In this article we explore who is most likely to sustain a third degree tear, explaining the factors that increase the risk of a severe perineal tear.
What increases the risk of a third degree tear?
According to the Royal College of Obstetricians and Gynaecologists (RCOG), around 9% of women will suffer a third or fourth degree tear when giving birth. This can happen to any woman having a vaginal birth, although there are certain risk factors that increase the likelihood of a third or fourth degree tear occurring. These include:-
- First vaginal delivery;
- Baby is large in relation to the mother’s size;
- Previous history of perineal tear/obstetric sphincter damage;
- Fast second stage of labour;
- Instrumental delivery (e.g. forceps delivery);
- The active second stage of labour is longer than one hour;
- Mid-line episiotomy.
Can a third degree tear be prevented?
A third degree tear cannot be prevented, although there are certain things that can be done to minimise the risk.
During the actual birth itself, medical professionals should encourage a steady second stage of labour, urging a patient not to push until the time is right. Otherwise the perineum will not have stretched sufficiently and is more likely to tear.
Medical professionals should also ensure that if an episiotomy is required, a medio-lateral episiotomy is performed. This is when the cut is made diagonally, rather than straight down. This is a much safer method, as midline episiotomies can increase the risk of a tear extending to the anal sphincter.
If a woman has previously had a perineal tear and/or her baby is very large, discussions should take place with the obstetrician as to whether an elective C-section might be preferable.
Recovering from a third degree tear
If a third degree tear does happen, it should be diagnosed during a routine examination after the birth. A repair must then be carried out in theater by an experienced surgeon. Most women will go on to make a full recovery, although the wound will be sore in the months following the birth.
A minority of women will develop complications as a result of a third degree tear. However, this is normally because medical professionals failed to detect and treat the tear before a patient was discharged from hospital. There is no reason why this should happen, and when it does there is usually a case of medical negligence.
If your third degree tear was missed and you have developed complications, get in touch with us to discuss making a compensation claim.
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