We acted for a 26-year-old woman from regional NSW who sustained severe physical and psychological injuries during the traumatic birth of her first child.
Our client’s injuries included – a fourth-degree tear, urinary and faecal incontinence, and psychological injuries. Fourth degree perineal tears extend from the vagina through to the anal sphincter.
The client was admitted to the local regional hospital at 41+ weeks gestation. Her membranes had spontaneously ruptured at home following an uneventful pregnancy. She was commenced on intravenous Syntocinon to assist labour.
The client laboured for about 8.5 hours until she was fully dilated at 10 cm. She was then encouraged to start actively pushing about 45 minutes after she was found to be fully dilated.
After actively pushing for about 80 minutes, the client developed amongst other things an extremely swollen vulva – described as an “oedematous perineum”.
There was focus during the matter on the length of the second stage of labour. In this case, second stage had a duration of more than three hours – for first time mothers (subject to other factors) second stage labour is usually 1 to three hours.
The baby was delivered by forceps 20 hours after presenting at the Hospital. There was no attempt to deliver the baby by vacuum and our client was not offered a caesarean section despite her obvious maternal exhaustion. Her extensive perineal injury required surgical repair.
In investigating the matter, we sought opinions from an obstetrician/urogynaecologist, a colorectal surgeon, and a psychiatrist to assess our client’s mental state due to the traumatic birth.
In regard to second stage, the independent obstetrician/urogynaecologist – whilst critical of the 3+ hours duration – noted there to have been a shift in the past 20 years with increased tolerance of longer second stage. He attributed this to a move to limit the incidence of caesarean sections. In this case, the consequence of the lengthy second stage had resulted in major maternal birth trauma due to increasing oedema within the perineum. The independent expert felt that competent practice dictated our client being offered a caesarean section at an earlier time during second stage. His opinion was that earlier delivery by vacuum extraction – as opposed to forceps – would have avoided the client’s symptoms of urinary and faecal incontinence.
A colorectal surgeon was also engaged, and he agreed with the views of the obstetrician/urogynaecologist – that the clients ongoing faecal incontinence was caused by the fourth-degree tear.
An independent psychiatrist assessed the client finding her to have a major depressive disorder primarily as a result of the faecal incontinence.
This matter was resolved at mediation with our client receiving substantial compensation for her injuries.
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