Does an episiotomy prevent severe perineal trauma during childbirth or does it make it more likely?
Perineal tears and an episiotomy
A woman may suffer a tear to the area between her vagina and anus – and, if she is very unlucky, to the anus itself – naturally during vaginal childbirth. This is likely to be the product of the baby’s need to emerge from the vagina.
An episiotomy is a very different thing. An episiotomy is a surgical cut to the perineum made by one of the medical professional attending the birth in the belief that it may ease the baby’s birth or prevent severe damage to the mother.
There is some debate as to the impact of using an episiotomy and the current NICE Guidelines on care of the mother during childbirth states the following:
‘ Do not carry out a routine episiotomy during spontaneous vaginal childbirth.’
There is some concern that an episiotomy can contribute to the likelihood that the woman will experience a perineal injury.
Episiotomies and instrumental deliveries
However, in some circumstances, it is thought that an episiotomy may prevent a severe perineal tear (such as a third or fourth degree tear) from occurring. For example, if the medical professionals decide that the birth requires instrumental assistance such as a ventouse or forceps to help the baby emerge from the vagina, then, according to the Guidelines of the Royal College of Obstetricians and Gynaecologists, a mediolateral episiotomy should be performed.
Consequently, where an instrumental delivery is undertaken without an episiotomy having been previously carried out, the relevant medical professionals may be considered to have acted negligently. If the woman subsequently develops long-term complications of a severe tear, it may be appropriate to make a claim for compensation.
An accurate episiotomy
A poorly-executed episiotomy may increase the risk to the woman undergoing childbirth. A midline episiotomy is no longer recommended for use as it has been found to increase the chance of a severe perineal tear occurring. A mediolateral episiotomy is recommended which cuts away from the midline, thus reducing the threat of damage to the anus.
Where inappropriate use of an episiotomy, or a failure to use an episiotomy, is considered to have caused severe perineal trauma, it may be possible to make a claim for compensation.
Contact us to talk to a specialist medical negligence solicitor if you are suffering with the long-term impact of a 3rd or 4th degree tear due to a substandard level of medical care.
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