New study in the British Journal of Obstetrics and Gynecology has identified increased risk associated with vaginal births after caesarean sections. The study focused on 130,000 births from 2009 to 2014, and identified that women giving vaginal births after a caesarean section were 21% more likely to sustain significant vaginal trauma (third or fourth-degree tear) than first time mothers.
This kind of birth trauma relates to significant injury to a woman’s perineum, the region between vagina and anus. A third-degree perineal tear involves significant damage to the sphincter muscle, which helps control the bowels. A fourth-degree perineal tear is the most severe, as they extend through the anal sphincter and into the mucous membrane that lines the rectum.
While some perineum tears (link contains animated images of vaginal tearing) maybe repaired by obstetricians, more severe perineum tears may require general anesthesia in an operating room to repair. Even when perineum tears are repaired, some mothers who have sustained third and fourth degree tears during birth develop distressing issues that never disappear. For instance, mothers have reported dragging sensation in the pelvic floor, or a true prolapse of the vaginal walls, which may require additional surgical procedures to resolve.
While the risk for perineum tears during vaginal births is minimal, standard of care requires physicians to identify the increased risk of perineum tear for a vaginal birth following a caesarean section. Practitioners should identify the risk of serious vaginal trauma or uterine rupture as well as the risk associated repeat caesarean section to allow expecting mothers to make informed decision about their birthing choices.
Gurrajan is a trial attorney at Grewal Law, PLLC. He represents victims and families in personal injury and wrongful death claims. His primary focus is on medical malpractice claims, specializing in airway complications and surgical errors.