A new mum was left with incontinence issues after midwives incorrectly diagnosed the severity of a tear suffered whilst giving birth.
In spring 2015, Emma*, fell pregnant with her first child and was due to give birth in December. Throughout the pregnancy, Emma suffered from depression and stress-related symptoms however this improved when she went on maternity leave in November.
The day after Emma’s estimated delivery date a sweep was performed. Four days later she was experiencing a little bleeding and had started contracting. Emma decided to attend her local hospital where the midwife arranged for her to be seen in the pregnancy assessment unit. Nurses in the pregnancy assessment unit reassured Emma, and a second sweep was then carried out.
The next day, in the early hours of the morning, Emma returned to the hospital as her contractions had increased in length; however shortly after arriving she was sent home as she was in the latent phase of labour. Later that evening, Emma decided to return to the hospital as she had much more bleeding, however she was reassured by nurses and sent home again.
The following morning, Emma once again returned to the hospital as her transactions had increased. Her contractions continued to progress and around an hour later she gave birth to her daughter.
The delivery of Emma’s daughter was natural; however, during the delivery the midwife present advised Emma that she had suffered a second-degree tear. This was then stitched up by the midwife and Emma remained in hospital until the afternoon before being sent home.
Around two weeks after giving birth, Emma fell as though she was passing wind through her vagina and decided to attend her GP. Her GP performed an examination of her vagina and the tear. They informed Emma that she was not suffering from a fistula and if she was to pass any stools through her vagina, she would need to return to her GP for further examination and treatment.
Sometime during the following week, Emma felt she may have passed stools through her vagina and had begun having problems with her breasts. This was treated with antibiotics which unfortunately then caused thrush. Emma contacted her GP and informed her that she’s passed stools through her vagina approximately three times. She was then referred to a treatment clinic for further examination.
Emma attended her appointment at the treatment clinic and after her examination was informed that her issues of urgency and incontinence were not something they were able to deal with. She was then referred to the pelvic floor team at a hospital for further investigations.
Upon attending her appointment with the pelvic floor team, Emma was advised it looked like she may have suffered a third-degree rear, rather than a second degree. The doctor advised that the problem was with her anal sphincter and she would need to be treated by the Digestive Disease Colorectal Department at the hospital. Emma was also referred for physiotherapy to build up her pelvic floor muscles.
A month later Emma was seen by the surgical team at the hospital and the consultant advised he wished for her to undergo an ultrasound scan and an anal manometry. He also prescribed Loperamide to slow down Emma’s bowel movements.
Two days later an ultrasound scan was carried out and the sonographer explained Emma had suffered a third-degree tear to her anal sphincter whilst giving birth to her daughter, and not a second-degree tear as she was originally informed. It was then mentioned that she may need surgery to correct the tear.
Whilst on Loperamide, Emma noticed improvements within a week and it helped reduce her urgency and incontinence. An anorectal manometry was also carried out at the treatment centre.
Following a complaint Emma made to the hospital where she gave birth to her daughter; the hospital contacted her and arranged for a consultant urogynaecologist and pelvic floor specialist to look through her files.
Emma attended the consultant’s clinic and he also confirmed it looked like she’d suffered a third-degree tear. He stressed to Emma that she couldn’t remain on medication forever and would likely need surgery. It was recommended for her to undergo electrical stimulation in the meantime to see if this offered any improvement, and he would see her again in six months’ time.
At this point it was also advised that Emma would be required to have a C-section for any future children, which was upsetting for her to hear.
The following month Emma started electrical stimulation, however, this made little difference or improvement to her symptoms. She was reviewed again by the consultant a few months later and he advised against surgery as he believed this would have little benefit to Emma.
It was recommended for Emma to have posterior tibial nerve stimulation (PTNS) which involves putting a needle into the ankle and sending an electric current through it to stimulate the nerves. This would need to be carried out once a week, for at least 30 minutes, over 12 weeks. Emma’s consultant also reiterated that she would require a C-section, should she get pregnant again and she is likely to need to take medication for a long time as her symptoms are likely to get worse during menopause.
Emma was subsequently reviewed by the continence nurse and it was agreed for her to continue with probe nerve stimulation but using a vaginal probe, as she was experiencing pain with the rectal probe.
As a result, she began her PTNS treatment which provide a little bit of improvement with her symptoms.
Unfortunately though, Emma still continues to have problems passing stools and still suffers from incontinence. She often feels like she won’t make it to the toilet in time and try’s to ensure she doesn’t travel too far away or goes to places where she already knows where the toilet is. Emma has also been advised she still may need surgery and has a 10-15% risk of needing a colostomy in the future.
Following the treatment Emma received, she contacted our team at Fletchers to bring a claim against the negligent hospital trust. We investigated Emma’s claim and at the beginning of this, achieved a settlement of £60,000 for Emma.
Although her compensation won’t rectify the negligence Emma has suffered, she can now use her compensation to seek further private medical care and concentrate on her career, family and the future.
Amy Kirk, a medical negligence lawyer who dealt with Emma’s case said
It’s incredibly unfortunate that Emma has been left with these ongoing problems. I hope her case will highlights the importance of midwives recognising the correct degree of tear sustained at birth, to ensure that the appropriate repair of the perineal trauma and recovery takes place. I wish Emma and her family all the best for the future.
*Emma’s name has been changed to protect her identity.