Continuous stitching causes less pain than interrupted stitches when used for repairing the perineum after childbirth
When women give birth the perineum (the area between the vaginal opening and back passage) sometimes tears or it may be necessary to have an episiotomy (surgical cut) to increase the size of the outlet. Episiotomies and tears that involve the muscle layer (second degree) need to be stitched. In the UK alone, approximately 1,000 women per day will experience perineal stitches following vaginal birth and millions more worldwide. A midwife or doctor will stitch the episiotomy or second degree tear in three layers (vagina, perineal muscle and skin). Traditionally the vagina is stitched using a continuous locking stitch and the perineal muscles and skin are repaired using approximately three or four individual stitches, each needing to be knotted separately to prevent them from dislodging. Researchers have been suggesting for more than 70 years that the 'continuous non-locking stitching method' is better than 'traditional interrupted methods'. This review looked at 'continuous stitching methods' compared with 'traditional interrupted stitching methods' and identified seven trials involving 3822 women. Results from the trials showed that stitching just underneath the skin (subcutaneous) was associated with less pain; however, when the 'continuous stitching method' is used for repair of all three layers, this is associated with even less pain. Other research is needed to assess perineal repair training programmes. In addition, research is needed to look at interventions that may reduce the incidence of perineal trauma during childbirth.