Siobhán Ryan at Cian O’Carroll Solicitors recently settled through mediation an important High Court medical negligence case for €700,000 on behalf of a mother whose life was permanently altered by a severe perineal tear that was never identified or repaired at the time of her delivery.
Our client gave birth at South Tipperary General Hospital. The delivery was assisted by the use of forceps. As is typical forceps, an episiotomy incision was made to enlarge the opening of the birth canal and following the birth, this incision was repaired with sutures. The negligence however was that no proper examination was performed to examine the muscles of the anal sphincter complex and as a result, a very severe third degree perineal tear of these muscles went undetected and unrepaired. That failure had devastating consequences for our client.
A perineal tear is an injury that occurs between the vagina and the anus during childbirth. In mild cases, it involves skin and muscle only. In more serious cases, the tear extends into the muscles that control the anus. These muscles, known as the anal sphincters, are essential for continence or both faeces and wind and injuries to them after childbirth must be identified correctly and repaired promptly if damaged.
In our client’s case, she had suffered what is known as a Grade 3C perineal tear. This is one of the most serious obstetric anal sphincter injuries. It means the tear went right through the external anal sphincter and into the internal anal sphincter. When this injury is missed, the life-changing damage usually becomes permanent.
In the months after the birth, our client experienced repeated infections of the episiotomy wound and required further surgical procedures. These infections were a clear warning sign that a deeper injury had been overlooked.
As time went on, she developed permanent bowel incontinence due to damage to the sphincter muscles. She also suffered severe narrowing of the vagina, making sexual intercourse impossible. These injuries affected every aspect of her life, including her confidence, her relationships, her ability to work and her independence.
Almost five years later, she was referred to the National Maternity Hospital at Holles Street for an endo anal ultrasound. This is a specialist scan designed to assess the anal sphincter muscles. Despite her symptoms, she was told by senior clinicians that the muscles were essentially normal.
When we were later asked to act for her, that reassurance did not match her clinical picture. Her symptoms were exactly those we see in women who have suffered serious sphincter tears at childbirth.
We arranged an independent endo anal ultrasound in the UK with a leading colorectal surgeon. That scan showed a full thickness tear through both anal sphincter muscles, confirming a Grade 3C tear that had been missed and left unrepaired for seven years.
Even more concerning, when our expert and an independent consultant radiologist reviewed the single image retained from the earlier scan at Holles Street, they were able to see clear evidence of the tear on that image. It was there all along but had not been reported by Holles Street.
Had our client accepted what she was told and not trusted her own experience, she would never have known the truth about her injury. She would have been denied both accountability and the damages now needed to adapt her life around a permanent disability.
This case is a reminder that serious perineal tears are not an inevitable consequence of childbirth. When they occur, they must be identified, explained and repaired properly. When women continue to suffer symptoms that do not make sense, those concerns deserve to be taken seriously and properly investigated.