Are perineal tears avoidable?
Up to 90% of women suffer a perineal tear during vaginal child birth, especially if they are giving birth for the first time. Could this potentially traumatic experience be avoided?
What are perineal tears?
A perineal tear is an accidental tear to the area around and between the vagina and the anus. The majority of tears (1st degree) are only skin-deep and heal naturally. Approximately 9% are deeper (2nd degree), affecting the muscle of the perineum and require stitching. The most severe tears (3rd and 4th degree tears) are rare (only approximately 5% of women in the UK) and extend across the perineum to impact on the anal sphincter and anal canal respectively.
Why do they happen?
Perineal tears occur at the point of the baby's delivery if it is proving hard for the baby to emerge through the vagina and are more likely to occur if the baby is large or presenting in an unhelpful position.
Fundamentally, the baby needs to be delivered, and that needs to happen within a reasonable time frame to ensure the health of both baby and mother. So, if there is a problem with the delivery, a solution needs to be found.
- 1) One solution may be to assist the delivery with either forceps or ventouse. However, the use of instruments in the delivery process increases the likelihood of a perineal tear.
- 2) Another solution may be for the medical practitioner – that may be a midwife or a doctor – to choose to make a deliberate cut in the perineum to enlarge the gap through which the baby can emerge. This is called an episiotomy and, although the purpose is to enable to baby to be born, there is some evidence to suggest that an episiotomy increases the likelihood of a more severe tear developing.
- 3) A caesarean section instead of a vaginal birth would remove the possibility of a perineal tear but a C-section offers its own significant risks and may not always be an appropriate solution.
In these circumstances, it might be argued that a perineal tear is sometimes unavoidable, a wound to the perineum of the mother being preferable to endangering the life or health of the baby.
Reducing the risk
There are actions which may reduce the chances of a tear such as:
- Choosing the best position in which the mother gives birth
- Massaging the perineum in the weeks before the birth to increase the flexibility of the perineum
- Pelvic floor exercises during pregnancy may also enhance the flexibility of the perineum
However, the degree of success of these methods in reducing severe tears is not clear.
The importance of identification
Given that perineal tears are bound to happen in certain circumstances, the focus of medical practitioners should be on recognising when they have occurred, identifying them accurately and repairing them fully and appropriately.
This involves the need for a thorough examination after the birth to ensure that, where a 3rd or 4th degree has occurred, it is not missed. Where a severe tear is diagnosed, it needs to be repaired under local or general anaesthetic in an operating theatre by a suitably-trained surgeon.
Medical Negligence
If you experienced a severe tear during childbirth which was not accurately diagnosed and treated at the time, you may be entitled to make a claim for compensation for your pain and subsequent suffering.
Contact Glynns Solicitors to discuss your experience with a solicitor experienced in dealing with birth injury cases.
Please call us on 0800 234 3300 (or from a mobile 01275 334030) or complete our Online Enquiry Form.
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