Clinical Negligence and Birth Injury: Third and fourth-degree tears

Tue 23rd Aug 2022

Childbirth can, unfortunately, cause birth trauma and this, or the resulting effects, can sometimes be due to clinical negligence, as partner Rachel Pearce explains.

A common type of birth injury is a perineal tear, with minor tears occurring in around 90 per cent of women. A more serious third or fourth-degree tear occurs in about three in ten women and this is known as an obstetric anal sphincter injury (OASI).

How do these perineal tears occur and how often is this down to clinical negligence?

Third and fourth-degree tears

There are different severities of perineal tear that can occur. This can either happen naturally or can be through the actions of a healthcare professional.

There are many natural causes for tears such as babies weighing more than 4kg, long second-stage labour or shoulder dystocia. However, other factors could include using forceps or excessive force or twisting to deliver the baby.

Midwives and doctors sometimes make a small cut to the vaginal opening to create more room for the baby to be delivered. This common practice is known as an episiotomy; however, this can sometimes lead to a tear occurring which may be due to clinical negligence.

While perineal tears are sometimes unavoidable, there are cases where severe perineal tears have occurred which could have been avoided.

A first-degree tear is the most common. These are minor, skin-deep tears which may require some stitches but for the most part, they can be left alone to heal naturally. A second-degree tear involves the muscles of the perineum being damaged and this will need stitches to heal.

A third-degree tear tears into the muscles which control the anus. When a third-degree tear extends into the anus itself, this becomes a fourth-degree tear. This should be immediately obvious to the clinicians and diagnosed straight away and immediate surgery performed, along with appropriate aftercare.

The importance of post-birth care

If the perineal tear is accurately diagnosed immediately following birth or soon after to be of a certain degree, then a proper repair can be carried out by way of surgery. In this instance, six to eight in ten women with third or fourth-degree tears will not have long-lasting complications.

However, muscular tears can be extremely serious. Failure to recognise and repair potential problems early on can cause problems later in life. Severe perineal tears require surgery and not just stitches. It is not just the physical complications to consider but also the social and mental impact it can have on a person’s life.

There may be a case for financial compensation if clinical negligence can be established.

The recovery process

After six to twelve weeks of giving birth, you should be offered a follow-up appointment to check you are healing properly. Here you can disclose if you are having any bowel problems, as it is common after a perineal tear. Don’t be embarrassed to disclose this information no matter how minor you think it might be. If the answer is yes, then you should be referred to a specialist.

Clinical negligence compensation

Clinical negligence compensation can be sought if the medical team has failed in their duty of care. Examples include using too much force when delivering the baby or the use of forceps creating or adding strain to a tear, a failure to lower the chance of tearing, or not properly identifying the degree of the tear. In addition, the perineal tear might fail to be repaired quickly enough or they may fail to recognise symptoms of infection.

How we can help

At Coodes, we have helped to support many women who have experienced these types of injuries and successfully obtained compensation where clinical negligence has been established.

If you have experienced a perineal tear and feel that, at any point, your care was poor or substandard, we’re here to help you and can talk to you about your options.

Please note that there is a strict limitation period for bringing these types of claims – more information can be found here.

Our expert birth injury lawyers are here to help you, please get in touch.

Tue 23rd Aug 2022

Rachel Pearce

Head of Clinical Negligence & Personal Injury

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