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Fourth Degree Tears
Fourth degree tears Medical Negligence

Fourth Degree Tears

The Royal College of Obstetricians and Gynaecologists estimate that over 85% of women who have a vaginal birth will suffer some degree of perineal trauma. Of these, a minority of mothers will unfortunately sustain a fourth degree tear, an injury which can extend into the anal canal and rectum. This article takes a closer look at fourth degree tears, from why they happen to whether or not they can be prevented.

Can The Vagina Tear When Giving Birth Naturally?

A tear can happen naturally during labour, or a medical professional may deliberately make a surgical cut through the perineum to enlarge the vagina (known as an episiotomy).

Whereas episiotomies were once carried out by way of procedure, they are now considered to increase the risk of third and fourth degree tears, and so are usually performed only when it is deemed necessary. This may be, for example, when a baby needs to be delivered urgently, or to enable a forceps delivery.

What Is A Fourth Degree Tear?

Vaginal tears have varying degrees of severity: first and second degree tears are relatively minor and usually cause no lasting damage, while third and fourth degree tears are more serious, and can result in further complications.

A fourth degree tear can be classified as a birth injury that extends from the perineal muscles to the anal sphincter complex and rectum. It is not always easy to predict when this kind of tear will happen, but factors that increase the risk can include the following:-

  • First vaginal birth;
  • The baby is larger than average (over 8 pounds 13 ounces);
  • Labour is induced;
  • Long second stage of labour;
  • Assisted delivery (eg. forceps delivery);
  • The baby's shoulder gets stuck behind the mother's pubic bone.

Can Vaginal Tears Be Prevented?

There are a number of things you can do during pregnancy to help prevent vaginal tears occurring during childbirth:

  1. Perineal Massage: when you are around 34 weeks pregnant you should start to gently massage your perineum every day. This will soften and smooth the skin, helping it to stretch during delivery.
  2. Eating healthily: good nutrition will also help the skin to stretch.
  3. Pelvic floor exercises: doing pelvic floor exercises (sometimes known as Kegel exercises) will help strengthen the muscles needed during childbirth.

During labour, preventing tears can be difficult as factors such as the size of the baby and the frame of the mother usually have a part to play. Even so, it is widely considered that you are less likely to tear if you have a slow, controlled delivery which will allow your perineum to slowly stretch.

Fourth Degree Tears and Medical Negligence

If a fourth degree tear has occurred, it should be detected by medical professionals after delivery by means of an examination for genital trauma (including a digital rectum examination). Once detected, a fourth degree tear should be repaired by a surgeon in a well-lit theatre, where the wound will be sutured.

Occasionally, however, a mother will sustain a fourth degree tear which:

  • Fails to be diagnosed;
  • Is wrongly diagnosed as a more minor tear;
  • Is inadequately repaired.

While each case is different, if any of these situations arise it may be that is was as a direct result of medical negligence. If so, it may be possible to claim compensation for the pain and suffering caused. It is best to seek early legal advice from a medical negligence lawyer who will asses your claim and advise you on the best course of action.

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Early legal assistance can be vital so please contact us if you would like to discuss your situation. Please call us free on 0800 234 3300 (or from a mobile 01275 334030) or complete our Online Enquiry Form.

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