Injuries to mothers during childbirth

The clinical negligence department at law firm Leigh Day & Co has represented a number of women who have suffered from injuries during childbirth which have resulted in psychological as well as physical damage such as perineal tears.

Whilst their babies have been delivered safely they have been left with problems that can last for years. Often such women are unwilling to undertake further pregnancies because of their experiences.  Women are often reluctant to approach their GPs about such intimate injuries, just talking about their experiences can be extremely embarrassing for them. Maternal injuries are sometimes unrecognised or negligently misdiagnosed and wrongly treated and it is possible for women in such cases to be awarded compensation.

Perineal tears

The Royal College of Obstetricians and Gynaecologists estimate that over 85% of women who have a vaginal birth will suffer some degree of perineal trauma and of these 60-70% will need suturing.  Perineal trauma affects women's physical, psychological and social well-being and can disrupt breast-feeding, family life and sexual relations.  It is vital for women's future well-being that injuries to the perineum are correctly identified as quickly as possible and that expert advice is sought by midwives and doctors attending deliveries.

Perineal tears can vary in severity and are classified as first, second, third and fourth degree tears.  A first degree tear can usually be repaired by suturing and long-term problems are rare.  Third,or forth degree tears can extend to the anal sphincter, and are likely to need specialist treatment.  In the most severe cases the anal canal is opened and the tear can spread to the rectum.

What does this mean for the mother?

Symptoms following perineal tears can include severe pain, incontinence of flatus (wind) and solid stool and agonisingly painful sexual intercourse.  For some women these symptoms can last for years.

Perineal tears may occur quite naturally, as a consequence of childbirth, not all tears (or treatment for them) will result in a claim. The following cases which the clinical negligence department has handled illustrate ones that did.

Case 1

Sally Jean Nicholes, partner in the clinical negligence department, recently acted for a woman who sustained a 3rd degree perineal tear during vaginal delivery of her first child at a UK teaching hospital. The tear was misdiagnosed and repaired as a superficial tear, leaving the anal sphincter damaged. 

Afterwards her symptoms including incontinent of faeces and flatus were such that she sought advice and the misdiagnosis was confirmed. However, the misdiagnosis and inadequate repair meant that the best opportunity to achieve a satisfactory repair was lost. She was advised that an operation to repair the sphincter was possible but that she should postpone this until she had completed her family. She was also advised that the delivery of any further children should be by caesarean section, with a slower recovery period and associated physical limitations.

She adapted her daily routine to manage her symptoms, nevertheless they had a profound effect on her working and family life; the symptoms were deeply embarrassing, humiliating and deprofessionalising.  She was unable to return to work as she had planned being forced to take twice as much maternity leave. Having returned to work she had to reduce her workload as she was unable to cope. She was forced to give up many of her regular activities.  Unsurprisingly these factors combined to cause her extremely low self-esteem and self worth.

The Defendant admitted that the treatment she had received was negligent but denied that it had caused her symptoms because, they argued, the outcome may not have been improved even if an immediate repair had been carried out. Expert evidence obtained concluded that her symptoms would be improved following reconstructive surgery to her sphincter. 

The claim was settled by negotiation shortly before trial and substantial damages were awarded.

Case 2
 

Olive Lewin, partner in the clinical negligence department has acted for a woman who received compensation from a West London hospital after the tear she sustained during the delivery of her first child was misdiagnosed. Following the birth of her baby, the woman concerned was told that she had suffered a second-degree tear and that this would require suturing.

The woman was allowed to go home the following day, but a week later she began to pass stools through her vagina. The lady was seen by a consultant gynaecologist, who diagnosed a third degree tear from her vagina to her anus. She was referred to a colorectal surgeon and underwent numerous operations for bowel surgery and vaginal reconstruction. She suffered severe depression and required counselling.  The hospital admitted liability and the case was settled for a significant sum.

Case 3
 

Partner Frances Swaine and solicitor Maria Panteli of the clinical negligence and human rights departments acted for a woman who received compensation as a result of a third degree tear sustained during the delivery of her first child which was not diagnosed.

The woman had opted to have her baby at The Birth Centre, which is based in South West London and has many celebrity clients.  The Birth Centre is run by independent midwives under the direction of Caroline Flint.  The woman was reassured that the Birth Centre backed on to St. George’s Hospital, which meant that assistance would be at hand in the event of problems during the delivery. 

During the vaginal delivery, the woman sustained a third degree tear but she was told that she just had a small perineal tear and that this would heal naturally over the coming weeks.  Over the next few months, during the regular home visits from the midwives, she was reassured that the perineal tear was healing.  However, the woman gradually became aware that she was incontinent of faeces and flatus.  She had to undergo an anal sphincter repair, a vaginal reconstruction and an ileostomy, which the woman found very traumatic and humiliating.  The woman still suffers from poor control of flatus, the occasional passage of faeces into the vagina and problems with anal hygiene resulting in anal irritation.  She also suffers from difficulty with rectal evacuation and frequently needs to go back to the toilet because of incomplete rectal evacuation.  Her physical injury caused her to suffer a prolonged depressive reaction as a direct result of the events surrounding the birth of her first child and had a detrimental impact on her self-esteem and her relationship with her husband. 

The expert obstetrician and gynaecologist instructed by us confirmed that had a proper examination been performed by the midwife following the delivery, the third degree tear would have been identified and an experienced obstetric opinion would have been sought.  Had the third degree tear been properly repaired at the time, our client would not have suffered the terrible symptoms that she did.  Any further pregnancies will have to be delivered by caesarean section.

If you have been affected by any of these issues please contact the clinical negligence department at law firm Leigh Day & Co on 020 7650 1200.

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