Perineal Tears During ChildbirthPublished on: 19 January 2021
It is common knowledge that a mother who delivers a child by caesarean will need six weeks to recover physically. If a caesarean is required then the implications are discussed at length during the antenatal period, and preparations can be made by the mother to ensure she can rest and recover once the baby arrives. What is less talked about by midwives, doctors and mothers themselves are tears, despite research finding that nine in 10 women will tear to some extent during a vaginal delivery.1
Grading a Tear
Tears are graded from first degree to fourth degree. Small, skin-deep tears are known as first degree tears and usually heal naturally. Tears that are deeper and affect the muscle of the perineum are known as second degree tears. These usually require stitches by a midwife. A third degree is a tear that extends into the muscle that controls the anus (the anal sphincter). If the tear extends further into the lining of the anus or rectum it is known as a fourth-degree tear. Third and fourth degree tears require surgical repair by a doctor as soon as possible after your baby is born, under spinal anaesthetic or an epidural in theatre. You are likely to need a catheter for a short period afterwards and the follow-up care includes pain relief, a course of antibiotics to reduce the risk of infection, laxatives for comfort and physiotherapy follow-up. Most women make a full recovery within four to six weeks, although rarely complications can arise and medical advice should be sought as soon as possible. Key complications to look out for include:
Signs of infection such as if your stitches become more painful or smell offensive;
You cannot control your bowels or when you pass wind; or
Continued pain and discomfort when having sexual intercourse.
It is also important to focus on your mental health. Experiencing complications when giving birth can be very distressing and disturbing, and for some women there is a risk of post-traumatic stress disorder. Following a perineal tear, if you are developing anxiety, have low mood or feel that you need additional support, you should talk to your healthcare professional.
The diagram below from The Royal College of Obstetricians and Gynaecologists helpfully summarises the anatomy and how tears are graded.
Difference Between an Episiotomy and a Tear
A tear happens spontaneously with delivery, however, an episiotomy is a cut made by a healthcare professional through the vaginal wall and perineum. This may be done if your baby needs to be born more quickly or to make more space for your baby to be born. If you have an episiotomy you will need stitches. These are normally done under local anaesthetic.
On the most part, it is thought that an episiotomy will help prevent a severe tear as it can be controlled, however, it is possible for an episiotomy to extend and become a deeper tear.
When to Consider Making a Perineal Tear Claim
Whilst suffering a tear is incredibly common, there are situations where the acts and/or omissions of midwives and doctors can lead to a mother either suffering a worse tear or having a more complicated recovery. Women tend to be reluctant to discuss their symptoms and see this as part of having a baby. Whilst not all tears will give rise to a legal claim, it is important to talk about your delivery and recovery and be aware of potential failings. The most common types of claims we see include:
Poor birth planning and/or management of labour;
Failing to repair a tear in a timely manner after delivery;
Failing to appropriately identify the severity of a tear leading to a sub-standard repair; and
Failing to act on signs of infection post-repair.
If you would like to discuss your labour or perineal tear with one of our experts, please call us on 0800 652 3371.
If you would like further information, the following organisations specialise in supporting women who have suffered perineal tears:
RCOG Perineal Tears Hub: www.rcog.org.uk/tears
Mothers with Anal Sphincter Injuries in Childbirth (MASIC): https://masic.org.uk
Birth Trauma Association: www.birthtraumaassociation.org.uk
Bladder and Bowel Community: www.bladderandbowel.org