Tearing during childbirth

Women need to be better informed about their birth choices

Around one in eight births in the UK is what’s referred to as an ‘assisted delivery’, meaning that the baby is delivered using forceps or a ventouse, a vacuum pump.

According to recent research reported by the BBC, women are twice as likely to suffer severe tears and serious blood loss during childbirth in some hospitals.

There are four degrees of tears that can happen during birth, with the fourth being the most serious. These can lead to pelvic floor dysfunction and prolapse, bowel incontinence and interfere with sexual intercourse. Whilst third and fourth-degree tears occur in roughly one in 30 vaginal births, in some units in 2015-16 it was one in 15.

Haemorrhage is a major cause of illness in women who have given birth, occurring in about one in 40 women, in some maternity units, the rate rose to be as high as one in 20.
 

Making the right decision for mother and child

These figures highlight the need for women to be provided with better guidance and information concerning the risks associated with a delivery by forceps or ventouse, and given the choice of having a caesarean section. Whilst a caesarean birth also presents risks to mother and child, these need to be weighed up against the possible hazards of a fourth-degree tear.

Research has shown that the rate of severe birth trauma was five to ten times higher where forceps or vacuum was used, compared with caesarean births. Mothers suffered severe tearing in 19 per cent of forceps cases, 12 per cent of vacuum births, and 20 per cent where both techniques were used.

The World Health Organisation has suggested that hospitals should aim to have a caesarean rate of less than 10 to 15 per cent, however in most NHS hospitals, the rate is closer to 20 per cent.
 

The need for further investigation highlighted

The National Maternity and Perinatal Audit’s report concluded that the difference in reported rates could be due to the risk profile of women being seen in these units, awareness of the problems among doctors, and reporting standards. The Royal College of Obstetricians and Gynaecologists commented that all unexplained variations required further investigation, saying: “We urge all maternity units to examine their own results and those of their neighbours, both to identify role models and to drive quality improvement locally”.
 

Our view

We believe that women who are facing delivery by forceps or vacuum should be afforded the same standard of consent as women who consent to a caesarean delivery. These choices should take place as early as possible, ideally when women are considering their birth plans, not when they go into labour. There’s an urgent need for doctors to better identify women who may need an assisted delivery, and to ensure that these mothers have the risks of the available procedures clearly explained to them.

We have seen several cases where women have suffered life-changing injuries because of third and fourthdegree tears. We recently settled liability in a case involving a braindamaged child suffering from autism as a result of a fractured skull, caused by the mishandling of forceps.
 

Here to help

Our Medical Negligence team are on hand to talk about your clients’ healthcare issues and answer any questions they may have. To arrange a confidential discussion please call us on 0203 871 9258, or email medneg@attwaters.co.uk.