by Laura Craig, Associate
As a team we are frequently approached by mothers who have suffered a delay in diagnosis of vaginal tears following natural birth. The problems this can cause are wide ranging and can be devastating. They include loss of sensation, urinary and anal incontinence, sometimes resulting in the need for a permanent colostomy bag, painful sex and almost always a significant psychological element.
Women often find it too embarrassing to seek help, but early detection and the right treatment are vital to counter the long-term impact of a bad tear.
In many of our cases, it's apparent that risk factors and warning signs were not picked up by medical staff, including:
- Large, heavy baby
- Older mother
- Forceps delivery
- Failure to proceed with Caesarean section
- Failure to properly examine and identify tears after delivery
- Failing to repair tears in a surgical setting
- Symptoms of significant post-delivery pain being incorrectly attributed to a 'normal part of the post-birth experience'.
Where tears are correctly diagnosed and repaired at the time of birth, women can usually expect to make a good recovery, even where they have sustained the most serious third or fourth degree tears.
The BBC recently reported the story of two women who have suffered tear injuries, illustrating the devastation they cause.
Their stories are similar to that of one of my clients who sustained a third degree tear during the birth of her first daughter. Her tear went undiagnosed for 12 months.
She had a difficult labour, culminating in the use of forceps. Severe pain was the first symptom, and during the weeks following birth, instead of being able to enjoy her new baby, her symptoms worsened and she began to experience urgency when needing the toilet and an inability to control her bowels.
She returned to her GP twice, but was told it was simply part of the recovery from vaginal birth. Eventually, her tear was diagnosed, some 12 months after birth. Our investigations show that it should have been diagnosed and repaired immediately after birth.
My client has since undergone multiple repair surgeries which, sadly, have failed and she has now been fitted with a permanent colostomy bag. The delay in diagnosing and repairing her tear meant that she missed the crucial window in which to receive treatment and avoid long-term damage.
Had she known that this was a possible outcome of birth, she would not have accepted her GP's response and rather than giving up and trying to deal with the embarrassment of her symptoms alone, would have insisted on further investigation.
It is vital that both mothers and medical professionals are educated about tears and understand what to look out for so that repairs can be undertaken as early as possible and to avoid women hiding their symptoms through embarrassment.
The Royal College of Obstetricians and Gynaecologists has recently teamed up with the Royal College of Midwives to work on a joint project to improve care techniques in more than a dozen hospitals.
Hopefully, improved training and awareness will become mandatory across all medical services to ensure that these devastating outcomes are kept to a minimum.