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Injuries to Mothers

Injuries to Mothers

Perineal Tears - Mismanaged Labour Complication Claims

There are many things to be aware of that can happen when having a baby and some you just really hope won't happen, however some of these things are beyond your control during child birth eg tearing.

If such things do happen you are relying on your medical team to treat you in the right way in order to prevent the damage being any more than is necessary to deliver your baby. Sometimes, however, this doesn't happen and you may feel like you have been let down by the medical professionals that treated you and may be considering making a claim for negligent care.

Perineal Tear

Delivering a baby can lead to overstretching of the birth canal, causing tearing to the perineal tissue and can often be a natural part of childbirth with most women recovering well without any long term complications, but not everyone is that fortunate.

Identifying a Perineal Tear

There are a number of guidelines in place to help identify a severe perineal tear. Sometimes, they are missed by the doctor or midwife which can lead to a potential medical negligence claim.

The failure to identify and repair a tear shortly after birth is usually as a result of:

  • A failure to carry out a thorough genital examination following birth
  • A misdiagnosis in the severity of the tear
  • The repair not being carried out correctly

Complications of a Perineal Tear

If there is a failure to recognise and repair a third or fourth degree perineal tear you may suffer one of the following complications:

  • Losing control over of your bowel motions
  • Passing wind frequently and uncontrollably
  • Feeling an urgency to get to the toilet fast
  • Pain or soreness in the perineum
  • Painful sexual intercourse
  • Fear about future pregnancy and birth
  • A fistula (hole) between the anus and vagina
  • Psychological damage

How a solicitor can help you

We understand that poor treatment during pregnancy, labour and after labour can have significant effects for both you, your child and your partner, and that these symptoms can have an effect for years to come causing misery, low self-esteem and even relationship break down.

Our medical negligence team has a strong medical background including many former nurses who are now qualified as solicitors and who are able to talk to you about your options. We will guide and advise you through the claims process, helping you to achieve a financial settlement to ensure you have access to medical and health related services that you need in the future.

If you believe that you have suffered a birth trauma then please contact us.

Classification

There are four grades of perineal tear and in order to determine the severity of the tear and how much damage has occurred, The National Institute For Clinical Excellence (NICE) has issued guidance classifying the tears:

First Degree tear – This is the most superficial tear. It involves the skin of the perineum and the tissue around the opening of the vagina or the outermost layer of the vagina itself, but no muscles. They usually heal quickly and do not require any stitching.

Second Degree Tear – Injury to perineum involving perineal muscles but not involving the anal sphincter. Therefore these tears go deeper into the muscles underneath. These tears need to be stitched closed, layer by layer.

Third Degree Tear - is a tear in the vaginal tissue, perineal skin, and perineal muscles that extends into the anal sphincter (the muscle surrounding the anus).

Fourth-degree tear – is a tear that goes through the anal sphincter and the tissue underneath it.

Risk Factors

The following factors are associated with an increased risk of a third degree tear:

  • Birth weight over 4 kg
  • Baby is born face up (persistent occipitoposterior position)
  • First vaginal delivery (nulliparity)
  • Induction of labour
  • Epidural analgesia
  • Having to push for a long time (second stage longer than 1 hour )
  • Shoulder dystocia
  • The distance between the vaginal opening and anus is shorter than average.
  • Midline episiotomy
  • Assisted delivery
  • Previous vaginal birth and had a third- or fourth-degree laceration.

NICE guidelines state that:

  • Before assessing for genital trauma, healthcare professionals should explain what they plan to do and why.
  • The initial examination should be performed gently and with sensitivity and may be done in the immediate period following birth.
  • If genital trauma is identified following birth, and if there is any suspicion that the perineal muscles are damaged, then further systematic assessment should be carried out, including a rectal examination to assess whether there has been any damage to the external or internal anal sphincter.
  • Referral to a more experienced healthcare professional if uncertainty exists as to the nature or extent of trauma sustained.
  • Repair of the perineum should be undertaken as soon as possible to minimise the risk of infection and blood loss.

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