What is Perineal Trauma?
Perineal trauma is a regular occurrence in childbirth. So, what is it and what can be done about it?
What is the perineum?
The perineum is the area between the legs which, in women, contains the vagina and the anus. When describing perineal trauma, the term is often used to refer to the area between the two.
What is meant by 'perineal trauma'?
The phrase 'perineal trauma' refers to damage that is done to the perineum. In women, this is most likely to occur during childbirth when a 'perineal tear' can occur. This is where the skin and sometimes the underlying muscle between the vagina and the anus tears as the baby emerges through the vagina.
Perineal tears are classified as follows according to how severe they are:
- 1st degree tear: a skin-deep tear which might affect the vagina and/or perineum
- 2nd degree tear: a deeper tear which might also affect the muscle of the perineum
- 3rd degree tear: a tear which continues across the perineum from the vagina and additionally affects the anal sphincter (the muscle that controls the anus)
- 4th degree tear: this is the most severe form of tear, which also damages the anal canal or lining of the bowel
Occasionally a tear may occur at the top of the vagina.
Why does damage to the perineum occur?
Perineal damage is a common occurrence during childbirth, with possibly up to 90% of women experiencing a tear of some degree. Fortunately, the vast majority of these will be 1st or 2nd degree tears which usually heal easily. Only approximately 5% of women in the UK suffer a more severe tear.
There are a number of factors which might make a severe tear more likely such as:
- A large baby
- A long delivery
- An assisted birth with forceps or ventouse
- Having an episiotomy ( a deliberate cut by the midwife or doctor to ease the baby's passage)
Can anything be done to prevent perineal damage?
Some research suggests that the position the mother uses during childbirth can affect the chances of a tear. A squatting position may increase the risk of a tear, whereas giving birth on all fours may reduce the chances of this happening.
It is also suggested that regular massage and exercise of the perineum in the weeks before the birth can make the skin more flexible and help it to cope with the arrival of the baby.
During childbirth, it is possible that applying a warm pad to the perineum can help it to stretch to allow the baby out.
How is perineal damage repaired?
The repair of a perineal tear depends on the type of tear that has occurred.
A first degree tear is most likely to repair naturally, although it is important for the mother to be careful with personal hygiene to prevent infection in that area.
A 2nd degree tear will probably need stitches which can be done on the maternity ward by the midwife or doctor.
A 3rd or 4th degree tear is a severe tear which needs to be repaired promptly by a skilled surgeon in an operating theatre under local or general anaesthetic. The mother will probably be given a course of antibiotics to reduce the chances of infection. Pain relief and laxatives to ease the pressure on the bowel are also likely to be necessary.
Medical negligence
The most important factor in a woman's recovery from a severe tear is the timing and adequacy of her repair. If a severe tear is not diagnosed and repaired shortly after the birth or if the repair is inadequate, appalling long-term effects can develop including an inability to control the bowel.
Where this occurs, it may be possible to make a claim for compensation which could help to deal with the life-changing impact of a severe tear.
Contact Glynns Solicitors to discuss your situation. We are specialists in medical negligence and have considerable experience in supporting women who have suffered the long-term effects of severe perineal tears.
Please call us on 0800 234 3300 (or from a mobile 01275 334030) or complete our Online Enquiry Form.
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