Obstetric anal sphincter injury is the perineal outcome that matters most over a woman's lifetime. The measures with the best support are a slow, controlled delivery of the head, warm compresses on the perineum during the second stage, and, where an episiotomy is needed, a mediolateral cut at about 60 degrees from the midline at crowning rather than a midline one.
After every vaginal birth, examine the perineum and do a rectal examination before repair, so that a sphincter tear is recognised and repaired by someone trained to do it.
- Aim for controlled, slow delivery of the head with the woman's cooperation
- Offer warm perineal compresses in the second stage
- If an episiotomy is needed, cut mediolaterally at about 60 degrees at crowning
- Do a rectal examination after every vaginal birth before repairing a tear
- Ask about bowel and bladder symptoms at the postnatal check
Why it matters
Missed sphincter tears cause most of the long-term faecal incontinence after childbirth.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for obstetrics & gynaecology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free