Perineal Tear Claims: 3rd and 4th Degree Tears

What is a perineal tear?

A tear to the perineum, the area between the vagina and anus, is a birth injury mothers can suffer during childbirth. While minor tears are fairly common (affecting around 90 per cent of mothers) and tend to heal quite quickly, some vaginal tears can be severe, take longer to recover and could have been avoided.

We are expert in pursuing negligence claims for birth injuries to a mother, including perineal tears. Read similar cases here.

Perineal tear causes

Recognised risk factors include:

• Baby weighing more than 4kg
• Induction
• Epidural
• Long second stage labour
• Shoulder dystocia
• Midline episiotomy
• Forceps delivery
• Occipitoposterior position

Degree of perineal tear

In some cases, a doctor or midwife may need to perform an episiotomy and cut the perineal area to help with delivery. Sometimes the episiotomy can extend and become a perineal tear. 

A tear is not always reason to make a legal claim but, in certain circumstances, where treatment has been negligent, particularly if you suffer a 3rd or 4th degree tear, you may have grounds for a claim.

The Royal College of Gynaecology classifies degrees of perineal tear as:

1st degree tear: injury to the perineal skin and/or vaginal mucosa; 2nd degree tear: injury to perineum involving perineal muscles but not involving the anal sphincter.

3rd degree tear

A 3rd degree tear involves the skin, back of the vagina and muscles of the perineum being torn, extending to the anal sphincter. Third degree tears during childbirth need to be stitched closed.

4th degree tear

A 4th degree perineal tear is the same as a 3rd degree tear but extends to the rectum. This also requires stitches. 3rd and 4th degree tears are generally repaired in theatre with either local or general anaesthetic.

Perineal tear symptoms

If left untreated, a perineal tear can cause persistent pain, bladder, bowel and sphincter issues, faecal incontinence and flatulence. Sitting and passing urine be painful. As well as the physical impact, a childbirth tear can also have serious psychological impact on a new mother.

Sometimes a fistula (hole) can develop between the anus and the vagina after the tear has healed and may require surgery. Scar tissue can develop once the tear has healed. In extreme cases, a woman may require a temporary colostomy.

Substandard maternity care resulting in a tear can include:

• Not appreciating risk factors for perineal tears and failure to advise properly before giving birth.
• Failure to take steps before or during childbirth to minimise the risk of tearing.
• Failure to properly diagnose and repair a tear immediately following delivery.
• Delay in diagnosing a tear.
• Failure to react to signs of infection, abnormal or unusual symptoms.

Perineal tear recovery

After between 6-12 weeks following perineal tear surgery, you should be offered physiotherapy and be reviewed by an experienced obstetrician and gynaecologist. If a perineal tear is correctly diagnosed and repaired, around 60-68% of women are asymptomatic within 12 months. 

If negligent treatment during labour results in a 3rd or 4th degree tear, we can help you claim compensation to help you recover. This can include for pain, suffering and loss of amenity as a result of the injury, and:

• Therapies including counselling and specialist physiotherapy.
• Medication or private health care costs, including further surgery or treatment.
• Travel expenses to and from GP or hospital appointments.
• Loss of earnings.
• Adaptations to the home, for example, an en-suite/additional bathroom.
• Help with childcare.