There are four degrees of tears the fourth of which is the most serious. This is a tear which extends from the deeper layers of the vagina through to the anal sphincter and rectal lining. Such tears can cause pelvic floor dysfunction and prolapse, bowel incontinence and interfere with sexual intercourse. Fortunately fourth degree tears are uncommon but they can be very debilitating for the woman.
I acted for a 19 year old woman who had delivered her first baby. She sustained a fourth degree tear which should have been avoidable had the doctor who delivered the baby, using forceps, taken more care. She suffered double incontinence, psychological problems and painful intercourse. The pain from the injury interfered with her ability to look after, and also bond, with her baby. Her claim was settled before trial but no amount of money could restore her quality of life.
There is a strong argument that women should be much better informed of the risks associated with an instrumental delivery (delivery by forceps or ventouse) and given the option of a caesarean section instead. A section does of course carry its own risks, which must be carefully evaluated, but a section would avoid the very significant, and often life changing, symptoms which come with a fourth degree tear.
By Sara Westwood at firstname.lastname@example.org / 01603 877000