The World Health Organisation (WHO) has this month published new guidelines on care of women during childbirth, entitled ‘Intrapartum Care for a Positive Childbirth Experience’. Will this influence procedures related to the prevention of perineal trauma during childbirth?
Guideline Approach
The new guidelines emphasise the importance of a woman-centred approach to childbirth, with less emphasis on medical intervention.
‘This guideline is a consolidated set of new and existing recommendations on essential labour and childbirth practices that should be provided to all pregnant women and their babies during labour and childbirth irrespective of socioeconomic setting. It promotes the delivery of a package of labour and childbirth interventions that is critical to ensuring that giving birth is not only safe but also a positive experience for women and their families.’
Perineal Trauma
Recommendations which might impact on the occurrence and likelihood of perineal trauma during childbirth include the following:
- ‘For women without epidural analgesia, encouraging the adoption of a birth position of the individual woman’s choice, including upright positions, is recommended.’ Consideration is given in the guidelines to the possible impact of the birthing position on the likely need for an episiotomy, the likelihood of perineal tears occurring and the duration of the second stage of labour.
- ‘For women in the second stage of labour, techniques to reduce perineal trauma and facilitate spontaneous birth (including perineal massage and a ‘hands-on’ guarding of the perineum) are recommended, based on a woman’s preferences and available options’ The guidelines acknowledge the importance of such techniques in helping to prevent third and fourth degree tears.
- ‘Routine or liberal use of episiotomy is not recommended for women undergoing spontaneous vaginal birth.’ The guidelines recognise the uncertainty of the evidence regarding the possible influence of an episiotomy on the likelihood of a severe perineal tear occurring and recommends that, should an episiotomy be considered a necessity, the woman’s consent must be gained and a medio-lateral incision is the recommended technique in order to reduce the risk of ‘complex obstetric anal sphincter injury.’
In line with the NHS ‘Better Births’ initiative, the new WHO guidelines also recommend continuity of carer/midwife during all stages of pregnancy and childbirth in order to improve both the experience of childbirth and its outcomes for both mother and child.
Medical Negligence
Perineal trauma is a regular occurrence during vaginal childbirth and, in the UK, between 5 and 10% of women are thought to experience severe tears.
When 3rd or 4th degree tears do occur, it is vital that the injury is diagnosed and repaired shortly after the birth. Where a severe tear is missed due to negligence, it may be appropriate for the woman to make a claim for compensation for her suffering and subsequent problems.
If you are suffering with the appalling long-term effects of an undiagnosed severe perineal tear, contact us to discuss your experience with a specialist medical negligence solicitor.
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If you, or your family member, has suffered a birth injury tear, please call us now for free, no obligation advice on 0800 234 3300 (or from a mobile click to call 01275 334030) or complete our Free Online Enquiry.
