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Can the correct birthing position prevent perineal tears?

Can the correct birthing position prevent perineal tears?

Perineal tears during childbirth can be painful and lead to long-term discomfort and faecal dysfunction. Consequently, there is debate as to whether the maternal position can affect this outcome.

What is a perineal tear?

A perineal tear is a tear affecting the area between the vagina and anus occurring as the baby emerges from the mother's body. Approximately 90% of first-time mothers are thought to experience some level of tear. Fortunately, most tears are superficial affecting only the skin of the perineum and vagina and may not even need stitches. However, severe tears such as 3rd and 4th degree tears can affect the muscle of the perineum and the anal sphincter as well as the anal canal and require treatment in an operating theatre.

Does the maternal position matter?

There has been some research into the relationship between the maternal position during labour and birth and the likelihood and severity of perineal tears. However, there are a range of other physical factors influencing the likelihood of a perineal tear occurring which makes absolutely conclusive findings difficult to obtain. Additionally, factors such as the influence of the medical practitioners and cultural impact on the mother may impact on the outcome and choices made during labour.

However, research has produced some agreed findings as follows:

  • A squatting position was linked with a higher number of severe 3rd and 4th degree tears.
  • A lateral position (on the side) was linked with a better outcome for the perineum with less need for stitches
  • Use of a birth cushion led to fewer 2nd degree tears
  • An upright position for both labour and birth led to a reduction in the need for episiotomies and assisted births
  • An upright position seemed to be linked to a higher number of 2nd degree tears
  • A supine or recumbent position was linked to a greater number of 3rd degree tears
  • An upright position was linked to fewer 3rd degree tears
  • An 'all fours' position appeared to be beneficial to the perineum
  • Use of a 'birthing bed' appeared to lead to fewer episiotomies and better perineal outcome

Responding to a 3rd degree tear

It is difficult to predict a severe perineal tear, although there are some influencing factors such as a large baby, an assisted birth, and a long second stage of labour.

However, it is possible to ensure a prompt and thorough approach to dealing with a perineal tear once it has occurred.

Your medical practitioner should carry out an examination of the vaginal and anal area following the birth to look for signs of any perineal trauma. This may involve a digital anal examination.

If a third or fourth degree tear has occurred, the entire tear needs to be repaired by a skilled surgeon in an operating theatre and the mother needs to be given a course of antibiotics to reduce the risk of infection during the recovery period.

Medical Negligence

If a 3rd or 4th degree tear goes undiagnosed, the mother can experience significant and unpleasant effects such as on-going wind and faecal incontinence, on-going infections and pain and problems with sexual intercourse.

If you have experienced the on-going effects of an undiagnosed perineal tear, contact Glynns Solicitors. We have significant experience of handling compensation claims for the victims of birth injuries and would be happy to discuss your situation with you.

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