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Tears During Childbirth

Author: Neil Fearn  Bullet  Dated: 13/05/2015

According to the Royal College of Obstetricians & Gynaecologists, 90% of women tear during childbirth. For any mother, this can be a daunting time.

Mothers shouldn't fall victim to neglect from their doctors

The 4 Degrees of Perineal Tears

If it was your first vaginal birth, you had an assisted delivery, had a large baby or an extended labour, you would have been more at risk of developing a tear during childbirth. Tears are often referred to as perineal tears and can range from being small and superficial to a full on tear between the vagina and anal sphincter.

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.

It is not always possible to avoid a perineal tear , and, in some cases your midwife or Dr may decide that an episiotomy (a surgical incision made in the area between the vagina and anus (perineum)). would be appropriate. According to the National Institute for Health and Care Excellence (NICE), episiotomies should not be used during spontaneous vaginal births. Spontaneous vaginal births are when the mother falls into labour without the help of medication or techniques to induce labour. Health & Social Care Information Centre statistics from 2012-13 show that the number of spontaneous deliveries was at 61%.

Most mothers will not be aware of the damaging effects of a perineal tear until one has already happened. Complications can arise if the severity of the tear is not recognised and the tear has not been stitched correctly or in a timely manner, having long-term effects on your recovery. This can be a depressing time for most women but especially for young mothers during their first birth as often a lot of emphasis is put on planning for birth. However, there's no certain way of determining if you will tear or not.

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.

Claiming from the NHS

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
  • • The distance between the vaginal opening and anus is shorter than average.
  • • Midline episiotomy
  • • Assisted delivery
  • • Psychological damage

According to the NHS Litigation Authority in 2010, £31,202,836 was spent on perineal tear claims between 2001 and 2010.

£18,847,299 of that total just came from third and fourth degree tears, the most invasive of the 4 types. From these figures we can see that the NHS has a record of acknowledging when they get it wrong and rectifying the problem with compensation.

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