Perineum tear during childbirth - How we can helpPrintPdfClose »

12/10/2011

The first few weeks following your baby’s birth should be a wonderful time - it’s a life changing experience, and most women are prepared for things to be different. Everyone warns you about the lack of sleep a new baby brings, and that breast feeding can be difficult, and that it will take some time for your body to return to its pre pregnancy state. However for some women, the weeks and months following birth are painful and stressful in a way they hadn’t expected, and find extremely hard to cope with.

Perineal tears are a common but less talked about effect of giving birth. Tears can be minor, causing only a little discomfort, or they can run deeper, into the pelvic floor muscles causing not only severe pain, but ongoing problems with incontinence.

• Many women, particularly those having their first babies, suffer small tears on their perineum - the area between the vagina and anus - during the second stage of labour. These superficial tears can be easily stitched by a good midwife, or left to heal of their own accord.

• More severe tears, or second-degree lacerations go deeper into the muscles underneath. Careful stitching is needed, layer by layer, to ensure the tear heals properly. It takes a few weeks for second-degree lacerations to heal, and most women suffer some discomfort during this time.

• A third-degree laceration is a tear in the vaginal tissue, perineal skin, and perineal muscles that extends into the anal sphincter (the muscle that surrounds your anus).

• The most severe laceration is referred to as a fourth-degree tear, and it goes through the anal sphincter and the tissue underneath it.

A well managed second stage of labour aims to avoid the most severe perineal tears. Episiotomies (a small incision into the perineum) are performed if:

• there is a risk of the mother’s perineum being severely torn unless her vagina is widened

• a quick childbirth is needed because there is thought to be a risk to the baby’s health

• complications mean that mechanical assistance, such as forceps (tongs) or suction, is required to deliver the baby safely.

In the past episiotomies were routine, however more recent studies have shown that they bring no health benefits to otherwise healthy women, and can cause unnecessary pain.

Indeed there is a risk of episiotomies tearing further, and becoming third or fourth degree lacerations.

The hours immediately after giving birth are crucial in determining how well a woman will recover from a perineal tear. A thorough examination is required to determine the extent of any lacerations, and careful stitching by an obstetrician is needed to repair any damage. Correct procedure demands that a midwife or obstetrician will assess any woman who has an episiotomy, or who they suspect may have a third or fourth degree tear. The assessment should include an examination of your vagina and anus, and afterwards the obstetrician should inform you of the extent of the tear, and give you all the information you need about surgery and treatment. Suturing of third or fourth degree lacerations requires surgery under anaesthetic (usually an epidural), so you will need to sign a consent form. The obstetrician will then stitch the damaged anal sphincter and the tear in the operating theatre. Aftercare should include antibiotics, and pain relief, together with careful monitoring by midwives or other health care professionals during the recovery period.

Problems occur if this stage is not managed correctly, and clinical negligence occurs if there is:

• Failure to properly assess the situation.

• Failure to suture the tear correctly (e.g. by a midwife in the delivery suite, not an obstetrician in an operating theatre)

• Failure to provide effective aftercare

- leading to problems ranging from severe pain, pain during sex, urinary and anal incontinence (with all its emotional as well as physical effects).

Reconstructive surgery can be required to repair poorly managed third or fourth degree lacerations.

If you, or someone you know, is suffering with problems associated with third or fourth degree perineal tearing then we can help.

Jane Couch and Richard Blair at WBW Solicitors specialise in clinical negligence cases surrounding birth, and will be able to help you get the support and care you need. Dealing with hospital authorities and claims for compensation can be daunting, especially when you are feeling low. We understand and can take that stress away. Our priority is dealing with cases quickly and sensitively, so that you can get back to enjoying time with your baby.

Jane Couch

Partner
T: 01626 202413
Email Me

Richard Blair

Partner
T: 01803 407632
Email Me