Episiotomy: what should you do if the stitches come apart?

Episiotomy is one of the possible outcomes of a vaginal birth. While in most cases healing occurs without difficulty, some women may experience pain, prolonged discomfort, or the feeling that the stitches are “coming apart.” What is an episiotomy? What are the signs that indicate stitches are coming undone, and when should you seek medical advice?

Episiotomy: what should you do if the stitches come apart? Here’s what you need to know.

What is an episiotomy?

Episiotomy is a surgical procedure that may be performed during a vaginal birth, particularly when the baby’s passage is difficult or in an emergency to speed up delivery. It involves making a small incision in the lower part of the vulva, between the vagina and the anus, at the level of the perineum. This procedure, carried out by a midwife or a gynecologist, aims to facilitate the baby’s delivery and is only performed when truly necessary.

Good to know: In 2000, nearly one in two women underwent an episiotomy. Fortunately, this practice has significantly declined and now concerns only 8.3% of births in 2021. Some facilities now report rates below 1%.

After an episiotomy, the incision area is carefully closed using absorbable sutures. These stitches, which fall out on their own within two to three weeks, are placed in several layers: first the vaginal mucosa, then the perineal muscles, and finally the skin.

It is also possible to have perineal stitches due to a natural tear, without having had an episiotomy.

Healing varies from one woman to another. Some regain comfort quickly, while others may experience difficulties or persistent pain for some time. In all cases, persistent pain should prompt a medical consultation, as solutions exist to relieve discomfort and/or work on the perineum accordingly (notably during perineal rehabilitation).

Want to learn more? Feel free to download the May app, where you’ll find plenty of resources to support and guide you throughout your pregnancy.

Episiotomy: in which cases can the stitches come apart?

Sometimes, episiotomy stitches may fail to hold, a phenomenon known as dehiscence. Several factors can explain why stitches may come apart:

• Excessive mechanical tension: efforts during the first few days (getting up, sitting down, carrying your baby) can strain the perineal area and cause the stitches to break.
• Local infection: an infection at the scar site can slow healing and weaken the stitches, making them more likely to come apart.
• Poor healing: certain medical conditions such as diabetes, clotting disorders, or poor perineal blood supply can delay healing.
• Insufficient hygiene care: lack of local care or the use of unsuitable sanitary products (irritating pads, prolonged moisture) increases the risk of maceration and dehiscence.

Episiotomy: signs that stitches are coming apart

Quickly identifying dehiscence helps act promptly and limit complications. Here are the main physical symptoms and changes at the scar site to watch for.

Certain physical signs should raise concern, including:

• Persistent or unusual pain: increasing discomfort, pain that returns after having disappeared, sharp or throbbing pain in the perineal, vaginal, or vulvar area, especially after the first days of the postpartum period.
• Abnormal bleeding: bright red, heavy bleeding or bleeding that resumes after decreasing may indicate a problem with the stitches.
• Unusual discharge: yellow, greenish, purulent, or foul-smelling discharge may signal an infection or stitches coming apart. Any suspicious odor from the operated area should always be taken seriously.
• Burning or warmth sensation: increased local heat, especially if associated with redness or swelling, may indicate inflammation or infection.
• Urinary discomfort: difficulty urinating, burning sensations, or unusual urinary leakage can also accompany dehiscence, as the perineal and bladder areas are weakened.
• Swelling or hardening: abnormal swelling or a hard lump (induration) may reveal a healing problem or infection.
• Changes in skin appearance: skin that appears fragile, torn, or shows areas of necrosis (darkened tissue) requires medical evaluation.

Episiotomy: what to do if stitches come apart?

Here’s how to care for your perineum and recognize the signs that should prompt you to seek medical advice quickly.

Episiotomy and stitches coming apart: when should you consult a healthcare professional?

Certain situations require prompt consultation with a midwife, gynecologist, or a visit to the maternity emergency department:

• A clear opening of the scar: if the stitches have come apart and the wound opens, exposing the underlying vaginal or perineal tissues.
• Intense or persistent pain: if the pain does not improve despite comfort measures, or suddenly worsens.
• Heavy bleeding: any abnormal bleeding should be reported without delay.
• Purulent discharge or suspicious odor: yellowish, greenish, or foul-smelling discharge may indicate an infection requiring prompt treatment.
• Fever above 38.5°C (101.3°F): fever combined with other local symptoms suggests infection.
• Urinary disorders or incontinence: difficulty urinating, burning sensations, or unusual urinary leakage may indicate deeper involvement.

In any case, if you notice any bothersome or unusual symptom, don’t hesitate to mention it during your midwife’s home visit—she will examine your scar—or to schedule an appointment at her office.

Episiotomy and stitches coming apart: medical management

Depending on the extent of the suture opening, management will be adapted:

In cases of minor dehiscence, without infection or significant pain: the healthcare professional may opt for a non-surgical approach. The wound is left to heal “open to air,” with meticulous hygiene and local care. Specific dressings may be suggested in case of oozing.

In cases of wider or deeper dehiscence: a surgical re-intervention may be necessary, usually under local anesthesia. The midwife or gynecologist will then re-suture the area after carefully cleaning it.

Prevention and tips for episiotomy healing

To prevent stitches from coming apart and optimize perineal healing, there are simple daily habits to adopt.

Care to perform

• Clean the perineal area, vagina, and vulva with lukewarm water after each bathroom visit and once a day with soap: choose a mild, neutral soap, then gently pat dry without rubbing.
• Change sanitary pads regularly: choose soft pads without micro-perforated film or irritating substances to keep the scar dry and limit maceration.
• Avoid tight clothing: opt for cotton underwear and, if possible, allow the area to breathe in open air as much as possible.

Professional support

• Have your scar monitored by a midwife at home, especially during the first week postpartum: she can quickly detect any sign of infection, dehiscence, or poor healing.

Good to know: In the days following childbirth, midwives can visit you at home. These consultations are fully covered by national health insurance during the first twelve days, and then by supplementary insurance plans afterward. They provide personalized and continuous support.

These consultations can also offer psychological support. Don’t hesitate to talk about your feelings or your pain.

Actions that promote healing

• Limit physical effort: avoid lifting heavy loads, standing for long periods, or excessively straining your perineum.
• Rest whenever possible: by adopting positions that do not compress the area.
• Ask for advice on pain management: healthcare professionals can suggest appropriate pain relief if needed.

Self-massage and rehabilitation

• Once the wound has fully closed (generally 2 to 3 weeks after childbirth) and with your healthcare professional’s approval, you can begin gentle perineal self-massage. Performed with a suitable oil, this helps restore flexibility and reduce apprehension when resuming sexual activity or rehabilitation sessions.
• Do not perform massage if the scar is painful: always wait for the green light from your healthcare professional.

In summary, good healing after an episiotomy relies on appropriate hygiene measures, careful monitoring of your perineum, and regular support from a midwife or gynecologist. Stitches coming apart when healing is almost complete are not necessarily dangerous. Even if they come apart early, outcomes are sometimes straightforward, but they still require close monitoring by a healthcare professional. However, it is important to seek medical advice promptly in case of complications or bothersome symptoms.

**

Photo credits: YuriArcursPeopleimages | micens | halfpoint | Dimaberlin | zelmab

This text was translated from French by an artificial intelligence. The information, advice, and sources it contains comply with French standards and may therefore not apply to your situation. Make sure to complement this reading by visiting the May US/UK app and consulting the healthcare professionals who are supporting you.