Perineal Tears: Am I entitled to compensation?

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If you have suffered a perineal tear due to negligence during childbirth, you may be entitled to claim compensation.

Perineal tears can occur during childbirth for a number of reasons, such as it being your first vaginal birth, the baby’s position and the baby’s weight.

Perineal tears

However, healthcare professionals should take the necessary steps to prevent third and fourth-degree tearing – and if you have suffered as a result of their negligence, you may be entitled to compensation.

We know that you may be reluctant to discuss the intimacies of childbirth with us, but our team of qualified medical negligence solicitors are here to confidentially listen, advise and help you seek justice for your suffering.

Healthcare providers have a duty of care to act in a way that protects their patients’ safety and provides a reasonable standard of care. If this has not been followed and you have suffered preventable harm as a result, you may be entitled to claim compensation.

What is a perineal tear?

A perineal tear is a tear to the area between the vagina and anus (the perineum). Tears can occur due to the increased pressure on the area during labour whilst the baby is delivered.

Approximately 90% of mothers have minor tears during childbirth, but some can be more severe, such as 3^rd and 4^th degree tears which can have life-changing consequences.

Although tears are common, with the right medical attention, the severity of them can be minimised. For example, if your birth is being monitored correctly, and healthcare professionals can see what you may be at risk of a severe tear, they can take action, by making a small cut in the area (known as an episiotomy).

However, if they do not monitor the progression of your labour, and leave you to suffer third or fourth degree tears, you may suffer on-going and long-term health issues as a result – that could have been prevented.

What causes perineal tear?

First vaginal birth: The risk of a perineal tear is higher for first-time mothers.
Baby’s position: The baby’s position during delivery can increase the risk of a tear. For example, if the baby is face up instead of face down.
Baby’s weight: A large baby, usually weighing more than 8 pounds, can increase the risk of a tear.
Delivery method: The use of forceps or a vacuum during delivery can increase the risk of a tear.
Episiotomy: An incision made in the perineum to assist delivery can increase the risk of a tear.
Labor length: A prolonged second stage of labor, or pushing stage, can increase the risk of a tear.
Maternal age: Older mothers have an increased risk of a tear.

What is an episiotomy

An episiotomy is a cut (incision) through the area between your vaginal opening and your anus. This area is called the perineum. This procedure is done to make your vaginal opening larger for childbirth.

Normally, once the baby’s head is seen, your healthcare provider will ease your baby’s head and chin out of your vagina. Once the baby’s head is out, the shoulders and the rest of the body follow.

Sometimes the vaginal opening doesn’t stretch enough for the baby’s head. In this case, an episiotomy aids your healthcare provider in delivering your baby.

It’s important to make a surgical incision rather than letting the tissue tear. Your provider will usually do an episiotomy when the baby’s head has stretched your vaginal opening to several centimetres.

Once you deliver the placenta, your healthcare provider will stitch the cut. If you don’t have an epidural, your provider may inject a numbing medicine into the perineum. This will numb it before the provider repairs the episiotomy.

When can I make a claim for perineal tear?

Substandard medical care can lead to a tear. This could be:

Not considering the risk factors for perineal tears and a failure to advise properly before giving birth.
Failure to take steps before or during childbirth to reduce the risk of a tear.
Failure to properly diagnose a tear immediately after delivery.
Failure to adequately repair a perineal tear.
Failure to react to signs of infection or unusual symptoms.
Failure to spot signs of a problematic birth
Failure to carry out a episiotomy

First and Second-degree tears

You may be entitled to make a claim for a first or second-degree tear if they were sustained due to negligence.

First-degree tear

A first-degree tear is the mildest form of perineal laceration, typically affecting only the skin of the perineum and occasionally the out layer of the vagina.

These tears may not always need stitches, but if they do, they generally heal within a few weeks. Some discomfort or stinging during urination may occur. This type of tear does not extend to the deeper muscles or anal sphincter tissues.

Second- degree tear

A second-degree tear involves both the skin and the perineal muscle. These tears may extend deep into the vagina, so it is important to have them stitched right away for proper healing.

While second-degree tears typically do not cause long-term problems, they can be quite painful.

What is a third- and fourth-degree childbirth tear?

