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Maternal birth injuries - what are they and what are the implications of this type of injury?

Medical negligence solicitor Claire White discusses the topic of maternal birth injuries during birth trauma awareness week

Exhausted new mother
Claire is a medical negligence solicitor based in Leigh Day's Manchester office.  You can follow Claire on twitter on @clairewhite336
Sadly we are seeing an increasing number of maternal birth injuries in the clinical negligence team at Leigh Day. Many of our clients who have these injuries are unaware of the severity of their injury, or that they have suffered an injury at all at the time of their discharge from hospital. Often their baby is born safe and well, but if the mother’s perineal tear is not identified and treated swiftly after delivery, then this can lead to long term problems for the mother which can last for many years to come.   

The Royal College of Obstetricians and Gynaecologists estimates that over 85% of women who have a vaginal birth will suffer some degree of perineal trauma and of these 60 – 70% will require suturing. 

Classification of injury  

The following classification has been adopted by the International Consultation on Incontinence and the Royal College of Obstetricians and Gynaecologists: 
  • First degree tear: Injury to the perineal skin and/or vaginal mucosa
  • Second degree tear: Injury to perineum involving perineal muscles but not involving the anal sphincter 
  • Third degree tear: Injury to perineum involving the anal sphincter complex: 
    • Grade 3a tear: Less than 50% of the external anal sphincter (EAS) thickness torn. 
    • Grade 3b tear: more than 50% of EAS thickness torn. 
    • Grade 3c tear: Both EAS and internal anal sphincter (IAS) torn.
  • Fourth degree tear: Injury to perineum involving the anal sphincter complex (EAS and IAS) and anorectal mucosa. 

The term “obstetric anal sphincter injury” is used to refer to both third and fourth degree tears. 

Symptoms 

Women who suffer from perineal tears can experience symptoms of incontinence to faeces and flatus (wind). These symptoms can last for the rest of the woman’s life and often cause serious embarrassment in work and social settings. Often women who have suffered from these symptoms develop problems such as anxiety disorders, depression, difficulty bonding with their child and even Post Traumatic Stress Disorder. 

In terms of the physical symptoms, sometimes surgery can help, but this is often a serious operation which may also require the woman to have a temporary colostomy for a period of time before the surgery can be completed. Unsurprisingly this is something that new mums with a baby to care for sometimes opt against. 

With other types of tear, such as those involving a tear of the rectal mucosa but with no damage to the anal sphincter complex (known as rectal button hole tears), revision surgery can be carried out by way of specialist skin graft, although this surgery can cure symptoms, it can also create anatomical abnormalities which many women find very distressing. 

Some individuals also find that specialist physiotherapy aimed at targeting and exercising the muscles affected can help ameliorate symptoms. It is important to ensure that a specialist physiotherapist is sought and there are several such therapists listed on the website of the birth trauma association 

In relation to the psychological symptoms, there are different types of treatment that can assist the individual with properly processing the trauma of what has happened to them. For many people this is linked to a feeling of being let down and/or unable to trust medical professionals in future. Treatments include Cognitive Behavioural Therapy (CBT) and Eye Movement Desensitisation Reprocessing Therapy. Many clients who begin psychological treatment report that they wished they had start this sooner due to its beneficial effect. 

Details of reputable therapists can be found at the British Association for Counselling & Psychotherapy  and EMDR UK & IRELAND.   

The symptoms of these injuries can also have a devastating effect on the individual’s relationship with their partner and family life in general. Sexual function, anger, irritability, and social anxiety can all be affected. This aspect of the consequences of maternal birth injury is being increasingly addressed now, and organisations such as the birth trauma association  have website sections dedicated to supporting fathers, partners and family. 

Maternal birth injures can occur as a consequence of childbirth without there having been negligence. However, medical professionals in obstetrics are trained to check carefully for these types of injuries after the delivery and to carry out the appropriate repair as soon as possible. If there has been a tear that was not recognised and repaired at the time of delivery, then the individual affected may be able to claim compensation due to the ongoing symptoms caused as a result of the tear. 

The more open and transparent we are in our conversations regarding maternal birth injury, the more new mums will know what to look out for and understand the importance of seeking help and advice as soon as possible. 

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