Claiming For A Fourth Degree Tear

The Royal College of Gynaecologists and Obstetricians estimate that around 85% of women will sustain a perineal tear during the course of a vaginal delivery. Of these, a small percentage will suffer a fourth degree tear, a serious injury that involves the perineum, internal sphincter and external sphincter.

Unfortunately such injuries are all part of childbirth; therefore a fourth degree tear cannot always be prevented. Instead, the medical team must do their utmost to detect the injury and repair the wound using their professional skill and expertise. If there is a failure to do so the standard of care may have fallen below an acceptable standard, meaning there will be grounds for a medical negligence claim. In this article we take a closer look at what could constitute substandard medical care, helping you to understand when you might be able to claim compensation for a fourth degree tear.

When can you claim for a 4th degree tear?

Fourth degree tears usually result in a medical negligence claim if one (or more) of the following has occurred:-

1. Failure to diagnose

The failure to diagnose a fourth degree tear is a common source of birth injury claims. After a vaginal birth, all women must have a vaginal and rectal examination to ensure any damage is detected. If this is not carried out, or if a midwife/doctor fails to diagnose a fourth degree tear during an examination, the women will be discharged from hospital without having the appropriate treatment. This will result in a number of health complications for the new mother, and will also necessitate additional treatment which will, in all likelihood, be less effective than if a primary repair had been performed.

2. Negligent repair

If a fourth degree tear is diagnosed after a delivery, a repair must be carried out in a well-lit theatre by a qualified surgeon. The wound should be sutured using dissolvable stitches, and should then be carefully monitored during the weeks after the birth. If a repair is not performed in such conditions (ie. in theatre by a qualified surgeon), or if the repair is unsuccessful because the surgeon has not displayed due skill and attention, the level of medical care will be deemed unacceptable.

3. Failure to prevent

Lastly, there are a few cases in which the actions or inactions of medical professionals contributed towards the occurrence of a fourth degree tear. Although it is true that such injuries are often unavoidable, there are times when the extent of injury could have been reduced or even prevented altogether. For example, if there is a prolonged labour or the baby is very large, the possibility of a fourth degree tear will be greater. Medical professionals should then consider expediting the delivery with an episiotomy, or switching to an emergency caesarean. If an episiotomy is performed the cut should be made diagonally; if it is made straight downwards there will be an increased risk of a fourth degree tear.

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