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Can Shoulder Dystocia Cause an Anal Sphincter Injury?

Can Shoulder Dystocia Cause an Anal Sphincter Injury?

Shoulder dystocia is one of many factors which can increase a woman's chance of suffering a severe perineal tear during childbirth.

Anal sphincter injuries in childbirth

Around 5 to 10% of all women giving birth vaginally are thought to suffer anal sphincter injuries. This means that a tear which might start at the vagina during the birth of the baby is so severe that it extends as far as the anus and, sometimes, also causes internal anal injury.

The effect of such an injury can be both long-term and highly distressing. The damage to the anal sphincter muscles can mean that the woman loses control of her bowel and cannot prevent or control the passing of wind and faeces.

It is crucial that diagnosis and surgical repair take place as soon as possible after the birth.

Shoulder dystocia

A number of factors are thought to influence a woman's chances of suffering a severe perineal tear during childbirth. One of those factors is shoulder dystocia during the course of the birth.

The term shoulder dystocia is used to describe the situation where the baby's head has begun to emerge but a shoulder becomes trapped behind the mother's pubic bone and prevents the baby from progressing further. Such a scenario can increase the mother's chance of suffering a severe tear. It may also mean that the baby is large which is also a risk factor for suffering an anal sphincter injury.

Additionally, if an instrumental delivery is necessary to ensure the safe birth of the baby, the woman is also more likely to suffer a severe tear.

Further risk factors

It is worth bearing in mind that there are other factors which can increase the likelihood of anal sphincter injury during childbirth:

  • If this is the woman's first vaginal delivery, she is more likely to suffer a severe tear
  • If the second stage of labour is prolonged, it is associated with a greater risk of a severe tear
  • If the woman is of Asian ethnicity, it also appears to increase her chances of suffering an anal sphincter injury

Awareness of risk

There is some evidence to suggest that the rates of anal sphincter injuries in childbirth are increasing. This may simply reflect a better rate of diagnosis but it may also indicate a lack of awareness amongst medical professionals of the issue and the associated risk factors.

Women who have given birth vaginally should undergo a thorough examination of the perineum and anus after the birth to check for damage. This should be of particular concern where the woman falls into one or more of the 'at risk' categories and may have sustained an obstetric anal sphincter injury.

Substandard care

Where a woman suffers the impact of an unrepaired third or fourth degree tear due to a failure to diagnose and repair her injury, the medical professionals attending her birth may be considered to have provided a substandard level of care.

Get legal advice

If you are suffering with the appalling long-term symptoms of a failure to diagnose your severe perineal tear, contact us to talk to a specialist medical negligence solicitor. It may be appropriate to make a claim for compensation.

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