Birth isn't just one thing. It's messy, painful, and often joyful. For many people, pregnancy and birth is an inherently risky, socio-political endeavor — and it can't be removed from the culture and institutions we live in.

The maternal health advocacy group Every Mother Counts reports [1] that the United States is the only high-resource nation with a consistently rising maternal mortality [2] rate, despite "spending more money per capita on maternal health than any country in the world." These numbers are even more shocking when you take into account race, class, and location. "Today, a woman is twice as likely to die from complications of pregnancy and birth than her mother was a generation ago. Black and Indigenous women are 2-3 times more likely than white women to die from complications of pregnancy and birth," according to Every Mother Counts [3].

Recently, there have been more and more discussions about how patriarchy informs birthing care and how expert medical treatment during labor (despite being outrageously expensive [4]) doesn't always translate into a better, healthier, or safer birthing experience.

One example of these patriarchal values impacting medical care? The husband stitch. For years, it's gotten a rap as a horrifying tale of childbirth, but the husband stitch has been around for decades — and despite being phased out, for some birthing people, it's still a scary reality.

What Is the Husband Stitch?

The husband stitch (also known as the "daddy stitch," "husband knot," or "vaginal tuck" ) is sometimes written off as a myth — but it's real.

"The husband stitch refers to an extra stitch being placed in a woman's vagina during a perineal repair after childbirth," labor and delivery nurse Liesel Teen, BSN, RN, founder of Mommy Labor Nurse [5], says. "The idea is that the additional stitch would make the woman's vagina tighter and in turn more pleasurable for both her and her husband during sexual intercourse." (However, some anecdotal evidence points to increased pain for the mother during sex [6] after the husband stitch is performed.)

How Common Is the Husband Stitch?

As Teen mentions, the husband stitch happens during a repair to the perineal — the ridge of tissue between the vaginal opening and anus — and the doctor may choose to add in extra, unneeded sutures to "tighten" the vagina. Tearing during labor is fairly common, especially for first-time parents, but the vast majority of tears are very minor, Teen says. Some people need stitches to repair natural tearing, and some do not.

Doctors can also opt to perform episiotomies (a surgical cut made to the perineum to make the vaginal opening larger) during labor, which also requires repair. Episiotomies were widely performed in the United States in the mid-19th century because they were thought to hasten the birthing process. One study [7] estimated that over 60 percent of birthing parents were given the procedure between 1860 and 1983 but that it was associated with postpartum pain and serious complications. High rates of unnecessary episiotomies have continued for decades, with a USA Today analysis [8] finding that dozens of hospitals from 2014 to 2017 were performing the cut at rates of 20 percent or more — drastically higher than the recommended five percent. (Although there's no national consensus on how often the procedure should be used, USA Today reports "a leading hospital safety group recommends that the cuts should occur in no more than 5% of vaginal deliveries," like, for example, if a baby's shoulder is stuck behind the pelvic bone [9].)

In rare cases, episiotomies can be necessary, but Teen cautions that they "can really increase your risk for severe tears . . . as well as long-term damage to the pelvic floor [10], vagina, perineum, and anal sphincter." Either way, if an episiotomy is performed (and in some cases with natural tearing), the doctor must stitch the cut. During this repair, it is possible for a husband stitch to be added in addition to the necessary sutures.

It's not always obvious to someone who's given birth that they've received a husband stitch — or even an episiotomy [11]— but some people discover they've received improper care while seeking postpartum pain relief or medical care. Because so many people are unaware they have it, it's hard to know exactly what the side effects are, but one woman told Vice [12] she experienced pain upon sitting or walking for months after birth and later learned from her doctor she was "stitched too tight."

This also means there are no clear records of how often natural tearing or episiotomies result in the husband stitch, but anecdotal evidence [13] suggests many people have undergone the unnecessary suturing. And because the husband stitch is not medically necessary, some even consider this practice a form of genital mutilation [14], which the World Health Organization states [15] "involves the partial or total removal of external female genitalia or other injury to the female genital organs for non-medical reasons." At the very least, it's a violation of consent and bodily autonomy with no medical basis made even more unacceptable because it objectifies people's bodies as a tool for sexual pleasure.

"Quite frankly, the idea of a husband stitch totally repulses me and thankfully is not something that I've ever seen in my eight years of practice as a labor and delivery nurse," Teen says. "The vagina does not need any additional suturing after delivery to tighten it back up."

How You Can Prevent a Husband Stitch

Bodily autonomy is a critical aspect of your birth plan [16]. If you feel concerned that your practitioner might perform an unneeded treatment, Teen recommends doing your research beforehand.

The best thing you can do to make sure you don't end up with an unauthorized episiotomy or husband stitch is to talk to your provider beforehand, Teen says. Tell your provider and nurses, incorporate your desires and boundaries into your birth plan, and make sure your partner is on the same page. Don't be afraid to lean on your partner during the process and ask them to help advocate for your needs.

You can also look up or ask for your doctor or hospital's rate of performed episiotomies. Some hospitals share their episiotomy rates, or you can also check reviews and ratings from The Leapfrog Group [17], a healthcare nonprofit and watchdog organization. "If your provider has a higher-than-average episiotomy rate, it might be worth looking into switching providers," Teen says. Just remember: sometimes they are medically necessary.

The husband stitch is certainly falling out of fashion — Teen says it was more common years ago — but it's something to be aware of if you're giving birth.

"I cannot stress enough the importance of birth education. Participating in high-quality birth education that is tailored to your unique birth experience is vitally important in making sure that you can advocate for yourself during your birth," Teen says. "And it's just as important for your partner [or] support person to participate in birth education. In the event that you are unable to speak for yourself, your support person can step in and lead the conversation."