It’s time we talked about perineal trauma

Today’s Victoria Derbyshire programme had an excellent film about perineal injuries during childbirth. You can read the associated article and see the film here (it’s about 15 minutes long). Four women shared their experience of having third or fourth degree tears during childbirth, resulting for some of them in urinary or bowel incontinence.

One of the striking facts in the film was that between 2000 and 2012, the rate of severe tearing during vaginal delivery increased from 2% to 6%. Although the programme was careful to state that this was “very rare”, in practice this translates into about 30,000 women a year. This huge increase in the rate, an obstetrician told the programme, was down to three main factors: the older age at which women have their first baby; an increase in the size of babies being born; and women themselves being bigger and heavier. But this isn’t necessarily the full explanation: the increase may simply be down to better recognition of tears as a result of the implementation of standard classification.

The programme also read out text messages from viewers. What was sad was the clear variability in treatment available. Although some women said their injuries had healed, others said they had been fobbed off when they complained about their perineal injuries, or that the injuries had persisted over months and years. One of those interviewed on the programme was effectively told that it was all in her head.

The good news is that the professionals are now taking this seriously: the Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Midwives (RCM) have developed an intervention package to reduce tearing in childbirth. The package is really just a simple change to the recommended way in which midwives deliver the baby, which has been shown to reduce tearing. It is being piloted in a number of hospitals and will eventually be rolled out throughout England.

Nonetheless, it’s shocking that in this day and age that a problem affecting so many women isn’t talked about or even taken particularly seriously. It was clear from the programme that many doctors aren’t adequately trained to deal with perineal tears. That – as well as better care during delivery – needs to change.

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