Midline Episiotomy and Medical Negligence
If you suffered a severe tear during birth and you have been told that you had a midline episiotomy, you could be the victim of medical negligence. Please contact us today to find out more.
What is an episiotomy?
An episiotomy is when the perineum is deliberately cut during a vaginal birth. The perineum is the area of skin between the vaginal opening and the anus.
An episiotomy is used to widen the size of the vaginal opening, allowing the baby to be delivered more easily.
The vagina will need to be made wider for one of two reasons:
1. Foetal distress
If the birth needs to be hurried along due to foetal distress, medical practitioners must quickly consider how best to proceed. It will be evident that the foetus is distressed as its heart rate will increase or decrease. One option is to proceed with an emergency Caesarean section. However, this will not be suitable if the baby's head has already descended down the birth canal. In such situations an episiotomy will be required to speed the birth up.
2. Instrumental delivery (forceps or a ventouse)
If an instrumental delivery is needed, an episiotomy will be help to widen the vagina, making room for the forceps/ventouse. An instrumental delivery will be necessary if it is a breech birth, if the mother is exhausted due to a prolonged labour, or if the mother has a serious health condition that puts her at risk of harm during a long labour.
Who has an episiotomy?
Therefore episiotomies are not performed routinely. They are only carried out when there is a clinical need to do so – namely, the baby is in distress or an instrumental delivery is needed. The NHS estimates that one in seven vaginal births involve an episiotomy.
Some countries, such as the USA, do perform episiotomies routinely. This also used to be the case in the UK, but the National Institute for Health and Care Excellence (NICE) now recommends that an episiotomy is only carried out when necessary.
How is an episiotomy performed?
A midwife or doctor can perform an episiotomy. If a patient has had an epidural she will not be able to feel anything past her waist. If she has not had one, the perineum should be numbed with local anaesthetic. Sharp scissors must then be used to cut the perineum, starting from the back of the vagina and extending diagonally downwards.
After the baby is delivery the episiotomy should be sutured with dissolvable stitches. Medical practitioners should check whether there are any tears present and repair them at the same time. The episiotomy wound will heal within approximately one month.
What is a medio-lateral episiotomy?
A medio-lateral episiotomy is when the cut is made downwards and to the side. In other words, a diagonal cut is made.
What is a midline episiotomy?
A midline episiotomy is when the cut is made straight downwards, from the vagina down towards the anus.
What type of episiotomy should you have?
In the UK, patients must undergo a medio-lateral episiotomy. This is a relatively new recommendation and previously midline episiotomies were permitted. However, this is no longer the case and midline episiotomies are not accepted practice in the UK.
Why is a midline episiotomy not allowed?
Midline episiotomies have been ruled out of UK medical practice because they are known to increase the risk of serious perineal tears.
It is not unusual for women to suffer a tear during a vaginal birth, although the majority will experience a first or second degree tear. These are superficial injuries that can be sutured in the delivery suite by a midwife or doctor. A small percentage of women will suffer a more serious tear, which will be either a third or fourth degree tear. These injuries are much more serious and extend into the anal sphincter complex.
A midline episiotomy increases the chance of a third or fourth degree tear occurring.
How do I know if I had a midline episiotomy?
If you have had a midline episiotomy, the episiotomy wound will go straight downwards. This differs to a medio-lateral episiotomy, where the wound will be directed out to one side. A doctor may have already told you that you had a midline episiotomy, or may be able to tell you during an examination.
Midline episiotomy and medical negligence
If a midline episiotomy is performed, the clinician who carried out the procedure will have provided a substandard level of medical care. If the midline episiotomy causes a patient to suffer a third or fourth degree tear, there will be a case of medical negligence.
Anyone who has had a third or fourth degree tear after a midline episiotomy should seek expert legal advice, as there could be grounds for a compensation claim.
Compensation for medical negligence
Those who are harmed because of medical error are legally entitled to pursue a medical negligence claim for compensation. In cases of midline episiotomies, the claim will centre on the fact that such procedures are not acceptable in the UK. The act of carrying out a midline episiotomy will therefore amount to a substandard level of medical care.
For a medical negligence claim to succeed, it must be established that a substandard level of care cause a patient wrongful injury. If a midline episiotomy leads to a third or fourth degree tear, it can be argued that the tear would have been avoided, had a medio-lateral episiotomy been performed. In other words, the tear was caused by the negligent episiotomy.
A patient who has experienced a third or fourth degree tear because of negligent medical care will be eligible to compensation.
Time limits
Medical negligence claims must be made within three years of the event. This means you must not delay in seeking professional legal advice, or you could run out of time to make a claim.
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