Understanding the long-term impact of a perineal tear

In many cases it is hard to pinpoint why a perineal tear occurred – often there is nothing that can be done to prevent them. However, factors that increase the risk of perineal trauma during childbirth include:

Can a perineal tear be prevented?

As highlighted above, perineal tearing during vaginal birth is a common occurrence and the exact cause can be hard to determine. In many circumstances, a degree of tearing is impossible to prevent. Furthermore, all medical professionals involved will be highly trained and should understand what actions to take to minimise the risk of tearing where possible.

However, there are circumstances where a tear itself can be the result of negligence. For instance, if there have been warning signs that a vaginal birth might carry a greater element of risk than usual (such as if the baby is in an unusual position or is large), a failure to perform a Caesarean section could be considered negligent. And if a Caesarean section had been carried out, there would have been no perineal tear.

If the midwife or other medical professional supporting the birth doesn’t take appropriate steps to address the risk of tearing, such as performing an episiotomy, then this might also be viewed as negligent.

As specialists in perineal tear claims, we will always actively investigate whether any actions or inactions by the professionals responsible for your child’s birth and the care leading up to it directly contributed to any perineal tear you suffered.

Episiotomy vs tearing

An episiotomy is a deliberate incision made to the perineum in order to widen the vagina and ease a difficult birth. These are performed in approximately 1 in 6 births.

An episiotomy may be performed if the medical team supporting a birth believes that more significant tearing will occur if the birth is performed unassisted. By making a manageable precise incision instead, this can prevent more extensive trauma to the perineum.

However, there are risks to this procedure. If the incision is performed too close to the midline of the perineum, or it is made too deep or long, then this may result in additional tearing or cause injury itself, and could be considered negligent if this causes the mother prolonged difficulties in future.

Experienced medical professionals understand how to perform an episiotomy as precisely as possible to prevent avoidable perineal injury. But, mistakes do happen. If you believe that incorrect or inappropriate care led to you suffering a perineal tear or extension of an episiotomy, we will conduct all necessary investigations to determine whether you have a claim.

As highlighted above, a first or second-degree tear will usually not require any treatment beyond applying stitches after birth. Third-degree and fourth-degree tears are far more substantial, and it is often critical that these are diagnosed and repaired through surgery quickly to reduce the risk of any long-term consequences, particularly faecal incontinence, befalling the mother.

In all circumstances, a primary repair of a perineal tear (surgery performed soon after birth when the tear has been identified) is much more likely to result in a positive outcome for the mother, with no long-term issues, than a secondary repair performed after a later examination.

As such, the misdiagnosis of a perineal tear or a failure to perform the necessary repair work soon enough is a primary cause of a perineal tear claim. If the doctor, nurse, midwife or other medical professional responsible for examining the mother following birth, doesn’t believe a tear is as significant as it actually is, or fails to make the diagnosis, then treatment might be less effective than it would have been.

For example, say an obstetrician fails to accurately assess a third-degree perineal tear, instead believing it to only be a second-degree tear. This means that, instead of a more extensive surgery inside an operating theatre, the tear will be stitched up immediately, but any injury to the anal sphincter will not be addressed.

This will mean that the injury to the anal sphincter will not heal effectively, resulting in long-term effects for the mother. This can include pain, faecal incontinence and an inability to control their wind, as well as the need for further surgery or treatment at a later date.

Another leading cause of perineal tear claims is if the surgery is carried out in good time but is not performed adequately. Or maybe the post-operative care is insufficient, potentially leading to a perineal infection of the wound or further consequences for the mother.

The RCOG has published guidelines for the management of third and fourth-degree tears, highlighting best practices to prevent mistakes from being made.

We understand the devastating effects a perineal tear can have on new mothers, and leave no stone unturned in determining whether the physical and psychological suffering they have endured was a result of negligence.

When you make a claim for perineal tearing, our specialist solicitors will talk with you to understand how you have been affected, with absolutely zero judgement and with complete transparency.

We will then thoroughly examine all available evidence you and the medical professionals in question provide relating to your case, as well as receive guidance from impartial obstetricians and surgeons to determine whether the perineal tear you suffered was not diagnosed correctly, or was not treated as soon as it should have been.

If we believe you have a claim, we will then manage this on your behalf to ensure you receive the compensation and answers you’re due, taking into account how the fallout from the tear has altered your lifestyle and your mental wellbeing. We understand the emotions involved in these delicate cases, and go to every effort to support and guide you every step of the way.

For more information, get in touch with our experts today.

Disclaimer

All content contained within this article is meant for general information only – this should not be treated as a substitute for medical advice from your doctor or another healthcare provider. If you require legal advice specific to your situation, please contact our team directly.

Gadsby Wicks is not liable for any diagnosis made from the content of this article, nor does it endorse any service or external site linked to within the article.

Always consult your GP if you are concerned about your health and wellbeing, or speak to us if you require legal advice.