“I Feel Broken, and No One Understands”: The Emotional Impact of a Third or Fourth Degree Tear
A third or fourth degree tear is a serious injury, and the emotional impact can be as hard as the physical one. Grief, comparison, shame, anger and trauma symptoms are common, and they are not signs that you are weak or ungrateful. The national standard expects women to be offered debriefing, psychosocial support and follow-up for their emotional health, and support is available through your GP, PANDA and Birth Trauma Australia. This guide explains what women commonly feel, what helps, and how getting answers about your care can be part of healing.
Everyone else in her mothers’ group seems to have healed. They talk about getting back to the gym, about date nights, about how the birth is already a blur. She nods along and goes home and sits on the edge of the couch, because sitting properly still hurts. She loves her baby so much it aches. And some nights, when she is very tired, she has thoughts she is ashamed of: that she wishes she could go back, that her body is ruined, that no one understands.
If any of that sounds like you, I want you to know straight away: you are not broken, you are not alone, and what you are feeling makes sense. A third or fourth degree tear is a serious injury, often to the most private part of your body, often after a frightening birth, at the exact moment the world expects you to be joyful. Women who have been through it describe grief, anger, shame, jealousy, numbness and fear. Those are not character flaws. They are human responses to something hard.
I’m a lawyer, not a psychologist, and this article is not a substitute for proper support. But I work closely with women after severe birth injuries, and I want to share what they have taught me, where to find help, and how getting answers about what happened can be part of healing.
- If you are having thoughts of harming yourself, or that your family would be better off without you, please call Lifeline on 13 11 14 (24 hours) or 000 if you are in immediate danger.
- PANDA, the National Perinatal Mental Health Helpline: 1300 726 306.
- Tell your GP, midwife or child and family health nurse how you are really feeling. You won’t be judged, and help is available.
What you might be feeling
Women describe many different feelings after a severe tear, often all at once. Tap one in the graphic above to jump to it.
FeelingGrief: “this isn’t how it was supposed to be”
Grief for the birth you hoped for, for the newborn weeks you spent in pain instead of in the bubble you imagined, for the body you had before, and sometimes for the sex life, the exercise or the confidence you have lost. Some women describe feeling robbed of their maternity leave. Grief doesn’t mean you aren’t grateful for your baby. You can hold both.
Back to the overviewFeelingComparison: “everyone else healed except me”
Online, you will find women who were “back to normal in two weeks” after a fourth degree tear, and women who are still struggling years later. Both are real. Recovery varies enormously, depending on the injury, the repair, infection, follow-up, and many things no one fully understands. Being slower to heal is not a failure. And jealousy of women who healed quickly is one of the most common feelings women admit to, once they feel safe to say it.
Back to the overviewFeelingShame: “I feel dirty, defective, embarrassed”
When an injury affects your bowels, your bladder or sex, shame often follows, along with isolation, because these are things we don’t talk about. Many women tell no one, not even their partner, how bad things are. Shame thrives in silence, and it begins to ease when you find even one person you can tell the truth to: a friend, a physio, a GP, a counsellor, or a peer support group.
Back to the overviewFeelingAnger: “no one listened”, “no one understands”
Anger at the clinicians who dismissed you. At the relative who said they “only had three stitches”. At your partner for not understanding. Sometimes, painfully, at your baby. Anger is often a sign that something genuinely was wrong, that you weren’t heard, or that the care you needed wasn’t there. It deserves to be taken seriously, not swallowed.
Back to the overviewFeelingTrauma: flashbacks, fear, feeling numb
Some women develop symptoms of birth trauma or post-traumatic stress: intrusive memories or flashbacks of the birth, nightmares, avoiding anything that reminds them of it, feeling constantly on edge, or feeling numb and detached. Some develop postnatal depression or anxiety. These are recognised health conditions, they are common after traumatic births, and they respond well to treatment, particularly with a psychologist experienced in perinatal trauma.
Back to the overviewWhat can help
- Telling your GP how you really feel. Your GP can arrange a mental health treatment plan, which gives you access to Medicare rebates for sessions with a psychologist, and can check for postnatal depression, anxiety and post-traumatic stress.
- A psychologist who understands perinatal and birth trauma. PANDA and Birth Trauma Australia can help you find support.
- Treating the physical injury properly. Ongoing pain, incontinence and problems with sex feed the emotional distress. Getting the right physical care, such as pelvic health physiotherapy and specialist referrals, is mental health care too. Our guides on recovery, bowel symptoms, sex and ongoing pain can help you ask for it.
