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Training and awareness of perineal injuries during childbirth is vital to reduce problems after childbirth


    A study by specialist Consultant Obstetrician, Mr Abdul Sultan, revealed that early diagnosis and repair of perineal injuries suffered during childbirth resulted in less problems after childbirth and much better long term outcome for mothers.

    By Hannah Blackwell

Specialist consultant Abdul Sultan recently did a review of cases following an earlier study into the treatment of perineal injuries (vaginal and anal tears during childbirth). He reviewed the success rate for women who underwent surgery to repair severe perineal tears immediately after childbirth, and those who received treatment after some period of delay. This revealed that immediate diagnosis and repair resulted in a much better long term result than women whose tears were not identified at all or in full until some time later.

It is a recognised risk that women can suffer perineal injuries when delivering their babies. Women who are first time mothers, giving birth to large babies or who have suffered a tear during a previous delivery are at more risk. The risks are also increased where the delivery requires some instrumental intervention, such as forceps.

Outcome of delayed diagnosis of tear

Where the midwives or obstetricians fail to diagnose the tear or under-estimate the true extent of the injury, delayed secondary repairs have been shown to provide significantly less good results for mothers, who can be left with long term physical and psychological injuries as a result. Problems after childbirth can include incontinence and psychological harm such as loss of confidence and libido.

The results of the recent review are straightforward: appropriate and immediate treatment limits the long term consequences of a severe perineal tear.

As clinical negligence lawyers it is our experience that injuries to mothers during childbirth cannot always be avoided. As such the occurrence of an injury is not automatically cause for a complaint about the treatment provided, however (1) the failure to recognise that an injury is very likely to occur so that the birth is properly managed to avoid tearing, or (2) failing to recognise that an injury has occurred at all or (3) under-estimating the full extent of an injury or (4) not acting quickly to repair an injury may all amount to negligent treatment and give rise to a claim for compensation for the injury suffered.

How to limit long-term damage

Guidelines produced by the Royal College of Gynaecologists and Obstetricians suggest that whenever there are risks that an injury has occurred, the mother should be “systematically examined” following the delivery to ensure any injury is diagnosed, understood and effectively treated.

It is clear that it is critical for healthcare providers to maintain focus on training and awareness of perineal injuries among midwives and obstetricians to improve outcomes for mothers and reduce long-term injury, and to limit complaint about treatment and medical negligence claims.

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