What position were you in for your stitches?

[PixieCake]

Has anyone been stitched up after birth in any position other than on your back with legs open?

I have bad SPD so must avoid this position (and absolutely NO STIRRUPS), but what will happen if I tear and need stitching up?

Any clues?

Hey Pixie, I've not had my LO yet (am 37 wks) I have quite severe SPD and at my last physio appt she said if I had to be stitched it would be ok on all fours. Sorry I can't offer any more insight / info.

sorry, was on my back on my sofa with legs on the arm rest with the sun from the patio doors lighting her way.

I had bad SPD so ended up in theatre for ventouse, was on my back but knees kept almost together. Second time they got these fab 'gynae boots' that were a bit like ski boots, which held my knees up to stop them flopping apart (epidural was a bit strong that time), first time was MrNC and some assistant holding them together. Worked a treat.

We did have a loop of string round my knees first time to ensure noone parted my legs too far, but it got lost somewhere between MLU pool and the delivery suite downstairs. Staff were all fab with positions though, even got me onto all fours for pushing - took six people!

i didnt have spd the first time round...no stirrups just legs open baby out and stiching done in same position...
personally i cant sit on all fours now..feels like my pelvis will fall down ...so not sure what the best position will be

As you know Billy I have exactly the same worry. I spoke to a midwife yesterday who has told me it is sometimes possible to do stitches while you are lay on your side with a pillow between your legs to open them a small amount. I too can't do on all fours, ouch! Sound upright wasnt possible for me in my last two births, it just killed my back. So this time, if I have another natural birth,I'm going to attempt on my side for giving birth and stitches if I need it.

Sorry, that should have been to Pixie. (blame my baby brain lol)

Hi again MrsPaynie,

I think it was your post that made me think about this problem. Someone said that midwives will only do stitches if you lie on your back with legs apart (not an option for me, although I had a 2nd degree tear last time), so I was just wondering if anyone else had been stitched in another position.

Good to hear that the MW you spoke to would do it while you lie on your side. I just worry about who will be on duty when I give birth and what I would do if they refused to stitch me up!

Anyone else?

Yeah same worry here, just because one midwife could do it doesn't mean they all would? That was my exact problem last time I gave birth, the midwife and dr basically forced my legs into stirrups as they said it was they only way to stitch me and I knew now different, even through I was crying in more pain from that than the whole labour

The person who is judging whether stitching is required, and may be doing the stitching, wants to do the best they can for you. Normally that means having a proper look and being in position for best access.

I could be wrong but I am guessing that the physio who advised an all fours position has

1. never had to look at a post delivery posterior vaginal wall
2. never had a needle in her hand, about to go near a fellow-woman's precious parts.

Noone can force you to do anything or be in any position. They can advise and give their reasons for that advice. If you decline, you decline.

Some women decline being examined for tears or decline any stitches. Some have to report problems later. Others don't have any problems.

Its worth bearing in mind that most midwives will prefer to leave well alone if it looks like it will heal well on its own. So if they think it needs a stitch, well worth getting best job possible.

All the best.

All of that makes perfect sense Jazzers, unless you have SPD. I have had two years of continued pain because of the position midwives put me in for my stitches. And they did force me, i said no several times and told them just how much it hurt as the midwife lifted my leg and the dr held the stirrups. I had a wonderful birth experience up until needing to be stitched. I understand they need to do 'the best job possible' however when it left me in agony two years later, I have to think there must be another position they could do it in? If not then I will seriously be considering a CS this time to avoid the possible need for stirrups all together.

I was on my back with my feet in stirrups, I didn't have SPD though.

Maybe you could ring the labour ward and ask them, or at your next appointment with your midwife, she could ring and ask?

Good Luck, fingers crossed you don't need stitching!

I too was stitched after homebirth on sofa so not a stirrup in sight but on back.

I know I couldn't suture in any other position than a mum on her bum - iyswim. I might well be able to get away without stirrups/legs splayed, but it would have to be a simple 'tidy tear'. I just wouldn't feel confident I could see the tear apex, the muscle layers and the extent of vaginal wall involvement in any other position or if the women wasn't able to open her thighs so I could really see.

