To Suture or Not to Suture? What Women Really Need to Know

 The bigger picture behind the suture/no-suture debate.

In the birth world, the question of whether or not to suture vaginal tears can feel like a line in the sand — a binary rooted in two opposing cultures. On one side, the medical model insists on suturing everything. On the other hand, some corners of the freebirth world say, leave it all alone.

But in our recent Born Through Movement call, we (Adelaide Meadow and Mandy Verghese) asked something different:

• What supports biological reality?

• What supports integration?

• What supports long-term pelvic health?

This isn’t about sides. It’s about nuance, assessment, and care that actually honors the tissues, the woman, and her lifelong wellbeing.

All Tears Heal — But Not All Integrate

Why healing isn’t just about closing a wound, but restoring function.

Your body knows how to heal. It will clot, swell, lay down collagen, and form scar tissue. But scar tissue isn’t the end. Real integration — where the tissue regains mobility, sensation, and function — is another story.

There are four stages of healing:

• Bleeding (hours)

• Inflammation (days)

• Proliferation (days)

• Remodeling (weeks… and beyond)

Scar tissue is naturally disorganized. Without support, it can spread, harden, and create long-term dysfunction — pelvic pain, prolapse, thinning perineal structures, or even a lack of sensation that shows up years later.

What Real Integration Requires

The roles of movement, circulation, and manual therapy in true healing.

Integrating tears, either surgically repaired or otherwise, requires optimizing lymphatic flow, blood flow, and overall movement of the tissue. This structural integration approach will be supported by manual therapy, addressing adhesions and scar tissue formation within the pelvic bowl.

Likewise, optimizing how we sit, stand, walk, move, and breathe ensures long-term hydration and motility of pelvic tissues — both of which are essential for integration following trauma.

In addition to these mechanical and manual therapy approaches, practices such as vaginal steaming, adequate nutrition, and herbal support can be incredibly generative in the healing process. I recommend that women focus their healing on structural integration approaches, while also including these other meaningful healing supports.

What Contributes to Tearing?

How prenatal patterns, positioning, and tension shape outcomes.

Tearing isn’t just a matter of how fast the baby came out. It's deeply influenced by:

• Fascial adhesions

• Lack of tissue motility

• Pelvic asymmetry

• Fetal position (asynclitic, oblique, OP)

• Circulation, lymph flow, and movement patterns

• The mother’s position — especially knees-wide or tension-loaded birth postures

We discussed the “two steps forward, one step back” rhythm in birth that allows for gradual stretch. And how coached pushing — when used to slow and ease the descent — can support the perineum, rather than rush the body.

The Truth About Suturing

What most women aren’t told about repairs, and what actually matters.

Here’s what many women don’t realize:

• Poorly done repairs can be worse than not suturing at all.

• Suturing creates more scar tissue by piercing healthy tissue to approximate a wound.

• Many midwives are not trained at the level of surgeons. They’re learning on live tissue — women’s genitals — often without access to surgical guidance or dummy practice.

• Asymmetrical tears are common. If they aren’t approximated well, healing becomes uneven, and structural integrity is compromised.

• Women who aren’t sutured sometimes take their healing more seriously — they steam, do scar tissue remediation, bodywork, and movement therapy.

But a well-done repair, paired with ongoing care, can support incredible outcomes.
The problem isn’t the suture — it’s the assumption that suturing alone is the solution.

When Might Suturing Be Supportive?

A clear-eyed look at situations where suturing supports structural integrity.

In terms of when to suture and when not to suture, this is a personal choice.

In my opinion, when the nature of the tear prevents the tissues from resting together evenly — as is often the case with muscular or asymmetrical tears — suturing will likely be supportive. In these situations, it can help preserve the long-term structural integrity of the pelvic tissues, assuming integration work follows the repair.

Symmetrical tears, grazes, and tears that rest together well when the legs are closed are candidates for potentially excellent healing without surgical repair.

What Do We Actually Need?

Support that extends beyond the moment of repair.

• Good assessment

• Skilled hands

• Informed consent

• Care beyond the repair: rest, nourishment, bodywork, emotional processing, movement, and time

Closure vs. Integration: Why It Matters

Understanding the difference between healing on the surface and healing deep.

As Mandy shared, there’s a big difference between wound closure and structural integration. And too many women are left with unresolved pain, symptoms that emerge years later, or a sense that something’s “off” — without knowing it traces back to a tear that wasn’t truly supported to heal.

Wound closure simply means the skin and tissue edges have been brought together — with sutures or otherwise — and the surface has healed.

But structural integration asks: has the tissue regained its function, sensation, and mobility? Are the layers of the pelvic floor working together again, or is there lingering restriction, tension, or disorganization?

True integration goes beyond closure. It involves restoring hydration, glide, and responsiveness to the tissues — not just sealing the wound, but bringing the body back into relationship with itself.

We’re Not Interested in Dogma — We’re Interested in Reality

An invitation to nuance, care, and deeper conversations.

This isn’t a call to always suture or never suture.

It’s an invitation to tell the truth about the body. To understand that everything heals, but not everything heals well — and that healing well requires care, information, and community.

As always, we’re here for that deeper conversation.

With you,
Adelaide + Mandy