A new study published today in BJOG: An International Journal of Obstetricians and Gynaecologists examines the mode of delivery and recurrence rate in a pregnancy subsequent to a third or fourth degree perineal tear.
Results show that among women who had a severe perineal tear at first birth, 24.2% were delivered by elective caesarean section, compared with 1.5% women who did not have a severe tear at first birth. Furthermore, the report found that among women who had a vaginal delivery at second birth, the rate of a severe tear was 7.2% in women with a tear at first birth, compared to 1.3% in women without, a more than five-fold increase in risk.
Commenting on the study, Professor Alan Cameron, Vice President of Clinical Quality for The Royal College of Obstetricians and Gynaecologists said:
“Around 90% of women tear during childbirth; however some women can suffer from more severe forms of tearing which can have both clinical and psychological impacts on a woman’s health.
“In recent years, we have seen the rate of third and fourth degree tearing increase to around 5.9% in England among first-time mothers.
“Tearing is an incredibly complex issue which could be influenced by a range of factors including clinical issues and education and training. However, one possible reason for this trend is the rise in complex pregnancies including; increased maternal age at first birth and maternal weight, which are linked to a higher birth weight and risk of perineal tears.
“It is vital that we address the issue with urgency as tearing can affect many aspects of a woman’s life longer term, including her physical and mental health, as well as future pregnancies. The RCOG and the RCM are currently planning joint work to improve the awareness of third and fourth degree tears’ incidence among health professionals involved in maternity care and develop tools to improve the prevention and management of severe perineal tearing.”