Understanding Perineal Tears: What Every Woman Should Know (written by a lawyer)
When I first began working in medical negligence, I met many women who said the same thing after childbirth:
“I knew something wasn’t right, but no one listened.”
Perineal tears are among the most common birth injuries, and for many women, they heal well. But for others, the pain, incontinence, or scarring that follows can change their daily lives — and they’re often left wondering whether their experience was preventable.
As a lawyer who has run many of these claims, I’ve seen the pattern too often: a missed diagnosis, a delayed repair, or a lack of follow-up care. This article is written for those women — to help them understand what happened, what good care should look like, and how they can seek answers safely and confidently.
What Is a Perineal Tear?
A perineal tear happens when the skin and muscles between the vagina and anus stretch or tear during childbirth. The severity varies:
- First-degree tears involve only the skin.
- Second-degree tears extend into the muscles.
- Third- and fourth-degree tears (known as “obstetric anal sphincter injuries” or OASIS) extend to the anal sphincter or rectum.
According to the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), around 3% of vaginal births result in a third- or fourth-degree tear. The Australian Institute of Health and Welfare (AIHW) has also reported a rise in recorded severe tears — partly due to improved recognition and documentation.
When a Tear Becomes a Legal Issue
Most perineal tears are unavoidable and heal with proper care. But medical negligence may arise where:
- The tear was not identified or was misclassified after delivery;
- The repair was delayed or done by an inexperienced clinician;
- There was a failure to provide antibiotics or physiotherapy follow-up;
- Or the woman was not informed of the risk before birth, particularly where instrumental delivery was planned.
In one matter I handled, a woman’s fourth-degree tear was recorded in her notes as “minor.” Months later, she presented with faecal incontinence and pelvic pain — only then learning that her sphincter had been torn during delivery. The emotional toll was enormous.
A claim like hers doesn’t only ask for compensation; it also asks for accountability — a chance to understand why she wasn’t heard, and how the system can prevent others from suffering the same fate.
Why These Injuries Are Often Missed
These cases often reflect systemic gaps in care rather than isolated mistakes. Research from the Lancet (2020) and BMJ Open (2022) highlights that improved training in perineal examination reduces missed injuries, yet many hospitals still lack mandatory review by senior staff. Common issues include:
- Under-recognition — junior staff may lack confidence diagnosing severe tears;
- Under-reporting — injury severity may be understated in records;
- Time pressure — post-birth examinations may be rushed in busy wards.
These are not one-off oversights — they point to a patient safety concern. When detection and repair systems fail, harm becomes predictable — and therefore preventable.
How to Know If You Have a Claim
From a legal standpoint, a claim may exist if:
- The care fell below what a reasonably competent clinician would have done; and
- That failure caused injury — physical or psychological.
If you experienced incontinence, pain during intimacy, or a sense that “something was wrong” but were told it was normal, an independent review of your records may help. We typically obtain maternity and operation notes and seek expert opinions from a uro-gynaecologist or colorectal surgeon. Even if no claim proceeds, this process can offer validation and clarity.
Further reading:
- “I Can’t Control Wind After Birth”: Understanding Fourth-Degree Tears and Your Rights
- Birth-Related Trauma After Forceps or Vacuum Delivery (written by a lawyer)
- Reduced Foetal Movements Late in Pregnancy: What a Mother’s Intuition Knows
- Severe Pelvic Floor Damage & Incontinence After Childbirth
Recovery and Validation
Healing from a severe tear is not only physical. Many of my clients describe grief, shame, or loss of confidence. That emotional injury is real — and worthy of care. Specialist pelvic floor physiotherapy, counselling, and peer support through groups such as the Birth Trauma Association of Australia can make a profound difference.
Recognising that the injury wasn’t your fault — and that your pain is legitimate — is often the first step toward recovery.
Why This Matters for Patient Safety
The increasing reports of women experiencing long-term effects from perineal trauma reflect a broader issue in maternity care. The aim should not merely be to avoid litigation but to improve training, consent, and follow-up care. As a lawyer, I’ve seen how early recognition and open communication can prevent disputes altogether. What women need most is transparency and respect.
Final Thoughts
If you’ve suffered a severe perineal tear and feel your care was inadequate, you are not alone. You have the right to review your care and the right to be treated with dignity and honesty. Every story told helps make birth safer for others — and as lawyers, that’s our shared purpose: to help ensure no woman feels dismissed or invisible in her own recovery.
