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Giving birth at home means that you have a statistically lower chance of tearing. Being able to labour instinctively and without restriction enables you to really listen to what your baby and body are telling you.  Lateral and hands-knees positions reduce the chance of tearing, and supine, squatting or lithotomy positions increase the chance of tearing.  Directed, coached or purple pushing are associated with increased tears and damage to the perineum therefore ‘mother directed’ pushing or breathing your baby down/out also helps with this process.  Your body’s sensations will often guide you on when to hold off.  The guaranteed use of a pool is another reason women choose to have their baby at home and this is also thought to help reduce tears as well as warm water compresses applied gently to the perineum. However even when taking all of this into account, some women will experience some damage.

If your midwife finds that there is some damage and suggests it needs suturing, it is your choice if you would like to have stitches.  Minor lacerations can generally be left to heal on their own, however, second degree tears may require stitches. There is no clear evidence that there is any benefit or harm to leaving most tears up to second degree unsutured but it is important to consider the opinion of your midwives when making your decision.

Introducing a foreign body ie the sutures, may increase the risk of infection and there is some evidence to suggest that women who did not have stitches experience less pain and discomfort during sex afterwards. It may be that the damage is superficial and stitches would only be cosmetic reasons rather than for function.

Ask both midwives for their opinion: exactly what degree of damage is there and where is it, can help you decide.  Sutures should be able to be performed at home unless the tear is more severe – 3rd degree or greater.  Ask if the midwife present is confident suturing and if she is not, ask them to call for someone who is.  With the exception of serious tears, you should not be expected to transfer to hospital for suturing and can insist that they find someone to come to you at home.

Midwife Thinking: Perineal Protectors

Science & Sensibility: What Is the Evidence for Perineal Massage During Pregnancy to Prevent Tearing?

Fear causes tears – Perineal injuries in home birth settings. A Swedish interview study

Midwifery Today – Preventing Perineal Tears (Part 1)

Midwifery Today – Preventing Perineal Tears (Part 2)

Perineal Protection / Avoiding Tears and Episiotomy

Royal College of Midwives: Guideline on Suturing the Perineum