- Peer support. Talking with women who have had severe tears can be enormously validating. Birth Trauma Australia runs peer support, and there are online communities for women with severe and complicated tears.
- A birth debrief. Understanding what happened, in a meeting with a senior clinician, helps many women make sense of the birth. Our guide to asking for a birth debrief explains how.
- Support for your partner. Partners can be traumatised too, especially if they saw a frightening birth. PANDA also supports partners and dads.
Questions to ask
1. I had a third (or fourth) degree tear and I'm not coping as well as I expected. 2. I keep having flashbacks / nightmares about the birth. 3. I feel numb, or angry, or ashamed, most of the time. 4. I'm struggling to bond with my baby. 5. My physical symptoms (pain, bowel, bladder, sex) are affecting my mental health. 6. Can I have a mental health treatment plan and a referral to a perinatal psychologist? 7. Can I be referred for a birth debrief? 8. Is there support for my partner?
What the guidelines say you should be offered
The national Third and Fourth Degree Perineal Tears Clinical Care Standard doesn’t treat the emotional impact as an afterthought. It expects women to be offered debriefing and psychosocial support after the repair, and individualised follow-up for their physical, emotional and psychological health after discharge. The Commission’s own information for women suggests meeting with a psychologist if you feel anxious or unsettled, and notes that partners may benefit from support too. The Queensland Clinical Guideline on perineal care asks for a multidisciplinary follow-up and debrief with senior staff after a severe tear.
If you were sent home without any of that, you weren’t given the care the standard describes, and the struggle you are having isn’t a personal failing.
When it can point to something going wrong
Emotional distress after a severe tear doesn’t mean anyone was at fault. But it can be linked to failures in care, for example where:
- you were never told what had happened to you, or were told in a way that left you frightened and confused
- procedures were done without your consent, or you were not listened to during the birth
- you were offered no debrief, no psychosocial support and no follow-up
- your physical symptoms were dismissed, prolonging pain, incontinence and isolation
- the tear itself, or the way it was repaired, involved care that fell below the standard
How the law looks at it
If an injury was caused by negligent care, the psychological consequences of that injury can be part of a claim, alongside the physical ones. In New South Wales, Part 3 of the Civil Liability Act 2002 (NSW) deals with mental harm, and some types of damages for mental harm require a recognised psychiatric illness, which is one reason a proper diagnosis and treatment record matters. Partners who witnessed a traumatic birth may, in some circumstances, have their own claim. Whether care fell below the standard is judged against what was widely accepted as competent professional practice at the time. 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.
Consent also matters. 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, after the woman had repeatedly refused. Being overridden in labour is something the law takes seriously.
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.
Our articles could my tear have been prevented? and how much compensation for a third or fourth degree tear explain more.
In my practice
The women I work with are not fragile. They are some of the strongest people I have met: they have kept caring for a newborn through pain, incontinence and sleeplessness, often while being told they were fine. What wears them down isn’t usually the injury alone. It is being disbelieved. Being told it was normal. Being the only one in the room who seemed to think something was wrong.
My doctoral research looked at patterns of failure in medical negligence, and one thing it taught me is that the harm of not being listened to is real, and repeated. That is why so many women tell me that getting their records, and finally reading in black and white what happened, was one of the most healing things they did. Not because it changed the past, but because it confirmed they hadn’t imagined it.
Seeking answers, including legal advice, isn’t vengeful or ungrateful. For many women it is how they reclaim the story of their birth.
Drawn from the experiences of many women I have worked with, combined and changed so that no one can be identified. It does not describe any individual client.
What she noticed. By five months she was physically improving, but she felt worse. She avoided her mothers’ group, couldn’t watch birth scenes on television, and lay awake replaying the moment the room filled with people. She felt like her body was ruined and that she had failed at the most basic thing.
What she was told. That she was lucky the baby was healthy. That tears were common. That she would feel better once she got some sleep. No one asked how she was feeling about the birth itself, and no one mentioned a debrief.
What the records showed. A fourth degree tear after a rapid assisted birth. No record of the tear being explained to her before discharge, no debrief offered, and no referral for psychological support despite a midwife noting on day two that she was “tearful and distressed about the birth”.
How she felt. “I thought I was failing at motherhood,” she said. “It turned out I was injured, and traumatised, and no one had helped me with either.” With a psychologist, a pelvic health physio and, eventually, answers about her care, she began to feel like herself again. She says the turning point was being believed.
