There seem to be conflicting views as to the influence of an episiotomy during vaginal childbirth on the likelihood of the woman experiencing severe perineal trauma.
What is a severe tear?
Most women experience a tear to the perineum during vaginal childbirth. This is usually a small injury which will heal quickly but for approximately 5% of women giving birth, the injury can be severe.
A severe tear – referred to as third or fourth degree tears – causes damage from the vagina, across the perineum to include the anus. The injury may include only damage to the external anal sphincter muscle or continue to include the internal anal sphincter and the anal canal lining. Such injuries need skilled surgical repair and can, if undiagnosed or poorly treated, leave the woman with long-term anal problems.
What is an episiotomy?
An episiotomy is a deliberate cut to the perineum, made by the midwife or doctor during the second stage of labour. Its intention is to ease the passage of the baby out of the vagina.
However, there appears to be some difference of opinion as to whether this can reduce or increase the likelihood that the woman will then receive a severe perineal injury.
The impact of an episiotomy on perineal trauma
- There is some evidence that undergoing an episiotomy can increase the chances of experiencing a third or fourth degree tear
- However, it would also appear that having an instrumentally-assisted birth (i.e. with forceps or a ventouse) is more likely to cause a severe tear if an episiotomy has not been used
The Royal College of Obstetricians and Gynaecologists recommends that where an episiotomy seems necessary, such as when an instrumental delivery is required, the nature of the cut can significantly affect the outcome.
Their recommendation is that a mediolateral episiotomy should be used rather than a midline episiotomy. This should turn the direction of the cut away from the anus at an angle of 60 degrees from the midline, thereby reducing the chance that a tear will affect the anal muscles.
However, the RCOG further observes that an appropriate angle can be difficult to achieve.
An episiotomy does not guarantee that a severe tear will not occur and the woman will require a thorough examination after the birth for signs of anal damage. A failure to diagnose a severe tear, leading to on-going problems may be considered to be a substandard level of care.
If a severe tear is thought to have been caused by an inappropriate type of episiotomy, the medical professional may be considered to have acted negligently.
Speak to a solicitor
If you are suffering with the shocking long-term symptoms of a severe perineal injury due to a negligent episiotomy, contact us to discuss your situation with a specialist medical negligence solicitor. You may be entitled to make a claim for compensation.
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