Can I Sue the NHS for a Negligent 4th Degree Tear Repair?

A fourth degree tear due to vaginal childbirth is a complex and severe injury. It requires not only an accurate diagnosis but a skilled repair. If this does not take place, the new mother may be left with appalling bowel symptoms which might justify her in making a claim for compensation.

4th degree tears

A fourth degree tear will cause extensive damage to the new mother:

A laceration to the skin and muscle of the area between the vagina and the anus (the perineum)
Injury to the external anal sphincter muscles which control the bowel
Injury to the internal anal sphincter muscles
Damage to the lining of the anal canal (the mucosa)
A fourth degree tear can additionally lead to the development of a fistula between the rectum and the vagina, allowing wind and faeces to leak uncontrollably out of the vagina rather than from the anus

Repairing a fourth degree tear

If such an injury to the mother is diagnosed following the vaginal birth of a child, it is crucial that a prompt and thorough repair is undertaken by an appropriately trained practitioner.

According to the guidelines on perineal tear management by the Royal College of Obstetricians and Gynaecologists, the following aspects are of importance:

The correct materials are used for the different aspects of the repair
The correct suturing techniques are used for the different parts of the repair
An examination is carried out after the repair to ensure that all damage has been identified and repaired

Medical negligence

If the repair of a fourth degree tear is found to have failed in some aspect, it might be appropriate to make a claim for compensation.

The management of a fourth degree tear might be regarded as negligent if the repair itself was incompetent, if part of the injury remained undiagnosed or if the subsequent management of the patient contributed to a failure of her repair and the development of symptoms.

Inaccurate diagnosis

It is also possible that the woman never received an accurate diagnosis in the first place. If a thorough examination of the new mother is not carried out shortly after the birth of her child, her severe tear may not be diagnosed. In these circumstances, a repair will not take place and she is likely to experience bowel difficulties as a result.