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No Warning About Third Degree Tears

No Warning About Third Degree Tears

Are perineal tears during childbirth a taboo subject? Women are frequently shocked at the appalling effects a tear can produce. Surely, they should be better informed by their medical practitioners.

What are perineal tears?

A perineal tear is an injury that can affect the skin and muscle in the perineum (the area between the vagina and anus) and sometimes the anus, which can occur during vaginal childbirth. It is a natural occurrence and is thought to affect approximately 90% of woman who give birth in this way.

For most women, the tear will be small and will heal quickly and successfully. For up to 5% of women, however, a more severe tear may occur. These are 3rd or 4th degree tears. They are more damaging because, in addition to affecting the perineum, these tears will damage the anal sphincter which controls the opening and closing of the bowels and, in the case of a 34th degree tear, the anal canal.

Why knowledge is power

Being made aware of the possibility of suffering a tear during childbirth is important for a number of reasons:

  • Some women are at a greater risk of suffering a severe tear and may wish to discuss the option of a caesarean section with their midwife or obstetrician
  • There are some recommendations for reducing the likelihood of experiencing a tear which women could carry our during the pre-natal period
  • If a severe tear should occur, the mother having an awareness and understanding of the nature of perineal tears may help to ensure an accurate diagnosis and better recovery

Who is at risk of a severe tear?

The Royal College of Obstetricians and Gynaecologists' Guidelines on the Management of perineal tears identifies a number of factors which increase the possibility of a severe tear occurring. Some of these factors only become apparent during the course of the birth and decisions as to management of the problem can only be made at that time. Others, however, may be useful for the mother to know in advance of the birth:

  • A mother carrying a bigger than average baby may be more likely to experience a perineal tear, especially if the mother herself is small. A baby greater than 4kg in weight is considered to increase the risk
  • A woman giving birth vaginally for the first time is also at greater risk of suffering a severe tear than a woman who has given birth vaginally previously but not suffered a severe tear
  • Women of Asian background also seem to be more susceptible to experiencing a severe tear

If a woman who falls into one - or all - of these categories fully understands not only the risk of a severe tear but also the possible long-term effects of a severe tear, she might wish to consider having her baby by caesarean section rather than risk her health, and possibly that of her baby.

What could you do to help?

Even for women who are not at a heightened risk of suffering a severe tear, knowledge as to the risk of any degree of tear could be extremely useful as they may wish to try strategies which might reduce the chances or severity of a tear:

  • Regular massage of the perineal area during the month before birth is thought to make the vagina and perineum more flexible so that it can stretch more easily to allow the baby to emerge
  • Pelvic floor exercises to develop the muscles may also help during the birth of the baby and may help recovery if a perineal tear does occur
  • It also seems that the choice of birthing position can affect the likelihood of a tear and the mother may wish to discuss this with her midwife

Tears are not avoidable

However, it is not possible to completely remove the risk of a perineal tear. If a mother chooses a vaginal birth, the baby needs to be born and a tear may occur. What advice and information may achieve is to reduce the severity of a tear and the long-term associated effects.

Diagnosis and Treatment

In the unfortunate event that a woman does experience a severe tear, prompt and accurate diagnosis is absolutely vital in order to ensure an effective repair. Where a delay occurs, the mother is much more likely to suffer long-term problems such as wind and faecal incontinence.

All new mothers should undergo a thorough examination after the birth of their child to check for any sign of perineal trauma. A digital rectal examination is necessary to ensure that a 3rd or 4th degree tear has not occurred which will need to be repaired in an operating theatre.

Medical Negligence

The number of perineal tears occurring seems to be on the increase. Therefore, it is all the more important that medical practitioners talk about, recognise and deal with those injuries which occur.

If you have suffered with the distressing, long-term effects of an undiagnosed third or fourth degree tear, speak to a solicitor about the possibility of a claim for compensation.

Glynns Solicitors are a specialist medical negligence practice with considerable experience of supporting claims for perineal tears. Contact us to discuss your experience.

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