Delivery after Previous Obstetric Injury

After sustaining an obstetric injury during a vaginal delivery, it is understandable a woman will be nervous when it comes to giving birth again. She may have concerns about how any further damage could affect her quality of life, as another vaginal delivery could lead to a recurrence of symptoms.

Obstetric Injuries during Vaginal Birth

During a vaginal delivery, it is unfortunately very common for a woman to sustain an injury. This is because the vagina must stretch to allow the baby to be delivered, which in turn can result in a perineal tear. The level of injury can vary drastically in terms of severity, with a third and fourth degree being the most serious. They can be classified as follows:-

3rd degree Injury involving the anal sphincter complex
- 3a Less than 50% of external anal sphincter torn
- 3b More than 50% of external sphincter torn
- 3c Internal anal sphincter torn
4th degree Injury involving the anal sphincter complex and the anal epithelium.

In the event of a third or fourth degree tear, it is essential the injury is quickly identified and treated. Otherwise a woman will find herself with an undiagnosed tear, which will quickly lead to symptoms such as pain during intercourse, poor bladder control and incontinence of flatus and faeces. However, even with the appropriate treatment a woman may still experience these complications, especially during the first 12 months after birth.

Furthermore, problems may arise due to an episiotomy. As a deliberate cut to the perineum, episiotomies can increase the risk of tears. This is particularly true in centres practising midline episiotomies (whereby the cut is made straight down) as opposed to mediolateral episiotomies (whereby the cut is made diagonally).

Mode of Delivery after Obstetric Injury

Injuries sustained during childbirth can have a detrimental affect on a woman's quality of life, often resulting in both physical and psychological trauma. That is why when women who have had previous obstetric anal sphincter injuries conceive again, they will face a dilemma as to the appropriate mode of delivery.

There is little evidence medical professionals can use as guidance when it comes to gauging the best mode of delivery after obstetric injury. Essentially, it is considered that if there are any ongoing symptoms – such as loss of sphincter integrity – that an elective caesarean section should be considered. Even though many women feel unhappy choosing this option, it may be best to prevent a significant deterioration in function. However, it is thought that in those who have no antenatal symptoms, there are few risks posed by a subsequent vaginal delivery.

In any case, women who have had obstetric injuries should consult with their doctor before making a decision. It is vital to obtain all the necessary information, from the potential complications of another vaginal delivery to the risks of a caesarean section.

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