A 3rd degree tear can affect anyone who has a vaginal delivery, even those who undergo an episiotomy.
Does an episiotomy stop a 3rd degree tear?
An episiotomy will not stop a 3rd degree tear from happening. You may have read literature that suggests an episiotomy will prevent a serious tear. However, this view is now outdated and it is accepted that a 3rd degree tear can affect any women, whether or not she undergoes an episiotomy.
In some cases, an episiotomy can actually increase the risk of a 3rd degree tear. More specifically, a midline episiotomy will increase the risk of a severe tear because the cut is made straight downwards. This makes it more likely that the cut will rip downwards when the baby is delivered.
For this reason midline episiotomies are no longer performed in the UK. Instead medical professionals must carry out a medio-lateral episiotomy, where the cut is made diagonally.
Diagnosing and repairing a 3rd degree tear
If you do suffer a 3rd degree tear and you have had an episiotomy, the tear should be diagnosed when the episiotomy wound is sutured.
Before the midwife or Registrar stitches the wound, the area should be closely inspected for other damage. This should include an examination of the vagina, perineum and anal sphincters. It is essential this is achieved, as it is the only way to diagnose a severe tear, such as a 3rd degree tear.
If a 3rd degree tear is found to be present, a doctor should be called to do the repair (if not already present). A midwife cannot repair a 3rd degree tear. The tear and the episiotomy wound can then be sutured at the same time.
Failure to diagnose and treat
Unfortunately there are occasions when a 3rd degree tear remains undiagnosed, and only the episiotomy wound is sutured. This means there is a defect underneath the perineum which extends into the anal sphincter complex. This will result in terrible problems for the individual concerned, often leading to faecal urgency and incontinence.
A 3rd degree tear may be undiagnosed because a proper examination was not performed, or the attending clinician missed the injury during the examination. Either way a 3rd degree tear that is left unrepaired will amount to a case of medical negligence. If this has happened to you, please get in touch with us today. You could be entitled to claim compensation.