Perineal Tear case settles for 6-figure sum

Jodi Newton

Stephanie Prior recently settled a claim relating to a woman who delivered her baby after a traumatic labour. Her son suffered a hypoxic brain injury and was transferred to another hospital shortly after birth for cooling therapy. Fortunately, his development was fine and he was a very active and happy baby and has fully recovered. Unfortunately, the client sustained a third-degree tear and suffered a significant physical injury. She also suffered an ongoing psychiatric injury and she was examined by an experienced perinatal consultant psychiatrist, the diagnosis and treatment plan that the psychiatrist recommended led to the client exploring treatment options and assisted with her recovery.

The birth injury case settled for a six-figure sum and the litigation process was cathartic for the client and enabled her to move forward and consider thinking about having a second child, which is something that she was adamant that she did not want to do when she first instructed Stephanie Prior.

We are often approached by families who have been through a difficult childbirth, either causing their children significant injuries or when they have sadly lost a child. Even in cases where the child is healthy, women approach us to assist with injuries they have sustained which can have a long-term effect on their physical health.

A common example of this is perineal tears. The Royal College of Obstetricians and Gynaecologists estimate that up to 9 out of 10 first-time mothers who have a vaginal birth will experience some tear, graze or episiotomy. A perineal tear is a tear to the perineum, which sits between the vagina and the anus. A minor tear is common and will usually heal quickly whilst a more severe tear may take longer.

Certain factors can increase the risk of having a perineal tear, although these are often unavoidable. This can include: having a large baby (over 4kg), induction, the use of forceps or ventouse during childbirth, pushing for a long term, shoulder dystocia or an episiotomy.

There are 4 degrees of perineal tears:

1st-degree perineal tear

A tear of the skin of the perineum and back of the vaginal mucosa. These are often smaller and do not need stitches; they will likely heal naturally.

2nd-degree perineal tear

A tear to the skin, back of the vagina and muscles of the perineum which requires stitches.

3rd-degree perineal tear

Involvesthe skin, back of the vagina and muscles of the perineum being torn, extending to the anal sphincter. Stitches will be needed.

4th-degree perineal tear

Similar to the 3rd-degree tear, it will also extend to the rectum. Stitches will need to be closed, and for third and fourth-degree tears, this will often be done under local or general anaesthetic in an operating theatre.

When evaluating whether your tear is the cause of medical negligence, the crucial factor will be the adequate diagnosis and repair of the tear. If the repair is performed with reasonable care, and no defects present, then there will most likely not be cause for clinical negligence. Repairing a third, or fourth, degree tear requires specialist training, which most SHOs will not have undergone. A repair should therefore be directly supervised by an ST6 doctor (a doctor in speciality training years 6 and 7) and should take place in an operating theatre.

If you have suffered a third- or fourth-degree tear, you should be given a course of 5-7 days of antibiotics and pain relief.

If you have been affected by a failure to diagnose or repair a tear during pregnancy, please contact Stephanie Prior, a Partner in our Clinical Negligence team who specialises in birth injuries and is a leading practitioner in this area.