Birth trauma · 15 min read · Published 27 October 2026 · Reviewed 27 October 2026 · Next review April 2027

By Dr Rosemary Listing, PhD (Law) · Medical negligence lawyer since 2013 · Of Counsel, Peter Evans & Associates

“It’s Just Part of Having a Baby”? Could My Third or Fourth Degree Tear Have Been Prevented?

“It’s just part of having a baby.” She has heard it from her mother, from a friend, and from the registrar who repaired her tear. But she keeps going back over the night: the hours of pushing on her back, the doctor who came in and reached for the forceps without explaining why, the moment she felt herself tear and no one said a word. She keeps wondering whether it had to happen that way.

If you are asking whether your third or fourth degree tear could have been prevented, you are asking a reasonable question, and an important one. Some severe tears happen despite excellent care. Others happen because of decisions that should have been made differently. As a medical negligence lawyer with a PhD focused on patterns of failure in medical negligence, I can’t tell you which applies to you without looking at your records. But I can explain what the national standard expects, the factors that increase the risk, what can reduce it, and what an independent expert would look at.

Not every tear is preventable, and not every tear is “just bad luck”

Third and fourth degree tears happen in a small proportion of vaginal births. RANZCOG’s caesarean on maternal request statement cites Victorian data putting the risk at about 1 in 26 for a first, unassisted vaginal birth, and the risk is higher with forceps. Some tears happen quickly and unavoidably, even with every precaution in place. But the national standard exists precisely because many severe tears can be reduced, and because the care around them, before, during and after, makes a real difference.

What the national standard expects

The Third and Fourth Degree Perineal Tears Clinical Care Standard (2021) sets seven quality statements. They are the clearest yardstick of what good care looks like in Australia. Tap any step in the graphic above to jump to it.

Quality statement 1Information and shared decision making in pregnancy

You should be told about the risk of a severe tear during pregnancy, including what increases it and what can reduce it, so that you can take part in decisions about your care. If no one ever mentioned the possibility of a severe tear, or the factors that applied to you, that is a gap.

Quality statement 2Reducing the risk during labour and birth

Clinicians should use evidence-based ways of reducing the risk, discussed with you. Victoria’s Better Births for Women collaborative used a bundle drawn from the Women’s Healthcare Australasia perineal protection work:

• a warm perineal compress during the second stage of labour
• hands-on perineal support, with gentle verbal guidance as the head is born
• an episiotomy when indicated, including during instrumental birth, at 60 degrees
• a genito-anal examination for all women after birth
• grading of any tear, reviewed by an experienced clinician

Across the services that completed the program, the rate of severe tears fell by 45%, from 4.41% to 2.44%. That figure is one of the strongest pieces of evidence that a meaningful share of severe tears can be prevented.

Quality statement 3Assisted (instrumental) birth

If an assisted birth is needed, the choice of instrument and its risks should be discussed with you. RANZCOG’s Instrumental Vaginal Birth statement (C-Obs 16) notes that, compared with vacuum, forceps are associated with a higher risk of third and fourth degree tears, and that an episiotomy in first-time mothers having an assisted birth reduced sphincter injury (by around 24% with forceps and 16% with vacuum in the evidence it reviewed). It also says verbal consent should be obtained and documented, and that women should be told the attempt may need to be abandoned for a caesarean.

Quality statement 4Identifying the tear

After birth, you should be examined by a suitably trained clinician, including a genito-anal examination, so that any tear is recognised and correctly graded. Missed tears are common: see “Nobody told me how bad my tear was”.

Quality statements 5 to 7Repair, care afterwards and follow-up

The tear should be repaired by an appropriately trained and experienced clinician in a suitable setting, followed by proper postoperative care (including debriefing, physiotherapy and psychosocial support) and individualised follow-up. Even where a tear itself was unavoidable, failures here can make the outcome much worse. Our articles on wound problems and recovery week by week cover this.