Third-degree tear

A third-degree tear is a tear in the perineum that extends into the anus. The perineum is the area between the vaginal opening and the anus. A tear of this nature can also be known as obstetric anal sphincter injury (OASI).

Third-degree tears occur in around 6 in 100 women. They are more common during a first vaginal birth. However, other factors that can increase the risk of a third-degree tear include:

Having a baby that weighs more than 4 kg
Having a baby that is born in a “back to back” position
Having an assisted birth, such as forceps or ventouse
Difficulty delivering the baby’s shoulders
Being of Asian ethnicity

After a third-degree tear is repaired, you may experience problems such as infection, leaking stool, or leaking urine. If you notice any of these problems, you should contact a member of your health care team.

Fourth-degree tear

A fourth-degree tear is a severe vaginal tear that extends through the anal sphincter and into the rectum. It’s the most severe type of vaginal tear that can occur during childbirth.

A fourth-degree tear is also known as an obstetric anal sphincter injury (OASI). It’s more common during a first vaginal birth, occurring in about 6 in 100 women, compared to 2 in 100 women who have given birth vaginally before.

Sometimes they require more complex repair than stitches alone. Healing may take 4 to 6 week or more. If you have a fourth-degree tear, you may need to take antibiotic medicine to prevent an infection.

After a fourth-degree vaginal tear is repaired, some problems that can happen include infection, separation of the repaired area, leaking stool — also called faecal incontinence — and leaking urine — also called urinary incontinence. If you notice any of these problems, contact a member of your health care team.

What can a perineal tear cause?

A perineal tear can cause a number of short-term and long-term issues, including:

Pain: It’s normal to feel pain or soreness for 2–3 weeks after giving birth, especially when sitting or walking. Pain relievers like paracetamol or ibuprofen can help.
Infection: Symptoms include smelly vaginal discharge, fever, or wound breakdown.
Incontinence: Difficulty controlling your bowels or passing wind. This can be frequency (needing to use the bathroom more often) or urgency (difficulty holding stool).
Dyspareunia: Difficulty having sex.
Hemorrhoids: Swollen blood vessels in the anus that can put pressure on the perineum and cause pain.

Most women who have a third- or fourth-degree tear heal completely and don’t have lasting complications. However, if you experience any of the following, you should contact your GP or midwife:

Pain that’s getting worse
Difficulty going to the toilet that’s not improving
Incontinence that’s not improving
Difficulty having sex that’s not improving
Vaginal bleeding that’s not getting better
A high temperature (above 38 °C)

When can I make a claim?

If you feel that you have suffered unnecessary harm as a result of negligence during childbirth, you may be entitled to make a claim. For a successful clinical negligence claim, we need to prove

The healthcare professional owed you a duty of care
The healthcare professional breached that duty of care
The breach of duty caused you harm
The harm you experienced was the main reason for the breach of duty
You suffered damage or loss as a result of the harm

Damage or loss can include:

Physical injury
Psychiatric injury, such as post-traumatic stress disorder (PTSD)
Financial loss, such as future earnings

How long do I have to make a claim?

Claims of this nature are subject to a three year limitation period. This means that claims have to be commenced within the courts in three years of either the date the negligent act occurred or the date you became aware that negligence had occurred.

In cases involving deceased victims this limitation period commences from the date of death and in cases involving minors, the limitation period starts when they reach their 18th Birthday.

The law surrounding limitation periods is complex, our specialist team will be able to advise further.

How much compensation will I get?

It is often difficult to value clinical negligence claims at their outset given the complexities involved however we will pursue two forms of compensation for you:

Firstly we will pursue compensation known as general damages – this is an award of money for the pain and suffering you have endured as a result of the negligence.
Secondly we will pursue compensation known as special damages – this is an award of money for all of your out of pocket expenses such as travel expenses, medication costs, loss of earnings, treatment costs both past and future. This list is not exhaustive and is very case specific.

**Why should I use Oakwood Solicitors Ltd?**

We have a dedicated team of solicitors and paralegals who have many years’ experience between them in running birthing injury claims. They are highly trained to deal with all aspects of clinical and medical negligence.

Oakwood Solicitors Ltd wishes to ensure that clients are not overwhelmed by legal jargon or medical terms that they don’t understand and aims to allow the claims procedure to be as transparent as possible.