There’s a particular kind of silence that follows a severe perineal tear.
You were told, somewhere in the blur of the first few hours, that you’d had “a bit of a tear” and that it had been stitched up. Maybe someone used the words “third degree” or “fourth degree.” Maybe nobody explained what that meant. You went home with a newborn, a body that didn’t feel like yours, and a vague sense that you should be grateful everything turned out fine.
And then the weeks went on. The pain didn’t settle the way you were told it would. Sitting was hard. Going to the toilet was frightening. You couldn’t hold onto wind. Sex was painful, or impossible. And when you raised it, you were told it was early days, that things take time, that this is just what childbirth does to a body.
If any of that sounds familiar, this article is for you. Not to push you anywhere — just to give you information you should have had a long time ago.
What the degrees actually mean
Perineal tears are graded by how deep they go.
- First degree — the skin only.
- Second degree — skin and the muscle underneath.
- Third degree — the tear extends into the muscle that controls your bowel (the anal sphincter).
- Fourth degree — the tear goes through the sphincter and into the lining of the bowel itself.
Third and fourth degree tears are grouped together under the term OASI — obstetric anal sphincter injury. They are not rare. The Royal College of Obstetricians and Gynaecologists has reported that around 6 in 100 first-time mothers having a vaginal birth sustain one, and that studies using specialised ultrasound have found sphincter damage in a much higher proportion of women again — damage that was never picked up at the time.
Read that last part twice. A meaningful number of women are living with a sphincter injury that nobody diagnosed.
An injury happening is not, by itself, negligence
This is the part we want to be straight with you about, because it matters.
Severe tears can and do happen even when everyone involved does their job properly. Birth carries risk. A tear on its own doesn’t mean someone was negligent, and no honest lawyer would tell you otherwise.
What can give rise to a legal claim is something different: a failure in the care around the injury. In our experience, and in the cases that come to us, the recurring themes are these.
The injury wasn’t identified. The RCOG has specifically noted that the majority of litigation involving sphincter injuries relates to a failure to identify the injury after delivery — leading to incontinence and, in some cases, a fistula that then requires major surgery. A tear that is found immediately can be repaired properly. A tear that is missed becomes a much bigger problem.
The repair failed and nobody acted. We have acted for women whose repair broke down within weeks, requiring a second operation by a colorectal surgeon, after being reassured they would have “no problems.”
Known risk factors weren’t taken into account. In one matter we’re familiar with, a woman had undergone a rectal procedure about a year before giving birth. Scar tissue from that procedure contributed to a fourth degree tear during a forceps delivery. Her obstetrician had never taken a proper history and didn’t know about it. Had he known, the risks of a vaginal birth — and the option of a planned caesarean — should have been discussed with her before she went into labour.
The instrument or the technique. In another matter, expert evidence established that an episiotomy had been cut at the wrong angle — too straight — which allowed the tear to extend into the anus. That’s not bad luck. That’s a technical failure that a careful expert was able to identify.
Nobody listened afterwards. Pain, discharge, incontinence, a feeling that something was wrong — reported repeatedly, and repeatedly dismissed. Delay in diagnosis is its own injury.
The part people don’t talk about
The physical consequences of a severe tear are hard enough. The rest of it is often harder.
Women tell us about the wind they can’t control at work, and the constant low-level fear of it. About wearing a pad years after the birth because a cough or a sneeze isn’t safe. About a relationship that ended because intimacy became impossible and no one would name what was actually happening. About being told by a health professional that if they made a complaint, no one would want to treat them.
None of that is an overreaction. Anxiety, depression, adjustment disorder and post-traumatic symptoms are recognised, compensable injuries when they flow from negligent care. They are not a separate, less serious category of harm.
“But it was years ago”
Time limits do apply. In general, a claim for personal injury must be commenced within three years of the date the claim becomes discoverable — broadly, when you knew or ought to have known that you’d been injured, that the injury was serious, and that it was caused by someone else’s conduct.
The important point is that this is not automatically the date of the birth. Where an injury was never identified, or where the connection between your symptoms and what happened during your care only became clear much later, the discoverability date can be considerably later than you’d expect. It’s a question of law and fact, and it differs from case to case.
So if you’ve been assuming the door closed years ago — it may not have. That’s worth checking rather than guessing.
What a conversation actually looks like
You don’t need your medical records. You don’t need to know whether what happened was negligent — working that out is our job, with the help of obstetric and colorectal experts we’ve worked alongside for decades. You don’t need to have decided anything.
You just need to be willing to describe what happened and what your life has looked like since.
Birth Injury Lawyers is led by Anthony Porthouse, an Accredited Specialist in Personal Injury Law with 36 years’ experience in medical negligence, listed in Doyle’s Guide as a leading medical negligence lawyer in NSW. We act on a no win, no fee basis, and we agree a clear fixed fee for each stage of your matter before that stage begins — so you always know where you stand.
We’ll also be honest with you about the other side of it. Medical negligence litigation is not quick, and it is not easy. It involves going back over things you may have spent years trying not to think about. What we can promise is that you won’t be doing it alone, and that we’ll tell you plainly what we think of your prospects — including if we think you don’t have a case.
If you’re not sure whether what happened to you “counts,” that’s usually a sign it’s worth a conversation.
