Medical Q&As

Perineal tear - need for section?

I am currently 33 weeks pregnant and am looking forward to new arrival. I have two other children. The first was born by vaginal delivery. However, during the delivery, I received a third degree tear and a lot of stitches. The doctor described it as a "tight squeeze". That baby was 8.5 lbs and the doctor advised that it would be wiser to do a caesarian section for future deliveries to minimize damage to perineum. The next baby was bigger (9 lbs) and so I had a caesarian section. Was this necessary and does possible damage to the perineum justify the risks associated with caesarian section?

A third degree perineal tear means that the tear has extended from the vagina, through the perineal muscles and into the anus. Sometimes the anal sphincter can be damaged by the tear resulting in varying degrees of anal incontinence. Damage may be present even if the sphincter appears to be intact at the time of the repair. Some studies have estimated that between 25 and 57% of women who have undergone repair for a third degree tear have some degree of anal symptoms afterwards. In some studies up to 30% of women had difficulty controlling flatus. Up to 8% experienced leakage of liquid stool and up to 4% of women experienced leakage of solid stool. Other studies have demonstrated that between 17 and 42% of women continued to have significant anal incontinence symptoms after four years of follow-up. Damage to the perineum can also result in prolapse of the womb or even of the rectum. Therefore the consequences of damage to the perineum are potentially serious and can have a serious negative effect on quality of life. I acknowledge the point implicit in your question that caesarian section is not without risk. However, as is often the case in medicine following a particular course of action is based on a consideration of balancing risks. In your case it was a case of balancing the risks of an elective section versus the risk of further damage to your perineum. Performing an elective section meant that your perineum was not going to be subjected to the possibility of a further tear.