Perineal injuries to the mother during childbirth may be referred to in a variety of ways. Here, we try to provide some clarity about terms and meanings and the implications for treatment.
Obstetric tears affecting the mother during vaginal childbirth are injuries which can damage the region between the vagina and the anus. This area of skin and muscle is called the perineum and comes under pressure when the baby is being born. The skin needs to stretch to allow the baby out and can be vulnerable to tearing – what is also known as a perineal tear.
Perineal tears can vary considerably in the extent of damage they cause, the symptoms they may produce and the length of time they may need to heal.
Assessment of damage
Careful assessment of perineal tears immediately after the birth, including a digital, rectal examination is absolutely vital in order to ensure that the mother receives the appropriate treatment and advice to help her recover.
A failure to examine a new mother thoroughly can lead to a misdiagnosis of her injury, a failure to repair appropriately or at all, and, in some cases, appalling and life-changing symptoms such as faecal and wind incontinence.
Classification of tears
Consequently, the Royal College of Obstetricians and Gynaecologists has adopted a standardised description of different degrees of perineal tear in order to try to improve the accuracy of diagnosis and repair, and thus improve a woman’s long-term likelihood of recovery.
Perineal tears are classified as 1st, 2nd, 3rd or 4th degree tears, increasingly in severity of injury and symptoms.
- 1st degree tears injure the skin of the perineum
- 2nd degree tears injure the skin and muscle of the perineum
- 3rd degree tears additional tear the anal sphincter muscles (external and/or internal)
- 4th degree tears additionally injure the internal lining of the anal canal
Repairing perineal tears
1st and 2nd degree tears are likely to heal fully and promptly. If necessary, they can be stitched in the delivery room by the midwife or doctor. The mother should be advised as to how best to care for herself during the period of recovery such as the need for hygiene to avoid infection.
3rd and 4th degree tears (otherwise referred to as Obstetric Anal Sphincter Injuries) are regarded as severe injuries with the potential to cause significant damage to the woman. These injuries should not be repaired in the delivery room by the midwife. They should be repaired in an operating theatre by a surgeon experienced in dealing with obstetric injuries.
Medical Negligence
Misdiagnosed or poorly-repaired severe tears can lead to substantial claims for compensation due to the shocking physical and psychological impact on the woman affected.
If you are continuing to suffer with wind and faecal incontinence or urgency due to a failure to treat your perineal tear competently, you may wish to consider discussing your experience with a solicitor.
Contact Glynns Solicitors, specialists in medical negligence law.
Free, No Obligation Enquiry
For immediate advice about your legal rights and options, please call us now on 0800 234 3300 (or from a mobile click to call 01275 334030) or complete our Free Online Enquiry.