Factors that increase the risk

Some factors are known to make a severe tear more likely. Having one doesn’t mean a tear was inevitable, but they should shape the information you’re given and the care you receive:

• a first vaginal birth
• a larger baby, or shoulder dystocia
• the baby facing upwards (occiput posterior, “sunny side up”)
• a long second stage of labour
• an assisted birth, particularly with forceps
• a very fast, uncontrolled birth of the head
• a previous third or fourth degree tear

What an independent expert would look at

If you seek legal advice, an independent obstetrician or midwife is usually asked to review your records. They will typically look at:

• what you were told in pregnancy about the risk of tearing, and whether your risk factors were recognised
• how the second stage of labour was managed, including how long you pushed, in what position, and how the birth of the head was controlled
• whether a warm compress and perineal support were used, and whether an episiotomy was considered when it was indicated
• if there was an assisted birth: why it was needed, who performed it, whether vacuum or forceps was chosen and why, whether an episiotomy was performed and at what angle, and what you were told
• the CTG (fetal heart monitoring) and the reasons for any urgency
• whether the tear was properly examined, graded and repaired, by whom and where
• the care and follow-up afterwards

Our guide to getting and reading your birth records explains how to get these documents.

Questions to ask the hospital

1. What risk factors for a severe tear did I have, and were they discussed with me in pregnancy?
2. Was a warm compress and hands-on perineal support used during the birth?
3. Was an episiotomy considered? If one was done, what kind, and at what angle?
4. If I had an assisted birth: why was it needed, who decided, and why vacuum or forceps?
5. Who was present at the birth, and how experienced were they?
6. Was my tear examined and graded by someone trained, including a rectal examination?
7. Who repaired my tear, where, and with what anaesthetic?
8. Has my care been reviewed, and has there been open disclosure?

A birth debrief is often the best place to ask these questions. If the answers aren’t satisfactory, our guide to making a complaint after a traumatic birth explains your next steps.

When it can point to something going wrong

• your risk factors were known but never discussed, so you couldn’t take part in decisions
• the birth of the head was rushed or uncontrolled, without perineal support, in circumstances where that wasn’t necessary
• forceps were used where vacuum would have been appropriate, or an assisted birth was done without an indicated episiotomy, or with an episiotomy at the wrong angle
• an assisted birth was performed by someone without adequate experience or supervision
• procedures were done without your consent, or after you had refused
• the tear was missed, misgraded or poorly repaired, or follow-up was inadequate

How the law looks at it

To succeed in a negligence claim you generally need to show that care fell below the accepted standard, and that this caused your injury, or made it worse. In New South Wales, section 5O of the Civil Liability Act 2002 (NSW) provides that a professional is not negligent if they acted in a way that was widely accepted by peer professional opinion as competent practice, unless that opinion is irrational. Other states have similar rules. Causation is dealt with in section 5D of the same Act. In practice, that means an obstetric or midwifery expert comments on the standard of care, and often another expert, such as a colorectal surgeon or urogynaecologist, comments on what difference proper care would probably have made.

Consent and information are part of the picture. In Rogers v Whitaker (1992) 175 CLR 479, the High Court held that doctors must warn patients of material risks. In Wallace v Kam (2013) 250 CLR 375, it considered how causation works when the complaint is a failure to warn. And in Gawthrop v Bendigo Health [2026] VSC 157, the Supreme Court of Victoria found that a vaginal examination in labour had been performed without free and voluntary consent, and that the woman had not been properly warned about the practical limits of her birth plan. Consent in birth is a legal requirement, not a courtesy.

Time limits apply. In New South Wales, a claim generally has to be started within three years of when you knew, or ought to have known, that you had been injured, that the injury was caused by someone’s fault, and that it was serious enough to justify a claim, with an outer limit of 12 years (Limitation Act 1969 (NSW) s 50C). Other states and territories have their own rules, so it is better to ask early than to wait.

If a claim succeeds, compensation reflects the effect of the injury on your whole life. Our guide to how much compensation for a third or fourth degree tear explains how it is calculated. Our birth injury map shows how these injuries connect to others.

