Stitches after birth almost never come apart because of something you did. What actually goes wrong is infection, and it does not announce itself by tearing. It announces itself as the first day that hurts more than the day before.
That difference matters because of where your attention goes. Most of us spend those first weeks guarding against a thing that is rare, while the thing that is not rare arrives quietly and gets read as a bad night.
Everything you do, you do as if they might pull
For weeks after my eldest was born I did not sit down. I lowered myself. One hand went behind me onto the seat, the weight went onto that arm, and I arrived on the chair in stages like something being unloaded.
Nobody taught me that. I invented it in a hallway on the second day and then did it several hundred times without ever deciding to keep doing it. I also stopped taking stairs two at a time, stopped reaching up to the top shelf, and started turning over in bed as one rigid piece.
All of it was in service of a fear that turns out to be almost entirely misplaced. The NHS puts it as plainly as it can be put: if you have had stitches, it is very unlikely you will break them, or open up the cut or tear again.
Most of the detail in this post comes from the patient pages of the Royal College of Obstetricians and Gynaecologists, and they go further. They take on the specific fear that runs this whole show, in one sentence: if you have stitches, opening your bowels should not open them. On the wound breakdown page the college is blunter still, saying it is rare for stitches to simply come undone.
The bowel fear deserves its own space and it already has some. That first one is a whole event with its own dread and its own timeline, and I wrote about the day it arrives separately. This post starts after that, in the ordinary weeks nobody prepares you for, and it is about reading them.
It helps to know what is actually holding you together. RCOG describes a first-degree tear as one affecting only the skin, small tears or grazes that usually heal quickly without any treatment, and a second-degree tear as one through the muscle of the perineum and the skin, which usually does need stitches and is normally repaired with local anesthetic in the room where you gave birth. Neither is likely to cause long-term problems, and the college is honest that both can be very sore.
Sore is doing a lot of work in that sentence. Sore is not the same as fragile, and I spent about six weeks treating them as the same word.
The curve you are supposed to be on, and the one habit that keeps you on it
There is a shape this is meant to have, and knowing the shape is most of what makes the weeks bearable. It is not a straight line down to nothing. It is a steep part, then a long shallow part, and the steep part comes first.
RCOG describes the skin part of the wound as usually healed within a few weeks of birth, with the promise attached that after that you should feel much less raw and tender. Two other things belong to the same curve. Stitches can irritate as healing takes place, and that is normal. And the NHS notes that stitches usually dissolve by the time the cut or tear has healed, though sometimes they have to be taken out.
With my son I noticed the curve because it was my second time and I finally had something to compare against. Each day was a small amount less sore than the day before it, and the amount was genuinely tiny. Not enough to notice on the day. Only enough to notice across three of them.
That is the property that makes this whole thing hard to read at home, and it is worth saying out loud. Improvement is invisible day to day and obvious across a week. Getting worse is the opposite. It is obvious in a day.
Which brings me to the habit. The single thing you are asked to do is wash, and the reason is not comfort.
The NHS asks you to bathe stitches every day to help prevent infection, using a bath or shower with plain warm water and then patting yourself carefully dry. RCOG wants the same and supplies the reason. Water only, wash or shower at least once a day, change your pads regularly, and wash your hands both before and after the toilet or a pad change, because that cluster is what lowers the risk of infection.
Nobody said the word infection to me on the way out of anywhere. They said keep it clean, which sounds like tidiness, and tidiness is the first thing to leave a house that has a newborn in it.
Washing is the first of six things RCOG offers as help, and the second and third are the same event approached from opposite ends. Drink at least 2 liters of water a day, which is about 68 ounces, and eat a balanced diet, with the stated aim of avoiding constipation. Then the position. Feet on a footstool so your knees come up above your hips, elbows resting on your knees, tummy bulged out with big abdominal breaths, which is how a stool moves without you pushing it. Do not strain, the college says, because straining weakens your pelvic floor. And take your time.
I read that footstool instruction across three babies before I put an actual stool in the actual bathroom. Knowing a thing and owning the object are not the same stage of knowing, and the object is the one that changes what you do at four in the morning.
