Perineal trauma: A women's health and wellbeing issue

It is well recognised that perineal and vaginal injury during childbirth affects between 75-85% of women (Smith et al, 2013; Royal College of Obstetricians and Gynaecologists (RCOG),2015; Australian Commission on Safety and Quality in Health Care (ACSQHC), 2017). The injury occurs spontaneously or deliberately, as a result of an episiotomy (Steen and Cummins, 2016a). Perineal tears are classified from first to fourth degree, depending on the anatomical structures involved in the tissue damage (RCOG, 2015; ACSQHC, 2017). Incorrect identification of the severity of perineal trauma and missed third degree tears can have devastating long-term consequences for women as well as clinical and legal implications (Lone et al, 2012). The NHS Litigation Authority report Ten Years of Maternity Claims (2012) identified perineal trauma as the fourth main cause for a woman to make an obstetric claim and £3.1 billion were awarded in legal damages. Interestingly, women made successful claims for varying degrees of perineal, episiotomy and labial injuries. Therefore, all aspects of perineal trauma need to be taken into consideration when providing perineal care, as substandard care can lead to negligence and substantial litigation costs.