Severe tears & pelvic floor injury
My Stitches Came Apart: Wound Breakdown and Infection After a Tear or Episiotomy
The short answer
If your perineal stitches have opened, or your wound is hot, swollen, very painful, smelly or oozing, or you have a fever, you need to be seen promptly by your midwife, GP or hospital. Wound breakdown (called dehiscence) and infection after a tear or episiotomy aren't rare. One Sydney hospital guideline puts dehiscence at up to 13.5% of repairs. They can usually be treated well when they're caught early. Problems arise when signs are missed or dismissed, a wound is left to heal badly, or the original tear was more serious than recognised. In those cases, a claim may be possible.
"Something's not right down there."
The first few days were sore, as you expected. But then, instead of easing, it got worse.
Maybe there was a smell you couldn't wash away. Maybe you saw with a mirror, or felt, that the stitches had come undone and there was a gap. Maybe you were shivering with a fever while trying to feed a newborn.
Maybe you rang the hospital, or mentioned it at a check-up, and were told it was "normal healing".
Pain that gets worse instead of better is your body telling you something. It deserves to be looked at, not explained away.
Signs of infection or breakdown
A UK hospital's patient guidance on severe tears describes normal soreness for two to three weeks. It tells women to seek help if the area becomes:
- hot, swollen or red
- weepy, oozing or smelly
- more painful, rather than less
- open, or the stitches have come apart
Also get help urgently if you have a temperature or feel generally unwell, or if you notice wind or faeces coming from the vagina. That can be a sign of a fistula.
The Royal Hospital for Women's perineal trauma guideline notes that breakdown typically shows up about one week after the repair. It lists fever, pain, swelling and discharge as the things staff should assess.
Why stitches break down
- Infection, the most common reason
- A tear that was more serious than recognised, such as a sphincter tear repaired as a minor one
- A repair that wasn't done well: poor technique, poor lighting or pain relief, or an inexperienced clinician
- Haematoma: a collection of blood under the repair
- Episiotomy. The Royal Hospital for Women's guideline lists it as a factor in needing a second repair.
- Other risk factors, such as a baby over 4 kg or a pushing stage over an hour, both noted in the same guideline
Not every breakdown means care fell short. Even good repairs can become infected. But the way a breakdown is recognised and managed matters a great deal.
What should happen next
A proper examination.
You should be examined, not just reassured over the phone. That means looking at the wound, checking for infection, and considering whether the original tear was more serious than recorded.
Swabs and antibiotics where needed.
The Royal Hospital for Women's guideline describes taking wound swabs and assessing for fever, pain, swelling, discharge and rectal injury. For severe tears, its third and fourth degree tear procedure includes routine antibiotics for five days after the repair, to reduce the risk of infection in the first place.
Senior review, and sometimes a second repair.
The guideline requires a consultant review for significant breakdown. A secondary repair in theatre may be offered once the infection has settled, particularly for significant pain or disfigurement. Some wounds are left to heal on their own. The right approach depends on the wound, and you should be part of that decision.
Follow-up.
If you had a severe tear, you should have specialist follow-up. If your wound broke down, follow-up should check how it has healed, and whether there's any damage to bowel or bladder control.
If this is landing for you, and your wound problems were brushed off or left to heal badly, I'd be glad to listen. No pressure, no obligation.
If it's healed badly
Sometimes a broken-down wound heals, but leaves problems behind:
- ongoing pain, or pain that has been dismissed
- tight or thick scar tissue
- a misshapen or gaping vaginal opening
- painful sex
- bowel symptoms, if the sphincter was involved. See "I can't control wind after birth".
Many of these can be improved by a specialist, sometimes with corrective surgery, sometimes with pelvic health physiotherapy. The Australian Physiotherapy Association's position statement on physical birth trauma sets out how physiotherapists can help.
When it may be negligence
A claim may be worth exploring if:
- the original tear was more severe than recorded, and was missed
- the repair was inadequate, or not done in the right setting
- infection or breakdown signs were dismissed, or treatment was delayed. See when being dismissed by a doctor becomes a legal issue.
- you weren't offered appropriate review or follow-up
- you've been left with lasting pain, disfigurement, or bowel or bladder problems
NSW Health's HealthStats page explains how tears are classified and repaired. Australia also has a national standard on severe tears, which sets expectations for identifying and caring for them. You're entitled to an honest explanation from the hospital through open disclosure. You can also raise concerns with the Health Care Complaints Commission.
For the wider picture, see severe perineal tears, severe pelvic floor damage and incontinence, and what a claim can cover.
Looking after you.
A painful, infected wound in the weeks after birth is exhausting and frightening. Birth Trauma Australia offers peer support, and PANDA is on 1300 726 306.
Frequently asked questions
Is it normal for stitches to come apart after giving birth?
It isn't rare, but it isn't something to ignore. If your stitches have opened, or the area is hot, swollen, smelly or getting more painful, see your midwife, GP or hospital promptly.
Will they re-stitch it?
Sometimes. A second repair is often done once any infection has cleared, particularly for significant pain or disfigurement. Some wounds heal well without one. Ask your doctor about the options.
My wound healed but it still hurts. What now?
Ongoing pain after healing can be caused by scar tissue, nerve involvement or a poor repair. Ask for a referral to a specialist perineal clinic or urogynaecologist.
Is there a time limit for a claim?
Yes. Time limits often run from when you knew, or ought to have known, about the injury and its cause. Please get advice early.
A closing thought
You were meant to be recovering, and instead you were fighting an injury no one seemed to take seriously. That's a lot to carry while caring for a newborn.
So here's a question: if someone had listened the first time you said it hurt, what would have been different?
Keep reading: Maternal birth injuries: what we must talk about · Birth trauma and obstetric negligence
This article is general information only. It is not medical or legal advice, and it doesn't replace advice from your own doctor, midwife or physiotherapist. Reading it does not create a lawyer–client relationship. If you are in crisis, please call Lifeline on 13 11 14 or 000 in an emergency.
