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Perineal Tear Management

Perineal Tear Management

Clear guidelines exist as to the management of perineal tears - in terms of prevention, diagnosis and treatment. And yet the rates of severe perineal tears are increasing and claims for compensation for the handling of perineal tears produce substantial sums. So, what is going wrong?

Perineal Tears

The majority of women will suffer some degree of perineal tear during vaginal childbirth. Most of these will be small tears which recover easily. For a few - approximately 5% - a more severe tear will occur which can produce long-term and life-changing symptoms.

Both NICE and the Royal College of Gynaecologists and Obstetricians offer guidelines as to the management of vaginal birth.

With regards to the prevention of perineal tears, advice is offered as to protecting and supporting the perineum, as well as the possible use of an episiotomy. However, some women are particularly at risk of a severe tear and, short of swapping to birth by caesarean section, it may be difficult to avoid a perineal tear of some degree.

Management of the Tear

Where management of perineal tears becomes a legal issue, however, tends to be in the handling of those tears after the birth - both in terms of diagnosis and treatment. In our experience, it is the failure to make an accurate diagnosis of these injuries that leads to long-term suffering and subsequent legal action.

The NICE guidelines on 'intrapartum' (during birth) care, recommend a clearly-lit initial examination for perineal trauma as soon as possible after the birth, followed by a thorough examination including a digital rectal examination where any signs of damage are apparent.

Such an examination is vital in order to identify a severe tear.

Severe Tears

Severe tears are classified according to the degree of damage experienced. Third degree tears damage the anal sphincter - which controls the opening and closing of the bowel - to a greater or lesser extent as well as the skin and muscle between the vagina and anus. Fourth degree tears additionally cause damage to the internal lining of the anus.

All forms of third and fourth degree tear require prompt surgical repair in an operating theatre. If the tear is not identified or is diagnosed inaccurately, and the appropriate surgery does not take place, the woman is at a significant risk of experiencing long-term loss of bowel control.

This can lead to an inability to prevent the passing of wind and faeces which can affect someone's professional and personal life dramatically.

Improving Care

The Better Births initiative introduced by NHS England in February 2016 attempts to improve aspects of maternity care by proposing a five-year plan with strategies and resources, deliverable by local maternity units.

Nonetheless, the rising number of birth injuries is recognised as a problem across the country and calls continue for better training to diagnose, record and repair perineal tears accurately and promptly.

Medical Negligence

The on-going symptoms of a misdiagnosed perineal tear can be life-changing and utterly depressing for the woman who experiences them. If you are suffering in this situation, contact us at Glynns Solicitors to discuss whether you can make a claim for compensation.

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