Are perineal tears increasing in the UK?
Severe perineal tears are uncommon but their effects can be life-changing. Recent studies have suggested that the number of perineal tears may be increasing in the UK. Is this a cause for concern?
What is a perineal tear?
Perineal tears can happen quite naturally when a woman gives birth via the vagina rather than with a caesarean section. As the baby approaches the opening of the vagina, the skin around the area – the perineum – will need to stretch to allow the baby to pass through and occasionally this will lead to a tearing of the skin. 1st and 2nd degree tears cause the least damage – affecting the skin and muscle of the perineum - and usually heal successfully, but 3rd and 4th degree tears can have significant long-term effects such as incontinence if not treated promptly.
Recent Research
Recent studies have shown an apparent increase in the occurrence of perineal tears. The research focused on first-time, single-child, head-first, vaginal births between 2000 and 2012 and found that the number of 2nd degree tears increased by over 20% during this period and the number of 3rd and 4th degree tears tripled. This seems to represent a dramatic change in the experience of first-time mothers.
Further research has shown that the chances of experiencing another perineal tear are increased when the mother has already suffered one during a previous delivery.
What does it mean?
Do these findings actually mean that severe perineal tears are becoming more common in the UK? And, if so, why?
One possible explanation is that there only appears to be an increase in perineal tearing but that, in fact, this is due to the introduction of clearer classification of perineal tears, leading to better recognition and recording of the different levels of tear.
However, an alternative explanation is that circumstances relating to the risk factors associated with perineal tears are changing, leading to an actual increase in 3rd and 4th degree tears.
Risk factors
It is interesting to consider if other factors might also be significant here. Known risk factors for 3rd and 4th degree factors include the following:
- A large/heavy baby
- Shoulder dystocia
- Assisted delivery (use of forceps or ventouse)
- An induced labour
The research mentioned above found that there is also a trend towards an increase in the age of first-time mothers, along with an increase in weight of the mother. This may, in turn, increase the likelihood of increased size/weight of the baby which may lead to a perineal tear. There was a clear correlation between the age – or youth – of the mother and the chance of her experiencing a tear, demonstrating that the older the mother, the greater her chance of experiencing a tear.
Shoulder dystocia, likewise, is more likely with a larger baby, a heavier mother and an assisted delivery.
Evidence also suggested that, where the birth required instrumental assistance, there has been an increased use of forceps, a factor that makes a perineal tear more likely.
How to reduce these risks
Awareness is an important factor for the first–time mother. Advice during the pre-natal period on how to prepare for and reduce the risk of a tear through exercise and massage of the perineum could help to reduce the risk of damage.
Awareness of the possible significance of the delivery position in influencing the chances of a perineal tear might also be useful as there has been some evidence that a squatting position is more beneficial.
Better training in the use of forceps and ventouse in assisted deliveries may also reduce the likelihood of a tear.
Dealing with a tear
If the incidence of perineal tears is increasing, it is vital that the guidelines and procedures for diagnosis and treatment are well-known and assiduously followed. Furthermore, once a 3rd or 4th degree tear has occurred, appropriate treatment by a skilled practitioner is key to the mother's recovery from this traumatic event. Treatment and stitching of a 3rd or 4th degree tear needs to take place in an operating theatre by a surgeon experienced in that field.
Medical Negligence
The long-term impact of a severe perineal tear can be devastating and impact on your relationship with your baby, your partner and your self-esteem. If you have suffered on-going effects of delayed diagnosis of a perineal tear, contact us at Glynns Solicitors to discuss whether you are entitled to make a claim for compensation.
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