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 would be very unusual to be in the situation where the very fact that a woman tore is negligent. We often have enquiries from women who have been fearful their whole pregnancy that they are going to have a big baby and therefore 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, in isolation, usually a reason to offer a woman a caesarean section.
However, at the end of 2011 NICE brought out new guidance on the provision of a caesarean section. In this guidance there is a section which refers to the maternal right to choose in certain situations where certain criteria are met. As such it may be that in the future we see more cases where women have had their request for a caesarean section refused and then find themselves sustaining a significant perineal injury, which could have been avoided had a caesarean section been performed. It may be that for those women they will be able to pursue a successful claim for medical negligence.
It is also not negligent for a baby to suffer 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 and in such a situation, 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 tear comes in the repair situation. Repairs are, in the main, carried out in a calm and controlled setting and as such there should be no reason as to why they cannot be carried out in a competent manner by appropriately trained and practiced obstetricians.
It is appropriate for a first or second degree tear to be carried out 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 a theatre, in sterile surroundings and by an appropriately trained obstetrician. The tear should be carefully assessed and that assessment should be documented. The repair 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 woman should then be given antibiotics and laxatives and she should have her six-week post-natal check with an obstetrician. If you have been diagnosed with a 3rd or 4th degree tear and this is not the treatment that you received and you are still suffering from problems, then you may have a claim for medical negligence during childbirth.
You may be able to make a claim if you weren’t given an episiotomy where there is likelihood of a serious tear. This surgical tear made at the opening of the vagina during childbirth, to aid a difficult delivery and prevent further injury. 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. If a woman has had a perineal tear, regardless of whether there are ongoing problems, that should be taken into account when considering the method of delivery for her subsequent baby. 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.