A 3rd degree tear cannot be avoided, although its occurrence can in part be caused by the actions of medical practitioners.
3rd degree tear
A 3rd degree tear is an injury involving the perineum and anal sphincter. It occurs when a baby’s head and shoulders pass through the vagina during childbirth, causing the tissue to rip. It does not affect every woman who had a vaginal delivery, with most hospital Trusts estimating that around 2% of patients will sustain such an injury.
Avoiding a 3rd degree tear
Although the risk of a 3rd degree tear is small, it is understandable that expecting mothers will want to know whether it can be avoided.
Unfortunately a 3rd degree tear cannot be avoided and it is natural risk of childbirth. There are certain factors which will increase the risk, but most of these cannot be controlled as it depends upon the mother, the baby and how the birth proceeds.
For example, the risk of a 3rd degree tear will be increased with:
- An epidural
- A first time vaginal delivery
- A forceps delivery
- A larger than average baby
- Birth complications such as shoulder dystocia
These factors cannot necessarily be regulated. For example, if the birth needs to be accelerated due to foetal distress, an assisted delivery (such as a forceps delivery) will be required, even though this is known to increase the risk of a 3rd degree tear.
Therefore in the majority of cases, a third degree tear cannot be avoided.
3rd degree tear and medical error
However, there are a small number of cases in which medical error will have materially contributed towards the 3rd degree tear.
For instance, if a patient undergoes a midline episiotomy and she suffers a 3rd degree tear, it could be argued that the tear was in part caused by medical error. This is because midline episiotomies are no longer permitted in the UK as they are proven to increase the risk of a tear. Instead medio-lateral episiotomies should be performed.
Furthermore, if a patient’s 3rd degree tear is not diagnosed and repaired, she will have been the victim of medical error. All perineal injuries should be identified and treated accordingly immediately after the birth. A failure to do so will represent a breach of duty.
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