In my practice

“It’s just part of having a baby” is one of the most powerful phrases in maternity care, and one of the most damaging. It closes down questions before they are asked. I hear it from women who were told it by clinicians, by family, and eventually by themselves.

My doctoral research looked at patterns of failure in medical negligence, and one of the things that work showed me is how rarely serious harm comes from a single dramatic error. More often it is a chain: a risk factor not discussed, a second stage that ran long, a decision made in a hurry, an instrument chosen without explanation, a tear graded by someone junior at 3am. Each link might look small on its own. Together they can be the difference between a tear and no tear, or between a tear that heals and one that doesn’t.

You are allowed to ask whether your injury was preventable. Asking isn’t blaming anyone. It is how you find out what happened to your body, and it is how care improves for the women who come after you.

Both/and: some tears can’t be prevented, and some can

Both things are true. Some severe tears happen despite careful, skilled care. And a significant proportion of severe tears can be prevented, as the 45% reduction achieved in Victorian hospitals shows. Holding both lets you ask the question about your own birth without assuming the answer either way.

The bigger picture

The NSW Legislative Council’s Birth Trauma inquiry received more than 4,000 submissions and found that much birth trauma stems from avoidable and preventable factors, making 43 recommendations. RANZCOG’s Birth Trauma Roundtable Final Report (July 2026) heard that consent processes often felt rushed or unclear. “It’s just part of having a baby” is no longer an answer that the profession itself accepts.

Support

• National Continence Helpline: 1800 33 00 66, free advice from nurse continence specialists, run by the Continence Foundation of Australia.
• PANDA (Perinatal Anxiety & Depression Australia): 1300 726 306, or panda.org.au.
• Birth Trauma Australia: birthtrauma.org.au, information and peer support for physical and emotional birth trauma.
• Our guide to finding support after birth trauma.

Whatever you find out, you deserve the truth about what happened to you, and care that takes your injury seriously. If you want help understanding your records, that is what we are here for.

With care,
Rosemary

Frequently asked questions

References

• Australian Commission on Safety and Quality in Health Care. Third and Fourth Degree Perineal Tears Clinical Care Standard. Sydney: ACSQHC, 2021. safetyandquality.gov.au
• Safer Care Victoria. Better Births for Women improvement collaborative. safercare.vic.gov.au
• Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Instrumental Vaginal Birth. C-Obs 16, 2020. ranzcog.edu.au
• Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Caesarean Birth on Maternal Request (CBMR). C-Obs 39, 2023. ranzcog.edu.au
• Royal College of Obstetricians and Gynaecologists. The Management of Third- and Fourth-Degree Perineal Tears. Green-top Guideline No. 29, 2015 (published on the RANZCOG website). ranzcog.edu.au
• Queensland Clinical Guidelines. Perineal care. Guideline MN18.30. Queensland Health. health.qld.gov.au
• Royal Hospital for Women, South Eastern Sydney Local Health District. Third and fourth degree tears: repair and management. Clinical Business Rule, 2023. seslhd.health.nsw.gov.au
• Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Birth Trauma Roundtable Final Report. July 2026. ranzcog.edu.au
• Legislative Council Select Committee on Birth Trauma (NSW). Birth trauma. Report, tabled 29 May 2024. parliament.nsw.gov.au
• Rogers v Whitaker (1992) 175 CLR 479; [1992] HCA 58.
• Wallace v Kam (2013) 250 CLR 375; [2013] HCA 19.
• Gawthrop v Bendigo Health [2026] VSC 157.
• Civil Liability Act 2002 (NSW), including ss 5D, 5O, 12, 15, 16 and 33.
• Limitation Act 1969 (NSW) s 50C.

Client stories in this article are composites drawn from many women’s experiences and have been changed so that no one can be identified. They do not describe any individual client.

This article is general information only. It isn’t medical or legal advice about your situation, and reading it doesn’t create a lawyer and client relationship. If you are worried about your health, please see your doctor, midwife or hospital. If you are in crisis, call 000 or Lifeline on 13 11 14. Legal services are provided by Peter Evans & Associates.