I'v supported the knees (to brace the pelvis) of those with spd whilst a speedy, experienced and very well practised surgeon - the obstetrician - has cracked on as quickly as possible. We kept knees/thighs together and the very bendy new mum was able to get her two knees up to her chest, which meant she made her vagina as visable as possible. I wouldn't be able do that for my fat belly huge boobs. But perhaps you could try it, gently, after discussing with physio?

I cannot imagine a tear that could be sutured in all fours - surely if it could it simply wouldn't need suturing at all Tears extend along the posterior wall of the vagina, so on all fours that would be upside down, facing the floor and invisable.

It's a tricky bugger this, for the really nasty cases of SPD.

BTW I had a bit of SPD and found tumeric extract amazingly helpful, much to my surprise. I'm sure it wouldn't cure or provide massive relief for serious cases, but anything helps doesn't it.

I did have SPD I did lie on my back but I didn't have stirrups, I have a feeling I did my feet together similar to having a smear test . But I have a hunch it depends on how bad/ internal the stitches you need.
.....
Ps ta for the turmeric info treedelivery, I can feel the bloody pain looming this time around, so might invest insome.

I had a second degree tear with SPD - gave birth on my side with one leg bent up with foot on the bed iyswim, labour pains were all in my back so didn't really care about anything else at the time, just getting off my spine.

The mw gave me the option of laying on my back and getting on with it immediately or doing it later with stirrups so I just got on the entonox and actually it wasn't that bad, just went as far open as I could manage and she didn't force me or try to get any more than I could go.

I was very badly bruised (think DD came out with her fists up by her face) and that has bothered me more than the stitches tbh but I think the mw did a neater job than last time when I was in stirrups as I have been much more comfortable and it feels 'neater' than last time.

Would totally recommend arnica if you do end up tearing. Good luck!

I have read some people can manage to do it in side-lying position with support for top leg HTH

I have stitched women not in stirrups two or three times. It is really difficult, if a tear is large and bleeding I would find it IMPOSSIBLE to stitch in any position other than lithotomy, maybe others would manage it though. A large tear can go four or five cm up the vaginal wall (sorry if tmi!), you have to be able to get to the apex, ie the top of the tear or it is possible to cause a haematoma, where there is a large collection of blood clotting inside the tear causing extreme pain. Having said that if you refused lithotomy, they could always do what treedelivery suggests, I can imagine that might work.

So maxbear, with that in mind, what would you advise of a pregnant woman with server spd? I know there is no way possible I could get into that position to be stitched without it causing injury to my pelvis, so would you say a c section would be a better option than to risk another tear that someone like yourself attending my labour wouldn't be able to stitch?

I had bad SPD and used stirrups but they pulled my legs up not apart if you know what I mean so they could 'access' me from below! Lovely!

Well you could always ask for your legs to be pulled up rather than apart, I can imagine that being possible as some posters have suggested. I work on a low risk unit so a lot of women with spd end up seeing consultants and delivering on the labour ward, not something I have much recent experience of I'm afraid. Having a section seems extreme if there are no other indications.

Having a section rather than needing to be stitched in stirrups doesn't sound extreme to me - speaking someone who has had nearly 2 years of pain every day following my pelvis being mucked up in my first labour. It has affected every aspect of my life, relationship, work, ability to look after my toddler etc etc.

I'm still very undecided about what is best. Some midwives may be happy to try to stitch in different positions, but it seems to be pot luck on who is on duty at the time.

If it is a small tear it would be possible to do on your side but if it is anything more than a few cm long then it is just impossible to get the correct access on your side. Of course nobody can predict how big a tear, if any, that you might have.
I have sutured in the position treedelivery describes and other women with SPD have chosen to use foot plates to brace their feet against which exposes the perineum but supports their pelvis. Have you measured the distance you are able to open your legs without pain? This might help you work out what position is feasible.
I think unless you have seen what suturing involves it is hard to imagine why midwives or doctors are not more flexible. But if you need sutures you want them done properly, right?
SPD is so debilitating I can understand why you are considering what might be considered the drastic step of opting for CS.