What is a perineal tear?
During childbirth some women suffer from a tear whilst the baby is being delivered. There are four grades of tear:
- Grade 1: injury to skin only and although the underling muscles are exposed they are not torn
- Grade 2: injury to perineal muscle but not to anal sphincter
- Grade 3: injury to the perineum involving elements of the anal sphincter but where the rectal mucosa is intact
- Grade 4: injury to the perineum where the anal canal may be torn and the tear may have spread to the rectum
Who will suffer from a tear?
There is no way to know who is going to suffer from a tear and who isn’t. However, there are some recognised risk factors:
- a large baby who weighs over 4kg
- a long second stage of labour
- shoulder dystocia
- forceps delivery
- a occipitoposterior position
- a midline episiotomy
It is essential that a detailed history is taken of the mother when she becomes pregnant. If a woman has previously suffered from a third or fourth degree tear then they may be at risk of developing anal incontinence and therefore, consideration should be given to whether a
caesarean section would be appropriate.
When does negligence occur?
The fact that a woman suffers a tear during childbirth is not normally negligent. The negligent treatment normally arises in regards to the manner in which the repair is undertaken.
When a tear occurs during childbirth the tear should be appropriately assessed after the baby has been born to assess the severity of the tear, particular attention needs to be given to ascertain whether the tear involves the anal sphincter.
When a woman is assessed as having a third or fourth degree tear it should be repaired in theatre with either regional or general anaesthetic. By using anaesthetic it allows the anal sphincter to relax which enables the torn areas to be repaired without tension. Further, it is essential that a third of fourth degree tear be repaired by a suitably trained obstetrician. If a repair is attempted by someone with inappropriate training it can lead to long lasting damage to the mother.
When a mother suffers from a third or fourth degree tear they are normally prescribed a course of antibiotics as well as laxatives. After about 6-12 weeks the mother is normally offered physiotherapy and should be reviewed by an obstetrician and gynaecologist.
If a third or fourth degree tear is not repaired appropriately it can lead to long term complications for the mother including faecal incontinence.
If you have concerns about a perineal/vaginal tear that you experienced during the delivery of your child, please contact us today for a free, no obligation chat.