A thorough examination of a woman’s perineum and anal region after the birth of a child is vital to ensure that she does not suffer a lifetime of unpleasant, debilitating and distressing symptoms.
The importance of a thorough perineal examination of a woman after she has given birth vaginally would appear to be widely agreed.
The guidelines of the National Institute for Health and Care Excellence (NICE) on caring for women and babies during childbirth, updated in February 2017, can be summarised as follows:
- Define perineal or genital trauma caused by tearing or episiotomy as 1st, 2nd, 3rd or 4th degree
- Before assessing for genital trauma, explain to the woman what is planned, offer pain-relief and ensure good lighting and position the woman so that her genital structures are clearly visible
- Perform the examination gently and with sensitivity
- If genital trauma is identified, offer further assessment including a rectal examination ‘to assess whether there has been any damage to the external or internal anal sphincter’
Royal College of Obstetricians and Gynaecologists
The RCOG Guidelines on Management of 3rd and 4th degree Perineal Tears states that ‘all women having a vaginal delivery are at risk of sustaining OASIs…They should therefore be examined systematically, including a digital rectal examination, to assess the severity of damage, particularly prior to suturing.’
Furthermore, in January 2107 the RCOG launched an OASI Care Bundle in collaboration with the Royal College of Midwives which stated that ‘a perineal examination, including a per rectum examination, (should be) carried out following all vaginal deliveries.’
The significance of a rectal examination
The above guidelines seem to leave no room for uncertainty. A rectal examination is necessary after every vaginal birth.
Without such an examination, it is possible that damage to the anus caused by the birth may be missed and this can cause the woman to become incontinent of both wind and faeces.
Severe tears are thought to affect approximately 5% of women giving birth vaginally. A severe tear is one which, in addition to tearing the perineum between the vagina and anus, also damages the muscles which control the emptying of the bowel and requires a skilled repair promptly after the birth.
If a tear is not diagnosed accurately, it is unlikely to be repaired effectively and long-term symptoms will probably develop.
If an inadequate examination after childbirth means that the woman’s perineal tear is not diagnosed leading to on-going problems, it may be considered that she has been treated negligently.
If you are suffering with the appalling long-term symptoms of a severe tear due to a failure to examine, you may wish to make a claim for compensation.
Contact us to discuss your experience with a specialist medical negligence solicitor.
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