Childbirth Injuries To Mothers

Injuries to Mothers During the Course of Labour - Part 1

3rd & 4th Degree Perineal Tears / Episiotomies

When you hear about birth injuries in the news it is almost always in relation to the baby. Horrific stories of unnecessary harm to babies sometimes seem to fill the news pages and the sight of parents emerging from the Four Courts in the presence of their child, often severely disabled with cerebral palsy or similar brain injury having secured a multi-million euro care package seems to have become commonplace.

What often goes unmentioned however is the incidence of injury to mothers in the course of delivery.  Certainly in the experience of my practice, such injuries are much more common than injuries to babies and where they do occur, mothers seem slow or reluctant to query whether the injuries they suffered were unnecessary or may even constitute negligence giving rise to an entitlement to compensation.

While I can only speak from my experience in the matter, it does seem that mothers are often too accepting of injuries from the birth and fail to ask questions of their medical professionals as to why they have suffered such harm, perhaps arising from a desire not to appear ‘ungrateful’ following the safe birth of a much wanted and loved baby.

Over the coming months I will be writing a series of articles on this issue, with each piece focusing on a specific area of injury that in my experience have been an issue in several cases that we have worked on and which I must therefore assume are not uncommon injuries affecting mothers.  In each case I will illustrate the issue with an explanation of the issues we build successful cases around and usually how, through legal action, our client was able to access independent medical advice and care which had been denied to them through the very health service that had caused the injury through injury.

Episiotomy / Perineal Tear

We begin the series with the issue of episiotomy and perineal tears.  During labour, in the course of a vaginal delivery of a baby, the area between the vaginal opening and the anus can come under a lot of pressure, particularly if the baby is large or the advance of labour is poorly controlled. Like any tissue, there is a limit to which it can stretch before tearing.  An episiotomy is a surgical procedure to enlarge the size of the vaginal opening to relieve this pressure and prevent a tear occurring. It is not so long since such procedures were very frequent indeed, but today episiotomy is used less frequently and the focus is on minimizing tear, repairing a tear promptly or avoiding the risk of tear entirely in cases of larger babies by caesarian section delivery.

If an episiotomy is conducted correctly, it should prevent a tear occurring or limit its severity by directing the line of tear away from the sphincter muscles so vital to bowel and bladder control.

Following the delivery, an episiotomy incision should be repaired by suturing (stitching). Such an event, if repaired competently, is unlikely to result in medium to long-term consequences for the mother and there is unlikely to be any legal issue arising either. Where however the incision is not made correctly or a severe tear occurs (such as a 3rd or 4th degree tear affecting the sphincter and anus) and is not sutured or repaired competently and in a timely manner, very significant harm can occur including pain, infection, incontinence and nerve damage leading to either pain or loss of sensation, often affecting sexual function or enjoyment.

An episiotomy should not result in such serious consequences but sometimes an episiotomy will not prevent a further tear which may then damage some of the structures of the sphincter or anus which lead to these serious consequences.

Tears during childbirth are categorized as follows:

  • First-degree tears – small, skin-deep tears which usually heal naturally
  • Second-degree tears – deeper tears affecting the muscle of the perineum as well as the skin; these usually require stitches
  • A third-degree tear extending downwards from the vaginal wall and perineum to the anal sphincter, the muscle that controls the anus
  • A fourth-degree tear extending to the anus or rectum

Medical negligence occurs when the care received has fallen below an acceptable standard and a patient has suffered injury or harm as a result. Where negligence can be shown, the patient is entitled to redress which society tends to call ‘compensation’ - though in truth, a sum of money can never truly reflect the magnitude of the wrong done - which is why I prefer the term ‘redress’.  In a perineal tear injury case, negligence may be proven in examples such as where:

  • The tear has been allowed to run too far, interrupting or damaging the sphincter muscle surrounding the anus or damaging the area’s nerve supply.
  • The tear has not been identified correctly and as a result, the injury has not been repaired, either adequately or at all. Such injuries can often be repaired to great effect but this must be done before muscle wasting occurs and the damage becomes permanent. They must also be performed by a skilled surgeon expert in rectal surgery - this is unlikely to be the doctor who assisted in the delivery of the baby. 

The consequences of such injuries are often devastating. No painful or lifestyle-limiting injury can be borne lightly either by the sufferer or their immediate family members. While pain may or may not be a factor, it is typical that such person will have issues to one degree or another with incontinence and possibly pain. For a young mother to have to bear such a condition, resulting perhaps in a loss of self-confidence and a dread of going out in public is only made worse by the understanding that this outcome was not an unavoidable and unfortunate consequence of childbirth but an negligently inflicted injury.

Working with a team of caring consultant gynecologists in the UK, our firm has been able to not only achieve successful outcomes to litigation for women harmed in this way, but perhaps more importantly, open up a pathway to the best possible care and treatment through the litigation process.

In the next article we will examine cases arising from bowel / bladder perforations in the course of childbirth.

Cian O’Carroll Solicitors, A Medical Negligence & Personal Injury Law Firm. FREEPHONE 1-800 60 70 80 | WWW.TIPPLAW.COM

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