Birth trauma inquiry hears £80m annual cost of treating perineal tears
In her role as champion for the support group Make Birth Better, Carley Ross attended a session of the Parliamentary inquiry into birth trauma this week, led by MPs Theo Clarke and Rosie Duffield.
The inquiry is investigating the reasons behind traumatic birth that currently impacts as many as one in three women in the UK, around 30,000 a year.
Research also shows that around 4-5% of women develop post-traumatic stress disorder (PTSD) after giving birth, equivalent to approximately 25,000-30,000 women every year in the UK.
A major cause of birth trauma is avoidable and unavoidable perineal tears some of which are caused by negligence during birth, are negligently missed or not properly repaired, with little follow-up or guidance to women who suffer one.
The session, attended by MPs, lawyers and medical practitioners, highlighted the physical and psychological impact of 2nd, 3rd and 4th degree perineal tears experienced during labour.
Clearly, the sooner the tear of any severity is repaired, the better the outcomes. Important failings in care raised at the hearing are the lack of specialist physiotherapists, the need for more training for GPs and for doctors and midwives to listen properly to how women want to manage their labours.
More work during the antenatal stage was recommended to prepare women of potential difficulties during birth to enable more informed choices around issues such as instrumental births or the move to immediate C-section.
For example, in the circumstance of high-risk second stage C-section (when the baby's head is already in the birth canal) generally this would necessitate an instrumental birth. If there is a discussion earlier in the pregnancy and a woman is adamant that she does not want an instrumental birth, she should be referred for a planned C-section before a potentially dangerous situation arises.
Psychological impact of OASI injuries
The average cost of treating 3rd or 4th degree tears is in the region of £80m year, not including litigation costs. For one patient, this equates to around £80,000 without factoring in loss of earnings. Evidence suggests that if a woman receives good follow-up after her injury, she is unlikely to develop PTSD which also requires extensive treatment and care.
Recommendations
Already under discussion to reduce the impact of birth trauma are Maternal Mental Health Clinics, easier access to appropriate care, integrated physical and psychological care packages and specifically mandatory training around the OASI (obstetric anal sphincter injury) Care Bundle that dictates how women suffering injury during vaginal delivery are treated.
As ever, midwives are key to improving outcomes and while recommendations include training on asking direct and simple questions following birth such as 'are you experiencing problems with bladder or bowel?', the ongoing and catastrophic shortage of midwives around the UK continues to put women and babies at risk of birth trauma.
If you have been affected by perineal tear, read about a potential claim and hear from clients.
You can read this case study regarding settlement for a woman suffering severe anal sphincter injury during a forceps birth.