"It's Just Part of Having a Baby": When a Severe Perineal Tear Wasn't Your Fault

You were told it was normal. That every mum tears a bit. That the pain, the leaking and the fear of leaving the house would settle down.

It's been months now, and it hasn't.

Maybe you can't make it to the toilet in time. Maybe you've stopped exercising, stopped being intimate, stopped going anywhere without knowing where the nearest bathroom is. Maybe you're grieving the body you had, and feeling guilty for grieving at all when you have a baby to be grateful for.

What is a third or fourth degree tear?

Most women who give birth vaginally have some tearing. Severe tears are different. A third degree tear extends into the muscle that controls the back passage (the anal sphincter). A fourth degree tear goes further, through the lining of the bowel itself. NSW Health explains the different degrees of tear on its HealthStats perineal tears page.

Clinicians often call these injuries obstetric anal sphincter injuries (OASIS). They can cause:

• Leaking of wind or faeces, or urgency you can't control
• Ongoing pain in the perineum or during sex
• Infection or breakdown of the repair
• A fistula (an abnormal opening between the vagina and bowel)
• Anxiety, low mood and birth trauma

What you may not know: there is a national standard for this injury

In Australia, severe tears are serious enough that the Australian Commission on Safety and Quality in Health Care created a dedicated Third and Fourth Degree Perineal Tears Clinical Care Standard. When it was released, the Commission described it as the first national standard aimed at reducing perineal trauma at birth.

Not every severe tear can be prevented. But the way a birth is managed, and what happens in the hours afterwards, makes an enormous difference. These are the moments where negligence most often occurs.

1. Warning signs that you were at higher risk

A first vaginal birth, a large baby, a long pushing stage, a baby in the back-to-back position, or an assisted birth with forceps or a vacuum all increase the risk. When those risks are present, clinicians are expected to take steps to protect the perineum, including controlling the birth of the baby's head and, where an episiotomy is needed, cutting it at the correct angle.

2. Being told about the risks of forceps

Assisted births carry a higher risk of pelvic floor injury, as RANZCOG's own patient information on assisted birth acknowledges. In Australia, since the High Court's decision in Rogers v Whitaker, doctors must warn you of material risks: the risks a person in your position would want to know about. If you were never told that forceps could cause this kind of injury, or offered an alternative, that may matter.

3. The examination after birth

After a vaginal birth, you should be offered a careful examination, including a rectal examination with your consent, to check whether the sphincter has been injured. The national standard sets out what identifying a third or fourth degree tear should involve. A severe tear that is missed and stitched as a minor tear is one of the most common causes of lifelong incontinence. If you were told you had a "small tear" or "a graze" but your symptoms say otherwise, this is a key question.

4. The quality of the repair

A severe tear should be repaired by an experienced clinician, usually in an operating theatre with good lighting and proper pain relief. A rushed repair in the birthing suite by someone without the right experience can fail.

5. Follow-up care

You should have been offered appropriate medication, pelvic floor physiotherapy and a follow-up review. If you raised symptoms and were dismissed, or told to "give it time" for months, the delay itself may have made things worse.

Signs that something may have gone wrong

You don't need to know the medical answers. But it's worth speaking to someone if:

• You were never told you had a third or fourth degree tear, but you have bowel or wind incontinence
• You had forceps and nobody explained the risks beforehand
• Your stitches broke down, became infected or needed a second operation
• You've been diagnosed with a fistula
• You raised your symptoms and were brushed off

Severe tears often happen during difficult births that involve other complications too. If your baby was also injured, you may find our article on shoulder dystocia and Erb's palsy helpful. If you lost a lot of blood after the birth, read when a postpartum haemorrhage may involve negligence.

You are not alone

In May 2024, the NSW Parliament's Select Committee on Birth Trauma published its Birth Trauma report after hearing from thousands of women and families. It found that a number of people had suffered preventable birth trauma in NSW, and that urgent work was needed to address it. Pelvic floor injury was one of the issues it heard most about.

Your experience is part of a much larger picture. Speaking up about it is not ungrateful, and it is not "making a fuss".

What can a medical negligence claim do?

A claim cannot undo what happened. What it can do is:

• Get independent experts to review your care and tell you honestly whether it met the standard expected
• Fund future surgery, physiotherapy, continence aids and psychological care
• Compensate you for pain, lost income and the changes to your daily life
• Give you answers, which for many women matters most

Some women also want the hospital to explain what happened. NSW public hospitals have an open disclosure process for talking with patients after things go wrong. You can also raise concerns with the NSW Health Care Complaints Commission or make a notification to Ahpra about an individual practitioner. These processes are separate from a compensation claim, and we can talk you through how they fit together.

Support while you recover

Whatever you decide about a claim, please look after yourself. These services understand birth injury:

• Birth Trauma Australia: peer support and information for people affected by birth-related trauma
• PANDA (Perinatal Anxiety & Depression Australia): national helpline 1300 726 306
• Gidget Foundation: free counselling for expectant and new parents
• What you can complain about to the HCCC

Related articles

• Birth injury and birth trauma claims
• "They said it was just a headache": missed pre-eclampsia
• When a stillbirth may have been preventable

This article is general information only and is not legal or medical advice. Every situation is different.