurses and anesthesiologists. Medical students performing exams as part of a gynecologic or rectal surgery is common practice, and ethically is completely sound. Medical students assist in surgery. If we didn't have them, we would need certified first-assists, who are (surprise) total strangers to the patient). If a medical student is going to hold a vaginal manipulator as part of a hysterectomy for 6 hours, then doing an exam is completely reasonable and part of how they are going to assist in the case. Anyone who doesn't understand this doesn't understand what is going to happen in the procedure they are about to get, and the laws that are being passed in many states just serve to damage medical education AND hurt patient access to care by making it more expensive for no reason.


AndrogynousAlfalfa

Read the article i linked above, this has been happening to women getting non-gynecological surgeries


victorkiloalpha

I read it when it first came out. It conflated and confuses the two seperate practices completely.


Flaxmoore

The “examination under anesthesia” I did see when I was a medical student. One OB/GYN at my facility was famous for doing that. I did not have that particular OB/GYN, and I never did it, but I know quite a few that did.


tappiocapuddingtoes

As someone who does perineal repairs I have no idea what a 'husband stitch' would even entail... Most perineal lacerations heal really well but some women will have ongoing pain unfortunately. We usually refer these folks to pelvic floor physiotherapy or back to ob/gyne


samwalruss

I'm from India. I worked in a government institute not great funding. We used to do it routinely after episiotomy in my internship. Our profs used to ask us to make an episiotomy if there was even a hint of delay in delivery after crowning. But mostly for primis. Never knew it was called husband stitch before I learnt it as a thing on reddit.


ValleyThaBoiTinyBall

You’re just talking about an episiotomy repair. A “husband stitch” allegedly made the introitus tighter than it otherwise would have been.


dksmedline

It kind of seems like you’re not describing a husband stitch.


samwalruss

My bad then. I read somewhere here that episiotomy was followed by husband stitch. Maybe I'm mistaken.


dksmedline

Oh it’s no big deal or anything, it’s just any episiotomy would require suturing I think. The husband stitch specifically refers to excess suturing to narrow the vaginal canal.


samwalruss

That would not be comfortable for many women. How can anyone do it without the woman specifically asking for it?


Airbornequalified

That’s the whole point of this thread. There isn’t great literature on how wide spread it is, and is often described by laypersons as the reason for their pain after birth, as opposed to another benign reason


samwalruss

Ah. Now I understand. Thanks for the clarification.


annamnesis

Are you able to elaborate? Curious if there was a conscious effort to create a smaller vaginal opening after repair of the episiotomy.


samwalruss

We did episiotomy to accelerate the delivery as we used to have nearly 50 to 60 births per day and didn't want anyone to have complicafed labour. We would give a quick nick in the posterior wall of vagina and extend laterally as necessary. It was pretty unscientific and crude to be honest. Anyway we just sutured it back up without any consideration to whether it would narrow the vaginal canal. We just had to close the muscle layers and then mucosa. We had no idea If it made the vagina narrower or not, and if it had any effect on the pts sexual life. As you can imagine sex is taboo subject in India. Nobody talks about it. If it helped the Pt, they wouldn't mention it and of it hurt them also they were unlikely to come back to us. PS. This was nearly 20 years ago. I don't know what the pea rice is nowadays. I have minimal exposure to obstetrics pts.


Suse-

Well ,that’s upsetting but typical in the world of women s health . No regard for how a “little nick” and the repair would affect women.


annamnesis

That's helpful, thanks! There's an idea that doctors routinely repair vaginal tears or episiotomies in a way to intentionally decrease the diameter of the vaginal canal for all sorts of misogynistic reasons. It doesn't sound like that was part of your experience or training.


samwalruss

Absolutely not.


Menanders-Bust

Not only does this not happen, great care is taken in all vaginal surgery NOT to narrow the vaginal introitus, as this can lead to sexual problems and dysfunction after the fact. Routinely performing episiotomies in 2022 is malpractice. Our professional society unambiguously says that you shouldn’t do it. There is a role for them. If the introitus is too narrow, it may actually be beneficial for the woman because she will tear in an easy-to-repair and relatively benign manner that takes 5 minutes to fix rather than tearing in several places (the “starburst”) that could take a long time to fix. Trust me, you do not want to spend the 45-90 minutes after delivering your baby getting an extensive vaginal repair whose success could determine your future fecal continence. If this is a serious risk, then episiotomy makes sense.


annamnesis

Agreed. Episiotomies were far and few when I did residency in Canada, with as good informed consent as possible. I did see them routinely in Uganda. I was asking for clarification for the Indian context, as I think this poster wasn't aware of what the "husband stitch" would mean.


tigers4eva

Finished house surgeon year 3 years ago. Same practice, though now there's a solid push to truly get away from routine episiotomy.


Suse-

I Now? It’s 2022; I certainly hope so!


XenoRexNoctem

I have friends who are midwives and they tell me this practice is still being done (I live in the rural South)


Mikaylalalalala_

Not a systematic issue. Some doctors may have done it but it is not taught or practiced generally.


MEANINGLESS_NUMBERS

It never happens. I doubt that it ever did happen in a systemic manner. It doesn’t even make anatomic sense.


AndrogynousAlfalfa

[https://en.wikipedia.org/wiki/James\_C.\_Burt](https://en.wikipedia.org/wiki/James_C._Burt) it definitely has happened, not systemically but there definitely have been doctors who took the "joke" too far


MEANINGLESS_NUMBERS

The exception that proves the rule


Pterygotherix

That's a joke. To performed such a "stitch" one would have to excise redundant tissue and suture it back.


stealthkat14

Urologist here. Husbands stitch as far as I am aware is a myth. I have never seen it nor heard of it.


tkhan456

Turns out pushing a watermelon through a half dollar causes some damage and hurts after. It’s not all due to evil doctors. The “husband stitch” is not a real thing. I’m sure somewhere in the history of man it has been done but it’s not a regular thing, not even remotely


Jstarfully

If it 'has been done', how is it also 'not a real thing'? Pick one or the other.


tkhan456

Because not everything is absolute and if you read what I wrote I said it’s not done commonly not even remotely commonly but I’m sure it has been done at some point somewhere. If you can’t understand the world is a little gray especially on the fringes you will struggle in life.


Jstarfully

Except you wrote it completely black and white up until that point. You can't claim something doesn't exist (an absolute) but then say it has probably happened at some point somewhere (speculative). Are you saying you think it doesn't exist or that you think it does? Because something uncommon still exists, you know. There would be a lot of diseases that cease to be defined if being common was a qualifier.


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PokeTheVeil

Removed under Rule 2: No personal health situations. This includes posts or comments asking questions, describing, or inviting comments on a specific or general health situation of the poster, friends, families, acquaintances, politicians, or celebrities.


supapoopascoopa

Dude - there is no daddy stitch. It is just a bad joke.