A recent article appeared in the Daily Mail entitled “The great childbirth taboo” which opened up the conversation on this issue for many women. The article centred on the tears women experience after childbirth that leave them with serious injuries such as incontinence, pain and painful intercourse. Many mothers, and especially first time mothers, are not told or simply do not realise that the symptoms that they are suffering from are due to a missed or incorrectly repaired tear and instead they simply put it down to being a normal consequence of childbirth. The symptoms are so deeply personal that it is something that has been seen as too embarrassing to talk about with their GP or their families and therefore the opportunity to diagnose them gets missed. The article in the Daily Mail was a reminder that women in this situation are not alone and highlighted the importance of seeking help at the earliest opportunity.
In this blog, I want to set out the avenues available for investigating a claim for medical negligence as a result of a delayed or poorly repaired tear and how to get the help that you might need.
Up to 90% of women experience a perineal tear during labour. The perineum is the area separating the vagina from the anus. There are different types of tears and you may hear these from the midwife or obstetrician, or see them in your medical notes referred to as a first, second, third and fourth degree tear with each increasing in severity in the areas of the perineum that have been affected.
The most serious of these are 3rd and 4th degree tears because the long terms symptoms can be significant for the mother and they should be repaired soon afterwards. This is known as a ‘Primary Repair’ and if there has been a Primary Repair, generally the prognosis is very good and it is unlikely that there will be any long term symptoms. If the tear is not diagnosed and treated within about 24 hours and certainly no more than two weeks after the delivery, it will not heal as well as it would if a Primary Repair had taken place and your doctor may have offered you a Secondary Repair. The success rates for Secondary Repairs are much lower than for a Primary Repair and usually result in long term incontinence of faeces and uncontrollable flatulence.
Therefore, if there has been a tear during delivery, this needs to be identified by medical staff as quickly as possible to give you that chance of a successful Primary Repair.
When might I have a case against the hospital?
From 1 April 2000 to 31 March 2010, there were 441 claims in England in which allegations of negligence were made arising out of obstetric perineal trauma (the fourth highest number of claims in obstetrics). The total value of those claims was estimated to be £31.2 million and 85% of these claims were related to misdiagnosis of perineal trauma. (Source: The Management of Third- and Fourth-Degree Perineal Tears, Green-top Guideline No. 29, June 2015)
After giving birth mothers are examined by their midwife or doctor who will check for any tears. If the midwife or doctor suspects a 3rd or 4th degree tear the mother will be examined in theatre and if they have torn, these tears need to be repaired under anaesthetic to stitch the damaged muscle and skin together. You may have a claim against the hospital if:
1. The tear was recognised and you underwent a Primary Repair but it was done poorly. A poor repair can result in an infection which can lead the wound to develop into a fistula or lead to urinary/faecal incontinence. You should therefore be given the correct information on looking after your wound and if you reported symptoms which suggested an infection and nothing was done about it, then it is possible that you have a claim for negligence against the hospital because any long term symptoms could have been avoided with proper care.
2. A 3rd degree tear might also be mistaken for a more minor injury such as a 1st or 2nd degree tear. As a result, the full length of the tear is not stitched and the mother is left with problems in her perineal muscles and/or anal sphincter causing discomfort, faecal incontinence and difficulty controlling flatulence. These symptoms often prompt the mother to seek further medical attention, which then results in the missed tear being discovered. However, as it may be days, weeks, months or even years before the patient obtains a correct diagnosis because concerns may be dismissed by clinicians or, because of the taboo surrounding the subject and the mis-held view that it is a normal part of childbirth, the correct information is not obtained from the mother. Symptoms include:
- Increasing levels of pain
- Difficulty going to the toilet
- Difficulty having sex
- Vaginal discharge and or/bleeding
- Leaking faeces or being unable to control win
3. There may have been a failure to carry out a thorough examination following the birth and so the tear might be missed entirely by a midwife or doctor and you missed the opportunity for a Primary Repair and the Secondary Repair has left you with long term consequences. As well as losing control over your bowel motions, many mothers report a real fear about future pregnancy and birth and psychological damage as a result. The entire experience can impact day to day life and the ability to work and socialise and therefore it is important to seek advice about your concerns over the treatment you received.