The fourth is an ice pack wrapped in a towel, and its warning is not decorative. Ice must never go straight onto your skin, because it can damage it. The fifth is for the sting when you pee, which RCOG says depends on where your tear is, and the answer is to pour body temperature water over the area while you go. That one has a post of its own, because for some people it stops being a sting and becomes a different problem entirely. The sixth is pelvic floor exercises, started as soon as you can manage after birth, which the college says helps healing by strengthening the muscles around the vagina and the anus.
Six things, and exactly one of them is a habit rather than an object or a position. After my eldest I did about two, and they were the two that involved buying something, which tells you everything about what I thought recovery was.
By the time my youngest arrived, twenty months ago now, I had a small ritual that would have looked ridiculous to me the first time. Plain water, no soap anywhere near it, and then patting dry rather than rubbing, which I had never once done in my life before and which felt like pretending to be careful. There was a towel for it hanging on its own hook, kept apart from every other towel in the house.
I did not arrive at that from a leaflet. I arrived at it from two previous recoveries, one of which I got through on luck and the other of which was harder than it needed to be. The third time I was not being diligent. I was being superstitious, and the superstition happened to line up with the guidance.
The day it turns around
Here is the reading that actually works at home, and it needs nothing except memory.
The question is not how much it hurts. The question is which direction it is going. Down slowly is the curve. Flat for a day or two is still the curve, because the curve is shallow and life is noisy. Up is a finding.
Up is a finding because of what causes stitches to fail, and force is not on the list. RCOG names two causes, and both of them happen underneath. An infection can do it, and so can pressure on the stitches from bleeding underneath, and either can leave an open or gaping wound. The medical name for that is perineal wound dehiscence, or breakdown.
Pressure from bleeding underneath is a strange thing to picture, and it is another reason the bleeding you are already tracking is worth tracking properly rather than just enduring.
RCOG lists what breakdown looks like from the inside, and this is where the direction idea comes from. An increase in pain. New bleeding. A pus-like discharge. And a general sense of beginning to feel unwell. Some women, the college adds, notice stitch material coming away soon after the birth, or can see for themselves that the wound has opened.
Notice that three of those are comparisons. An increase. New bleeding. Beginning to feel unwell. Every one of them requires you to know what yesterday was like.
I could not have told you. That is the part I want to hand over, because it is the actual failure and it is not a failure of nerve. After my eldest I genuinely could not remember on Thursday how much Wednesday had hurt. Pain does not store. It converts itself into a general impression of a bad week, and a general impression has no direction in it.
What I do now is smaller than a pain scale and about as sophisticated as a shopping list. One sentence a day, in a note on my phone, about one specific thing. Not how I feel. Whether I can sit down without the arm of the chair.
RCOG has a list of when to contact a healthcare professional, and it is five items:
- If your stitches become painful.
- If your stitches become smelly.
- If your wound does not heal.
- If you have been diagnosed with a first- or second-degree tear, but you are having problems controlling your bowels, for instance you struggle to make it to the toilet or control wind.
- If you have any concerns.
The last one is not filler and I would ask you to take it at face value. It is on that list because the people who wrote it know that the four above it need a comparison you may not have.
What happens next is not dramatic and it is worth knowing so the call feels smaller. RCOG describes an examination, possibly a swab of the perineum to find what is causing the infection, and for most women a short course of antibiotics with pain relief. Ibuprofen may help and is safe while breastfeeding. If the infection is making you unwell, the college says, you may need admission to hospital for intravenous antibiotics.
One thing surprised me and it is worth carrying, because it removes a reason to delay. If there is an infection, the wound will not be re-stitched. RCOG explains that re-stitching can trap the infection inside and that infected tissue may not hold together well anyway. If there is no infection, or it has been treated, it may be repaired in an operating room. Either way, nobody is racing you to a deadline before which the repair is still possible.
I had assumed there was a window. Some number of hours inside which a thing could be put back, after which you were stuck with whatever you had. There is no such window, and quietly believing in one is an excellent way to spend an evening not calling.
