Perineal Tear Claims - written by Gurdeep Singh, Solicitor, Clinical Negligence

Perineal Tear

During vaginal childbirth some women experience tears. The majority of tears occur in the perineum, which is the area between the vaginal opening and the anus. Perineal Tears can be classified by their severity:-

• First degree tears are small, skin deep tears and usually heal naturally.   
• Second degree tears are deeper and affect the muscle of the perineum and usually require stitches. 
• Third degree tears also involve the anal sphincter. These require surgical repair and usually a course of antibiotics to reduce the risk of infection and laxatives to make it more comfortable to when opening bowels.
• Fourth degree tears extend into the lining of the anus. These require surgical repair and usually a course of antibiotics to reduce the risk of infection and laxatives to make it more comfortable to when opening bowels.

Causes Of Perineal Tears

During vaginal childbirth some women experience tears due to the baby stretching the vagina during delivery. The risk of third or fourth degree tear occurring during vaginal birth is 3 in 100. The risk increases to 6 in 100 women, when it is a woman’s first vaginal birth. Although there is no way of knowing who is going to suffer a tear, clinicians do have additional recognised risk factors, which can assist in guessing whether a woman is likely to suffer a tear or not.  These are:-

• Baby is over 9lb;
• Long second stage of labour (the stage during a woman pushes the baby out);
• Shoulder dystocia (baby’s shoulder gets stuck behind the pubic bone); and
• Instrumental vaginal birth (forceps or vacuum assisted).

When Could A Perineal Tear Or Perineal Repair Be Negligent

In order for it to be negligence the Claimant must prove all of the following:-

1. The Claimant was owed a duty of care by the hospital/clinician delivering the baby.  In medical negligence claims this is easily established due to the existence of the clinician – patient relationship;
2. Breach of Duty of Care: the treatment that the Claimant received was substandard i.e. unacceptable;  and
3. Causation: as a result of the substandard treatment the Claimant suffered an injury.

There are different situations which may give rise to bring a perineal claim:-

• The clinician may have failed to take steps to reduce the risk of vaginal tears (for example during an instrumental delivery, although not always essential, the clinician may have failed to make an episiotomy).
• There may be a delay in diagnosing and treating/repairing a perineal tear.
• There may be a misdiagnosis of the perineal tear/classification of the perineal tear and as such appropriate treatment/repair is not provided.
• The perineal tear repair surgery may have been substandard.

Consequences Of Perineal Tears

Whilst most perineal tears heal well, unfortunately there are some that do not have a good outcome. Poor outcomes can include:-

• Infections, inflammation and pain;
• Urinary and/or faecal incontinence; and
• Psychiatric injury.

We have acted for women, whereby they have suffered perineal tears due to clinical negligence or had substandard repair of a perineal tear, resulting in poor outcomes. If you believe that you have suffered a perineal tear due to your delivery being mismanaged or you believe that your perineal tear repair was substandard and are suffering from the above, please contact us on 0161 873 2740 to discuss.