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Missed 4th Degree Tear After Midline Episiotomy

Shortly after being told she had a second degree tear, Cheri began to pass faeces through her vagina. She repeatedly sought medical attention, and was eventually told she had a missed fourth degree tear which had occurred after a midline episiotomy.

When giving birth to her second child, Cheri requested a caesarean section as her first delivery had required an emergency Caesarean. However, she was told that it was not hospital policy and she must try for a vaginal birth. At no point was she advised about the risks of a vaginal birth after caesarean.

The labour of her second baby was induced at 10am. At 4.45pm Cheri underwent an episiotomy, after which she gave birth to a healthy baby boy. The midwife who performed the episiotomy examined her and said she had sustained a second degree tear. This was sutured in the delivery room and Cheri was moved to the maternity ward for the night.

Before she was discharged the next morning, the ward nurse asked a doctor to examine Cheri as she was bleeding copiously. The doctor only examined the outside of the wound and said it was probably a haematoma. She was discharged home regardless, where Cheri remained in a significant amount of pain.

The following day Cheri passed a very loose stool and it felt as though it was coming through her sutures. She called the midwife who examined her later that day, but was told there was nothing wrong. The next day the same thing happened, and again Cheri called the midwife. The midwife made an urgent incontinence referral, but this had little effect as the appointment date was over a year later.

The following morning Cheri had a bath and noticed that the sutures were coming undone. She called the midwife who advised that she contact the hospital. Cheri did so but was told she simply needed to ask her GP for a course of antibiotics. They explained that doctors do not normally re-suture second degree tears and that it was fine to leave the wound open. Cheri did not feel happy with this and demanded an appointment. She was finally offered one later that day.

In hospital she was initially examined by a midwife, who then called a junior doctor, who then called a registrar. The registrar told Cheri that she had in fact suffered a fourth degree tear which had not been diagnosed after the birth. He also explained that she had undergone a midline episiotomy, rather than a mediolateral episiotomy, which was against hospital policy. This would have contributed towards the fourth degree tear occurring.

Cheri was admitted immediately and placed under the care of a colorectal surgeon and an obstetrician. They told her that her sphincter muscles had been completely damaged and that she would require a colostomy before a sphincter repair was carried out. A colostomy was fitted two days later, something which utterly devastated Cheri. The colostomy made life very awkward and she worried constantly about it leaking. She could not look after her newborn son properly and required a significant amount of extra help from her husband.

Three months later Cheri underwent an anal sphincter repair, and three months later the colostomy was reversed. She is no longer incontinent of faeces but she cannot control the passing of wind and does suffer faecal urgency. This has impacted on her ability to work.

Cheri has had to undergo three operations and years of distress because the midwife performed a midline episiotomy, and failed to diagnose a fourth degree tear. Cheri and her husband have experienced financial loss due to the amount of time Cheri required off work, not to mention extensive emotional trauma.

All of these complications could have been avoided, had Cheri's fourth degree tear been diagnosed immediately after the birth. We helped her make a claim against the negligent hospital and she was awarded in excess of £80,000 compensation.

(Details which might identify our client have been changed.)

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