Every year thousands of women give birth in the UK, however, sadly many women develop complications following birth including perineal and vaginal tears. Many of those suffering a tear go on to recover without incident; however there are a growing number of women who are not so fortunate.

The Royal College of Obstetricians and Gynaecologists (RCOG) have confirmed that the number of severe tears, have tripled between 2002 - 2012. They suggest that 6 out of every 100 women giving birth for the first time will experience a severe tear involving damage to the pelvic floor (which helps with bladder control) and/or the anal sphincter (which controls bowel movements).

Professor Michael Keighley, Consultant in Colorectal Surgery was so concerned about the number of severe tears being missed that in 2016 he set up the Mothers with Anal Sphincter Injuries in Childbirth Foundation (The Masic Foundation) to help prevent, identify and treat severe tears. If you would like further information about The Masic Foundation, or support please see: https://masic.org.uk/

There are various risk factors for severe tears including the average age of the mother giving birth, large babies, and gestational diabetes. Instrumental delivery (use of forceps or a ventouse cup) is also a known factor which increases the risk of suffering a tear to the anal sphincter. Alarmingly, the RCOG has confirmed that the use of forceps in the UK has doubled from 3.5% to 7% over the last five years. In contrast, in the US, Sweden, and Germany the use of forceps is just 1%.

The implications of a severe tear are significant and life changing. These include severe pain, hypersensitivity, difficulty sitting, damage to the anal sphincter leading to bowel incontinence, damage to the pelvic floor and bladder incontinence. In many cases treatment involves reconstructive surgery and in some cases the fitting of either a temporary or permanent ileostomy or colostomy bag.

Unsurprisingly the life changing symptoms of perineal and vaginal tears often result in a loss of self esteem, reduced sexual function, and potential for psychiatric harm including anxiety, depression and Post Traumatic Stress Disorder (PTSD). The physical and mental effects of a vaginal and/or perineal tear in turn often has a profound effect on relationships and the ability to work.

It is therefore hugely important that the risks and benefits of all methods of delivery (including those with increased risks of suffering a tear) are adequately explained to pregnant women. Pregnant women should be given this information when they have the ability to fully consider their options (not in an emergency situation when they have little choice), and consent should be taken by an appropriately trained medic and clearly noted within their records. Sadly this is often not the case. Maureen Treadwell, of the UK Birth Trauma Association confirms that many women who are more likely to tear are often not appropriately informed of their increased risks.

Professor Cameron of the RCOG maintains "Whether a baby should be delivered instrumentally is a matter of clinical judgment." However Professor Dietz, a world renowned Obstetrician based in Sydney Medical School argues that women have a right to be advised if they are at increased risks of an anal sphincter tear, that medics have a duty to inform women, and that women can then decide which risks they are willing to take.

The issue of taking proper consent during labour has recently been addressed in the cases of Montgomery, and successfully applied in the Court of Appeal case of Webster v Burton Hospitals NHS Foundation Trust (2017). Both cases show that medics have an obligation to advise patients of all material risks, and that once a patient has been duly informed they have the autonomy to make the ultimate choice about their own care.

If you are concerned about the care that you, or a family member received during or following labour, please contact Claire Cooper on 0845 274 6830 for a free discussion about your options.