As lawyers, we see many different types of potential medical negligence claims for women who have sustained some form of perineal tear during delivery. It is not the case that any and all tears suffered during childbirth are as a result of negligence.
We often have enquiries from women who have been fearful their whole pregnancy that they are going to have a big baby and feel that they are going to struggle with a vaginal delivery. While having a big baby does carry with it increased risk of tearing, or other complications which may result in tearing, the risk of having a big baby is not usually enough of a reason to offer a woman a caesarean section.
At the end of 2011, NICE brought out guidance on the provision of a caesarean section. Within the guidance there is a section which refers to the maternal right to choose in certain situations where specific criteria are met. If women have their request for a caesarean section refused and then find themselves sustaining a significant perineal injury which a cesearean could have avoided, it may be that women in this situation will be able to pursue a successful claim for medical negligence.
It is very rarely possible to make a claim for a situation where the baby has suffered a shoulder dystocia, which is where the baby’s head is delivered but their shoulders get stuck above the pelvis. This situation is almost entirely unpredictable and unavoidable, as well as being quite unusual. This is a very dangerous situation for both mother and baby, where delivering a live baby is the highest priority and it is very unlikely that you could bring a successful claim for suffering a tear in such circumstances.
The most common basis for a childbirth tear claim comes after the delivery. Repairs should be carried out in a calm and controlled setting and, as such, if carried out in a competent manner by appropriately trained and practiced obstetricians there should be no longer term complications.
It is appropriate for a first or second-degree tear to be repaired by an appropriately trained and qualified medical personnel in the delivery room.
However, if there is a risk that a woman has sustained a third or fourth-degree tear, then the repair should be carried out in theatre, in sterile surroundings and by an appropriately trained obstetrician. In these circumstances, the tear should be carefully assessed and that assessment should be documented. The repair procedure should be done in accordance with the guidance in relation to the type of suture and appropriate materials and, again, this should be fully documented. The mother should then be given antibiotics and laxatives and should have her six-week post-natal check with an obstetrician.
If you have been diagnosed with a third or fourth-degree tear and you did not receive this level of treatment - and you are still suffering from problems - then you may have a claim for medical negligence during childbirth.
You may also be able to make a claim if you weren’t given an episiotomy where there is likelihood of a serious tear. If an episiotomy wasn’t used correctly to prevent a tear, you may be able to claim for negligence if you are allowed to tear, or if the extent of the tear was not correctly dealt with or spotted after birth.
The other area where a perineal tear may be the cause of a pregnancy injury claim is during a subsequent pregnancy. Previous perineal tears should be taken into account when considering the method of delivery for subsequent children. If a woman is not counselled appropriately or is denied an option such as a caesarean section then, again, there is a possibility that if she goes on to sustain a further perineal injury as a result, she may have a claim for medical negligence.
Thompsons Solicitors has acted for clients who have experienced a whole range of symptoms after a childbirth tear. We have had clients who have experienced complete breakdowns of their perineum, leading to urinary and/or faecal incontinence, and in some cases even ending up with a colostomy to give the area time to heal.