Vaginal and Perineal Tears Claims

The perineum is the area of skin between your vaginal opening and your back passage (anus). Some women give birth without injury to the perineum, however, injuries or tears can occur at the time of vaginal delivery. A vaginal or perineal tear can occur quite naturally during child birth. 

An episiotomy is a cut made by a doctor or midwife through the vaginal wall and perineum to make more space for the baby to be born. A tear happens naturally as the baby stretches the vagina and perineum during birth.

The majority of women (up to 9 in every 10) will tear to some extent during childbirth. Most women will need stitches to repair the tear. 

There are four types of perineal tear:

• 1st degree tears involve injury to skin only and usually heal naturally 
• 2nd degree tears involve injury to the perineal muscles. These usually require stitches.
• 3rd degree tears involve injury to the perineal muscles and anal sphincter
• 4th degree tears involve injury to the perineal muscles, anal sphincter and the lining of the rectum

If only a first degree or second degree tear occurs, there are normally no long term complications. Third or fourth degree tears can however cause significant problems including

• pain and discomfort 
• bleeding when visiting the toilet
• pain during sexual intercourse. 
• problems with bowel control while the area is healing. Symptoms can include a feeling of urgency to empty the bowel so that it is difficult to ‘hold on’. There may be poor control of wind, difficulty wiping clean or loss of solid or liquid stools.

Evidence suggests that approximately one to three percent of women having a vaginal birth will sustain a third or fourth-degree tear. It is slightly more common for those giving birth vaginally for the first time, with a rate of 6 percent compared with two percent for those who have had a vaginal birth before

Can a third or fourth degree tear be prevented?

Third Degree Tears

A third degree tear involves the vaginal tissue, perineal skin, and perineal muscles that extend into the anal sphincter although the rectal mucosa remains intact.

Fourth Degree Tears

A fourth degree tear goes even deeper than a third degree tear and involves tearing into the anal canal as well as into the rectum.

A third or fourth-degree tear cannot be prevented in most situations because it cannot be anticipated. 

There are some factors that may make this tear more likely including:

• if you had a large baby (over 8 pounds 13 ounces/4 kg). The risk is increased to 2%
• if your labour was started artificially (induced). Risk increased up to 2% 
• if you had an epidural during your labour – up to 2%
• if your baby was born with its back to your back – up to 3%• if this is your first baby – up to 4%
• if the second stage (pushing) of labour was longer than an hour – up to 4% (Second stage is the time from when the cervix (opening to the womb) is fully dilated to the birth of the baby.)
• if there was difficulty delivering the baby’s shoulders at the birth – up to 4%
• if you had an assisted birth (forceps or ventouse) – up to 7%.

If it is clear that you are at risk of a tear as your baby is too large to be born without potentially causing a tear, your medical team should consider carrying out an episiotomy, ie a surgically performed cut to reduce the risk of a tear. If they do not take this action and you tear ‘naturally’ there is uncertainty both in terms of the size of the tear, but also in terms of how deep the tear will be. If you do sustain a third degree tear this can cause serious pain and discomfort.

Although an episiotomy makes more space for the baby to be born, it does not always prevent a third or fourth-degree tear from occurring.

As long as the tear is identified at the time you give birth and is stitched correctly by a doctor most people will make a full recovery, although it can take weeks or even months for this to happen.

Treatment

Treatment for Vaginal Tears and Perineal Tears includes:

• Repair by a surgeon in theatre
• Antibiotics (which reduce the prospects of infection as the stitches to repair the tear are likely to be very close to the anus)
• Pain relief
• Pelvic floor exercises
• Laxatives
• A review after six weeks
• In addition you will need to keep the area around the tear clean. 
• Whilst you are in extreme discomfort you are likely to be on a drip for fluids and a catheter will be used until you are fit to walk to the toilet.

If early diagnosis is made and the appropriate treatment is provided, there is a good chance of a full recovery.

Medical Negligence

You may have a claim for compensation if you have suffered a Third or Fourth degree tear due to negligent treatment connected with childbirth. Examples of circumstances where there may be a claim for compensation include 

• Where there was clear evidence that you were highly likely to tear but the medical practitioners failed to take action to prevent the tear such as carrying out an episiotomy. 
• Failure to identify and repair a tear in good time
• Substandard repair of a tear
• Failure to provide antibiotics leading to infection

Please contact us if you believe you may be entitled to compensation for vaginal and perineal tears, or other medical neglience claims such as appendicitis.