The Royal College of Obstetricians and Gynaecologists (RCOG) estimates that up to 90% of women suffer vaginal or perineal tears or grazes during childbirth. For most women, although painful at the time, these wounds heal without any long-term problems. For those who suffer more severe and extensive perineal tears, the consequences can be life-changing, including permanent bowel incontinence and perineal pain. Immediate diagnosis and specialist repair of severe perineal birth trauma provides the best chance of avoiding long-term disability from perineal injury. However, in a recent review of obstetric anal sphincter injury (OASI) birth trauma claims, NHS Resolution found that 58% (nearly six in ten) of the claimants who had experienced serious perineal tears during childbirth were initially misdiagnosed. Delayed diagnosis and inadequate repair of severe perineal birth injury increases the likelihood that the injured woman will suffer physical disability and psychological injury, as well as the need for additional surgical and medical treatment. The effects of perineal tears are rarely discussed, as symptoms of bowel incontinence and flatulence can be embarrassing for women to talk about. Many women suffer without any support or remain unaware that their symptoms are not simply an expected part of childbirth. A woman may be entitled to claim compensation where she is suffering from ongoing consequences of a third/fourth degree tear which was undiagnosed or incorrectly treated as a result of mistakes made by the midwives, doctors and other clinicians involved in her maternity care. What is a perineal tear? The perineum is the area between the vagina and the anus. During labour and childbirth, pressure on the perineum can result in tearing to the perineum as the baby is delivered. Sometimes it is necessary for a doctor or midwife to make a cut in the perineum to allow the baby to be delivered and minimise the risk of an uncontrolled and severe tear. This is known as an episiotomy. Episiotomies are not routinely carried out and are not required in every birth. How are vaginal and perineal tears in childbirth classified? Perineal tears are classified according to their severity. RCOG guidelines on the management of third and fourth degree tears classify perineal tears as follows: first degree tear – injury to the perineal skin and/or vaginal mucosa; second degree tear – injury to the perineum involving the perineal muscles but not the anal sphincter; third degree tear – injury to the perineum involving the external and/or internal anal sphincters; fourth degree tear – injury to the perineum involving the external and/or internal anal sphincters and anorectal mucosa. Third and fourth degree tears are the most severe as they cause injury to the anal sphincters and impaired bowel function. According to the RCOG, 3% of women experience third or fourth degree tear during vaginal delivery. What are the effects of a third or fourth degree vaginal or perineal tear? From a physical perspective, third and fourth degree tears are painful. They require suturing (stitching) and take time to heal. Sitting and passing urine become painful. Following perineal birth trauma, there is a risk of wound infection. A fistula (hole) can develop between the anus and the vagina after the tear has healed and this may require surgery. Scar tissue can develop once the tear has healed. The scar tissue can be itchy and raised and this can be uncomfortable. Third and fourth degree tears can lead to bladder (but more often) bowel problems, including incontinence, urgency and flatulence. Delayed or inadequate repair of severe tears can result in these bowel problems becoming permanent. In very severe cases, a woman may need multiple procedures to suture the area and may even need a colostomy which diverts part of the bowel through an opening in the abdomen. It is possible to have a further vaginal birth after suffering a third or fourth degree tear, although in circumstances where a woman is suffering with the ongoing effects of a previous birth trauma, she may choose to give birth by caesarean section. Severe, life-changing and very personal physical injury also has a psychological impact on the person who has suffered the injury. Pain and/or incontinence can affect the injured person’s social, sexual and intimate relationships. They may find it difficult to talk about the symptoms with their partner, and may also become isolated from friends, co-workers and family as they feel unable to leave the home. Can I make a perineal tear birth trauma claim? If you have been left with lasting disability as a result of negligent management of your delivery and subsequent vaginal or perineal tear, you may be entitled to make a birth trauma claim for compensation. The occurrence of a tear during childbirth is not always the result of negligence, as severe tears happen spontaneously during the birth and cannot be predicted. There are certain factors which can increase the risk of a birthing woman suffering a tear and these include: first time pregnancies; women of South Asian origin; multiple births; a birth weight greater than 4kg; a prolonged second stage of labour; instrumental delivery (involving forceps or Ventouse). Birth trauma claims related to OASI and perineal tears often relate to negligent misdiagnosis or delayed diagnosis of severe vaginal and perineal tears, inadequate post-natal examinations, and delayed or inadequate repair of the injury. Boyes Turner’s obstetric negligence specialists have secured compensation for clients in cases where severe tears should have been avoided, such as negligent performance of an episiotomy, or where a severe tear has been misdiagnosed, incorrectly sutured or surgical treatment takes place too late to avoid permanent injury. A third or fourth degree tear requires timely suturing in theatre. In cases of delay, a woman may need more than one repair surgery and may require further treatment such as biofeedback treatment and/or sacral nerve stimulation. Read more about some of our successful OASI and vaginal/perineal tear birth trauma cases: £375,000 settlement in a birth trauma claim for a woman who suffered physical and psychological injury and needed extensive ongoing surgical treatment after lengthy delays in diagnosis and treatment for a fourth degree tear; £200,000 settlement for a woman who suffered bowel incontinence and a psychological injury as a result of a delayed diagnosis and inadequate repair of a third-degree vaginal/perineal tear; £200,000 settlement in a birth trauma claim for a woman whose negligently managed delivery and inadequate repair of a third degree vaginal/perineal tear left her with severe faecal incontinence and psychological injury; £107,500 settlement for a woman who suffered physical and psychological injuries and multiple surgical procedures as a result of the negligent repair of her perineal tear. Read more about maternal obstetric injury and birth trauma claims. What compensation can I claim in a perineal injury birth trauma claim? If your severe vaginal/perineal tear was caused, misdiagnosed or inadequately treated as a result of negligent midwifery or medical care resulting in serious injury and/or disability, Boyes Turner’s birth injury solicitors can help you claim compensation for your injury and its consequences. The amount of compensation that can be claimed depends on your individual injury and circumstances. In cases involving obstetric injury, birth trauma and vaginal/perineal tears, we have helped clients recover compensation for: pain, suffering and disability suffered as a result of the negligent injury; the costs of therapies, such as counselling and specialist physiotherapy; the costs of medication or private health care, including further surgery or treatment; the costs of travel expenses to and from GP or hospital appointments; financial losses and expenses, such as loss of earnings, replacement clothing, bedding, incontinence pads, laundry; the costs of necessary home adaptations, for example, the creation of an en-suite/additional bathroom; the costs of domestic assistance/help with childcare. If you or your child have suffered a severe birth injury as a result of medical negligence, or you have been contacted by HSSIB/MNSI or NHS Resolution, you can talk to a solicitor, free and confidentially, for advice about how to respond or make a claim by contacting us.
