The Parliamentary inquiry into birth trauma, published on 13 May 2024, makes for disturbing, sometimes shocking reading. The All-Party Parliamentary Group on Birth Trauma received 1,300 written submissions. The stories shared were harrowing, and in many cases, the birth injuries experienced by women were caused by errors made before, during and after labour. Failures were often covered up by hospitals seeking to frustrate efforts by families to find answers. But most heart-wrenching are the accounts of women who were treated with an utter lack of compassion – being left on bloodstained sheets, calling for help and getting no answer, or being mocked when they voiced their concerns that something was wrong with them or their baby.
The inquiry and subsequent report were instigated by Theo Clarke, a Conservative MP and the daughter of a Baronet. We mentioned the latter because it shows that birth injuries and poor care can be suffered by any woman, regardless of socio-economic position. Ms Clarke led the first Parliamentary debate on birth trauma and chaired the inquiry.
Regarding birth injuries, the inquiry focused on perineal tearing, also known as obstetric anal sphincter injuries (OASI). Perineal tearing during childbirth refers to the lacerations that can occur in the perineum, the area between the vaginal opening and the anus, as the baby passes through the birth canal. These tears are common and vary in severity. They are classified into four degrees, with first-degree tears involving only the skin and second-degree tears also affecting the muscles. Third-degree tears extend into the muscle that surrounds the anus, while fourth-degree tears reach the rectum, causing more significant complications. The report found that long-term complications can result in women needing medical treatment years later. Professor Mike Keighley, a colorectal surgeon, told the inquiry that he and his colleagues saw a high referral rate in women aged 50-60, “in whom incontinence or prolapse had either emerged for the first time or has become worse, all due to an injury during childbirth that becomes unmanageable in later life.”
Vaginal birth and instrumental (assisted) birth are the two most significant risk factors for perineal tears. The inquiry found:
“…amongst first-time mothers giving birth instrumentally, 7.5% experience a severe tear, compared with 1.6% of those who have a spontaneous, non-instrumental vaginal birth, and have given birth before. The risk of OASI is nearly six times higher with forceps, and three times higher with Ventouse, than with spontaneous vaginal delivery.”
Other risk factors for severe perineal tears include:
• Prolonged second stage of labour (pushing)
• The baby is positioned back-to-back.
• Baby’s birthweight is greater than 4kg.
• The mother is over 35.
• The mother is of South Asian ethnicity.
• A fast birth.
• Shoulder dystocia (the baby’s shoulder gets stuck behind the pubic bone).
• The mother is short.
Medical negligence can significantly contribute to third and fourth-degree perineal tearing during childbirth, leading to severe physical and emotional consequences for the mother.
One common way medical negligence can result in a severe perineal tear is the failure to perform an episiotomy, a surgical cut made at the vaginal opening to prevent severe tearing when clearly indicated. Inadequate monitoring of the baby’s size and position or a failure to identify and manage complications like shoulder dystocia can also increase the risk of extensive perineal damage.
Misusing delivery instruments such as forceps or vacuum extractors is another critical factor. If not used correctly, these tools can cause excessive stretching and tearing of the perineal tissue. Additionally, poor communication and lack of coordination among the medical team can delay essential interventions, exacerbating the risk of severe tears.
The most recent available figures suggest that 3.1% of all vaginal births result in perineal tearing. The inquiry concluded that this figure is likely to be underestimated because so many tears are missed. One study cited by the inquiry estimated around 10 per cent of all women who give birth vaginally suffered tearing.
If an OASI is diagnosed and repaired shortly after birth, women can make a full recovery. However, Professor Keighley told the inquiry he had seen more than 200 women with third- or fourth-degree tears, and in 60% of cases, the tear had been missed when the baby was born. In some cases, the missed tear will be a result of medical negligence and the patient needs to contact a Birth Injury Solicitor to discuss making a compensation claim.
The inquiry also found that many perineal tears were misdiagnosed (for example, it was ruled to be a second-degree tear when it was in fact a third or fourth-degree tear). Not only did this lead to long-term problems, but many women also struggled to access support. The inquiry heard from one woman who:
“… described in a written submission how her fourth-degree tear was misdiagnosed by a midwife as a second-degree tear and repaired accordingly. Her later bowel incontinence was then wrongly diagnosed as irritable bowel syndrome, while a consultant at the hospital where she gave birth told her simply that her symptoms were the result of being “psychologically traumatised”. Over the course of 21 years she had 18 surgical procedures, the last being a colostomy in 2019.”
If you or your baby have suffered a birth injury through negligent care, you are far from alone. What matters now is you get the support you need to make a compensation claim so you can fund the rehabilitation and care you and/or your child needs. In addition, bringing a compensation claim can get you answers as to what caused you or your baby’s injuries and/or an apology from the NHS Trust concerned.
Our team has decades of combined experience in successfully advising and representing clients in birth injury claims. We are sympathetic, understanding, and are here to help you every step of the way.
Call us on 01 625 667166 today to discuss your claim.
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