Both/and: you can love your baby and grieve your birth
Both things are true. You can love your baby completely and still grieve what the birth did to you. You can be grateful to be alive and still be angry about how you were treated. You can be healing and still have hard days. None of these cancel each other out, and you don’t have to choose.
The bigger picture
The NSW Legislative Council’s Birth Trauma inquiry received more than 4,000 submissions, found that birth trauma has affected a substantial number of people in NSW and that much of it stems from avoidable and preventable factors, and made 43 recommendations. RANZCOG’s Birth Trauma Roundtable Final Report (July 2026) recommended trauma-informed care and expanded psychological support after birth. What you are feeling has been heard at the highest levels. You are part of a very large group of women, and the system is slowly starting to listen.
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.
You are not broken. You are a woman who was injured, carrying more than anyone can see. With the right support, physical and emotional, things can get better, and many women say that, eventually, they feel stronger than before. Please reach out. You deserve care, and you deserve to be believed.
With care,
Rosemary
Frequently asked questions
Is it normal to feel depressed after a third or fourth degree tear?
Feeling low, anxious, angry or traumatised after a severe tear is very common. It isn’t a sign of weakness. If these feelings last more than a couple of weeks or affect your daily life, talk to your GP, who can check for postnatal depression, anxiety or post-traumatic stress and arrange support.
Can you get PTSD from a traumatic birth?
Yes. Some women develop post-traumatic stress after a traumatic birth, with flashbacks, nightmares, avoidance and feeling on edge. It is a recognised condition and responds well to treatment with an experienced psychologist.
Why do I feel jealous of women who healed quickly?
It is one of the most common feelings women describe after a severe tear. Recovery varies enormously, and being slower to heal is not a failure. Peer support from women who have had similar injuries can help.
Will I ever feel normal again after a fourth degree tear?
Many women say that, with time, proper physical care and emotional support, they feel like themselves again, and some say stronger. If you are not improving, ask for more help rather than waiting.
Where can I get support for birth trauma in Australia?
Your GP can arrange a mental health treatment plan and referral to a perinatal psychologist. PANDA’s National Perinatal Mental Health Helpline is 1300 726 306, and Birth Trauma Australia offers information and peer support. In a crisis, call Lifeline on 13 11 14 or 000.
Can psychological harm from a birth injury be part of a claim?
Yes. If the injury was caused by negligent care, its psychological consequences can be part of a claim. In NSW, some damages for mental harm require a recognised psychiatric illness. Time limits apply, so it is worth getting advice early.
Questions about your care?
If you’re struggling with the aftermath of a severe tear and have questions about the care you received, we can talk it through gently and confidentially. There’s no cost to find out where you stand.
- Is this normal? Recovery week by week
- My stitches smell, came apart or feel open
- “Nobody told me how bad my tear was”
- “I can’t control wind after birth”
- I can’t hold it, or make it to the toilet in time
- Sex after a third or fourth degree tear
- Still can’t sit, months later
- Caesarean or vaginal birth next time?
- Could my tear have been prevented?
- “I feel broken, and no one understands” (you are here)
- How much compensation for a third or fourth degree tear?
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
- Australian Commission on Safety and Quality in Health Care. Recovering from a third or fourth degree perineal tear (information for women). safetyandquality.gov.au
- Queensland Clinical Guidelines. Perineal care. Guideline MN18.30. Queensland Health. health.qld.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
- 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.
Written by Dr Rosemary Listing, PhD (Law). Rosemary is a medical negligence lawyer and Of Counsel at Peter Evans & Associates. She has practised since 2013 and worked on many hundreds of claims, including for women injured during childbirth. Her doctoral research examined patterns of failure in medical negligence, and she is a Sessional Lecturer in Health Law at the University of Newcastle. She is responsible for all content published under her name.
Rosemary is not medically qualified. Clinical information in this article is drawn from, and checked against, the national Clinical Care Standard, RANZCOG publications and state clinical guidelines listed in the references. Legal information reflects the law as at the review date.
Last updated 27 October 2026. First published 27 October 2026. Next review April 2027.
Cite this article: Listing, R. (2026, October 27). “I Feel Broken, and No One Understands”: The Emotional Impact of a Third or Fourth Degree Tear. Reframe Legal. https://reframelegal.com/i-feel-broken-after-birth-tear/
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.