There is also a false alarm built into this, and it looks exactly like the real thing. Over-healing can happen, producing raised red patches called granulation tissue, which RCOG says can be uncomfortable and can keep bleeding. It is easily confused with a new infection. Antibiotics do not solve it, it usually settles by itself, and when it does need something, a clinic can treat it with silver nitrate in a procedure the college describes as painless.
None of which you diagnose from your bathroom. It is a reason to make the call, not a reason to spend an evening deciding which one you have.
There is one appointment already in your calendar for this, usually around six weeks, and RCOG expects it to include somebody actually looking at your stitches if you ask them to. That is worth knowing in advance, because it is easy to arrive at that appointment having decided not to bring it up.
A piece of thread on the pad is not the failure
In the second week after my eldest I found a single dark thread on a pad. It was maybe a centimeter long. I took a photograph of it, which I could not explain to you now, and I showed it to nobody at all.
I spent that evening deciding my body was coming apart, and then it was fine, and it stayed fine, and nothing ever came of it.
Here is what I did not know that night, and it cuts both ways. Stitch material coming away is on RCOG’s list of how women notice a breakdown, so it is not nothing. But the NHS also says stitches usually dissolve by the time the cut or tear has healed, and sometimes have to be taken out, which means loose thread is something they expect to be around.
A thread by itself is an ambiguous piece of evidence. It becomes information when you put it next to the direction, and that night everything else about me was pointing the ordinary way. Less sore than the week before, no new bleeding, no smell, no fever, no dread that was not simply my personality at that point.
The reason to know the healing shape is that it makes the ambiguous things survivable. RCOG describes new tissue growing to fill a gap gradually, tissue that may look red and may bleed a little on its way. It ends as a red scar for a while and then fades the way any scar fades. Red and a bit of blood are on the normal path, not off it.
And for anyone reading this because it already happened, three things from the college are worth having. Most women who have had a wound breakdown have no further problems from it. Once it is healed, it will not break down again from exercise or from sex. And having had one does not make it more likely in a future vaginal birth.
Two things this post is deliberately not. It is not the general postpartum warning list, the one that covers your chest, your calves, your blood pressure and sudden heavy bleeding. Those belong to your whole body rather than to your stitches, and they need their own page and their own attention.
The short version
- Stop bracing. The thing you are protecting against by lowering yourself into chairs is not what goes wrong.
- Wash it daily with plain water and pat it dry rather than rubbing. It is the one habit on the list that is actually about infection.
- Getting better is invisible day to day and obvious across a week. Getting worse is obvious in a day. That asymmetry is your instrument.
- Write one sentence a day about one specific thing you can or cannot do. Not a number, and not a mood. You will not remember otherwise, and every warning sign here is a comparison.
- A thread, a red patch, a bit of blood from new tissue. None of those is a verdict on its own. The direction of everything else is what turns them into one.
- Pain going up, new bleeding, a smell, or a feeling of being unwell means the phone, not another night of watching.
Sources
- Royal College of Obstetricians and Gynaecologists, First- and second-degree tears, patient information, Perineal tears and episiotomies in childbirth hub
- Royal College of Obstetricians and Gynaecologists, Perineal wound breakdown, patient information, Perineal tears and episiotomies in childbirth hub
- Both RCOG pages above were developed by the OASI Care Bundle Project Team, the OASI Care Bundle Clinical Champions and perineal specialists, and are based on RCOG Green-top Guideline No. 29, The Management of Third and Fourth Degree Tears (June 2015)
- NHS, Your body after the birth, page last reviewed 25 April 2024, next review due 25 April 2027
A note on this post. Written and edited by the NewBloom editorial team. NewBloom is not written by doctors, nurses or midwives, and nothing here is medical advice. We read the current guidance from bodies like ACOG, the CDC and the NHS and write down what it says, with every claim traced to its source and named in the sentence where it appears. General guidance is not the same as an answer about your own body. Your doctor, midwife or health visitor can examine you and we cannot, so anything here that raises a question about your own recovery is a reason to ask them. If something is wrong right now, contact your doctor or your local emergency number. More about how we write these posts.