Improving training for perineal trauma
The Birth Trauma Association has estimated that, over a recent 10 year period, perineal trauma compensation claims have cost over £31 million. This suggests a significant degree of medical negligence and a serious need for improved medical training.
Added to this, there is evidence to suggest that rates of severe perineal trauma are also increasing. Whilst it is not always possible to prevent a perineal tear, improving understanding of the problem amongst midwives and junior doctors may reduce incidences and help to ensure that, when they do occur, diagnosis is both prompt and accurate.
Why do perineal trauma compensation claims occur?
Perineal trauma claims generally occur either where a 3rd or 4th degree tear during childbirth has not been diagnosed, leading to potentially devastating physical and psychological effects on the mother, or where a tear has been identified but the repair has been inadequate or inappropriate. By this we mean that a 2nd degree tear has been repaired where a 3rd or 4th degree tear has occurred, leaving part of the tear remaining. Alternatively, the stitching of a severe tear repair may have failed.
Consequently, the mother's life and her ability to care for her baby may be significantly impaired.
What effects might the mother experience?
A mother who has experienced a perineal tear during childbirth can expect the best long-term outcome if the tear is diagnosed and thoroughly repaired promptly after the birth. An untreated 3rd or 4th degree tear, however, might produce the following symptoms:
- Wind incontinence
- Bowel incontinence
- The development of a fistula leading to leakage via the vagina
- On-going infections
- Pain
- Discomfort during sexual intercourse
These symptoms will not only be painful and embarrassing but may be so severe as to make it difficult for the mother to return to work, to socialise or to support her baby in the ways that she might have wished. In these circumstances, the mother may decide to make a claim for compensation for the effects that may not have developed had her severe tear been diagnosed and treated at the time of the birth.
Why might a tear go undiagnosed?
In recognising the increase in perineal trauma, The Royal College of Obstetricians and Gynaecologists, recently observed that the following factors may contribute to the problem:
- Inconsistencies in approaches to preventing OASIs (Obstetric Anal Sphincter Injuries)
- Inconsistencies in training and skills
- Lack of awareness of risk factors and long-term impacts of OASIs
- Variation in practice between health professionals
The OASI Care Bundle
The OASI Care Bundle Quality Improvement Project aims to reduce the rates of severe perineal tears and is being implemented in a number of maternity units nationwide. Developed by the Royal College of Obstetricians and Gynaecologists, in conjunction with Croydon NHS Trust, the London School of Hygiene and Tropical Medicine and The Royal College of Midwives, the project includes the following aspects:
- A multidisciplinary skills development module for health professionals
- Campaign materials to raise awareness
- A 'care bundle' which identifies interventions to effectively and safely care for the patient, including: speaking with the woman about OASI and her risk; communicating with her during the birth to enable a controlled delivery; performing an episiotomy when required; using the hands to provide perineal protection during the birth; a thorough examination after the birth to detect tears.
Improved understanding of the issue and its possible effects, alongside standardised approaches to informing, supporting and examining women before, during and after labour, should help to reduce incidences of 3rd and 4th degree tears and therefore reduce the costs of compensation claims for poor medical care.
Medical Negligence
If you are suffering the on-going and distressing effects of an undiagnosed or poorly treated severe birth tear, you may wish to consider making a compensation claim. Contact Glynns Solicitors to discuss your circumstances with a solicitor experienced in supporting claims for perineal trauma.
Please call us on 0800 234 3300 (or from a mobile 01275 334030) or complete our Online Enquiry Form.
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