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Are 3rd Degree Perineal Lacerations Or 4th Degree Vaginal Tears During Pushing, Birth And Delivery Due To Medical Negligence?

by The Beasley Firm  |  July 25, 2012  |  

Vaginal tears or perineal lacerations during birth can occur in the absence of any medical negligence. As a baby’s head is being delivered, a mother can experience a rip or tear in the tissue that is in between the vagina and anus (perineum). Some of the possible causes of a perineal laceration are:

  • A first vaginal delivery
  • A large or big baby
  • If you had a previous 3rd or 4th degree laceration
  • If the baby if face up or posterior position during delivery
  • If you had a previous episiotomy
  • Prolonged pushing
  • Use of forceps during delivery
  • A very fast delivery
  • If the distance between the vaginal opening and anus is shorter than average

Although minor tears occur in approximately 90 % of women in labor, 4% of women during a vaginal birth suffer deeper tears that are referred to as third and fourth degree tears. If a third or fourth degree tear is not properly diagnosed and treated appropriately, it can cause significant and life long vaginal, rectal or intestinal problems for the mother.

Perineal tears have four levels of severity and are classified according to the amount of skin, tissue or muscle damage:

  • 1st degree tear is a small tear of the perineum at the base of the vaginal opening. It usually involves just the top layer of skin and may or may not require stitches or sutures to repair it.
  • 2nd degree tear involves the skin around the vagina, underlying tissue and the pelvic floor muscles. Second degree tears are the same depth as an episiotomy and will require a few stitches to reinforce and reattach the pelvic floor muscles.
  • 3rd degree tear extends through the vaginal skin, underlying tissues, pelvic floor muscles and to the edge of the anus or rectum.
  • 4th degree tear is the same as a third degree tear but it extends completely through the anus or anal sphincter muscle.

Both 3rd degree and 4th degree lacerations must be correctly identified and properly repaired by an experienced obstetrician or health care provider. According to certain state laws, nurse practitioners or nurse midwives may not be permitted to repair 3rd or 4th degree lacerations without the assistance of a more experienced doctor or physician. Unfortunately, some 3rd or 4th degree lacerations are incorrectly diagnosed as 2nd degree lacerations so the repair of the tear is improper or insufficient leading to additional problems for the mother.

If a perineal tear is not properly diagnosed and treated it could lead to chronic pelvic pain, urinary incontinence, fecal or stool incontinence, dyspareunia or painful intercourse or a recto-vaginal fistula where there is a passageway from the intestine into the vagina. The symptoms of a recto-vaginal fistula may include:

  • Foul smelling vaginal discharge
  • Air coming out of the vagina
  • Frequent vaginal infections or vaginitis
  • Chronic or recurring cystitis
  • Stool or feces coming out of the vagina
  • Fecal or bowel incontinence

Women who developed 3rd or 4th degree lacerations during vaginal childbirth or who have had improper repairs of the tears can be faced with additional surgeries to correct the ongoing problems. If you developed a 3rd or 4th degree perineal tear during delivery and are now having fecal incontinence or developed a recto-vaginal fistula, you may be eligible for compensation. Please feel free to contact one of our experienced obstetrical malpractice team members for a strictly confidential and free consultation.

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