Perineal trauma during labour can be catastrophic for a woman’s physical and mental health. Bringing a medical negligence or birth injury claim is often essential for the Claimant to access the money required to pay for private rehabilitation and achieve a formal apology and an acknowledgement of the pain and suffering caused by negligent care. Due to the complexity of perineal tear medical negligence claims, Midwifery Expert Witnesses are essential for both the Claimant and Defendant when presenting their cases.
What is a perineal tear?
A perineal tear refers to a laceration of the skin and other soft tissues in the perineum, the area between the vaginal opening and the anus. This tear can occur naturally during childbirth as the baby’s head passes through the vaginal opening, stretching and sometimes tearing the tissue.
There are different degrees of perineal tears:
- First-degree tear – only the perineal skin and underlying superficial tissues are affected. It may require stitches and usually heals rapidly.
- Second-degree tear – the perineal muscles are affected but not the anal sphincter. Such tears typically require stitches and heal well.
- Third-degree tear – the tear extends into the anal sphincter, the muscle that surrounds the anus. It requires careful surgical repair to ensure proper healing and function.
- Fourth-degree tear – the most severe, this extends through the anal sphincter and into the mucous lining of the rectum. This requires surgical repair and can have complications like faecal incontinence if not properly managed.
What causes a perineal tear?
A perineal tear most commonly occurs during vaginal childbirth, though there are other potential causes and factors that can increase the risk of such tears.
- Size and position of the baby – delivering a large baby or a baby in an unfavourable position (such as “sunny-side up” or face-first) can increase the risk of tearing.
- Speed of delivery – a rapid or forceful delivery, especially during the second stage of labour when the mother is pushing, can lead to tears.
- First vaginal birth -women having their first vaginal delivery are more prone to experience a tear than those who have given birth vaginally before.
- Use of forceps or vacuum during delivery – instrumental deliveries can increase the risk of a perineal tear.
- Previous severe tear – women who have had a third or fourth-degree tear in a previous childbirth might have an increased risk of tearing in subsequent deliveries.
- Short perineal body – some women naturally have a shorter distance between the vaginal opening and the anus, which can increase the risk of tearing.
- Epidural anaesthesia – studies suggest that the use of epidural anaesthesia may be associated with an increased risk of severe perineal tears, possibly due to the reduced sensation and feedback during pushing, and the increased chances of forceps or a vacuum being required.
- Not having an episiotomy – an episiotomy is a surgical cut made in the perineum to enlarge the vaginal opening during childbirth. While once routine, it is now generally done to prevent a tear or to assist a difficult delivery. However, episiotomies themselves, especially if they have been performed negligently, can sometimes lead to more severe tearing.
Preventative measures, such as perineal massage, different maternal birthing positions, water births, and warm compresses, may reduce the risk of tearing for some women.
What is a Midwifery Expert Witness’s role in perineal tear injury medical negligence claims?
Expert midwifery evidence serves several crucial purposes in medical negligence claims. Firstly, a Midwifery Expert Witness can give an opinion on the standard of care provided. After examining the medical records and the Claimant, a Midwifery Expert Witness can attest as to whether correct protocols and best practices were followed during delivery, post-partum examination, and follow-up care. For instance, was the tear correctly classified? Was it properly sutured? Was the woman provided appropriate post-operative guidance?
A Midwifery Expert Witness can also set out how particular medical practices did or did not lead to complications or exacerbate the injury. For example, if a third-degree tear was misclassified as a second-degree tear and was thus not correctly repaired, it can lead to grave complications such as faecal incontinence. Expert testimony or an expert report can draw a clear line between the misclassification and the resulting issues and prognosis.
Perineal tears can have lasting consequences, affecting a woman’s physical health, sex life, and psychological well-being. A Midwifery Expert Witness can provide a future diagnosis which can cover the need for future medical interventions, potential for chronic pain or discomfort, and possible psychological repercussions. This evidence is often vital for determining the quantum of damages. In addition, a Midwifery Expert Witness can provide rehabilitative treatments or interventions, including physiotherapy, surgical interventions, or counselling, within their report.
Midwifery expert evidence plays a central role in perineal tear claims. The intricacies of childbirth, the intimate nature of the injuries, and the potential for life-altering consequences demand a meticulous, sensitive, and compassionate approach. A well-chosen expert not only helps establish the grounds for negligence (or defend such grounds) but also assists the Court with calculating a quantum of damages that will assist the Claimant with funding the rehabilitation she needs to recover.
How can Expert Court Reports Ltd help?
Expert Court Reports provides expert witnesses and medico-legal court reports for solicitors, barristers and other agencies, including the police, probation services, prisons, third-sector organisations, and private clients.