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Episiotomy requiring repair (01HDC05191)

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(01HDC05191, 16 August 2002)

Right to services of an appropriate standard ~ Services consistent with needs ~ General practitioner ~ Maternity care ~ Episiotomy ~ Perineal repair ~ Right 4(3)

A complaint was made about the maternity care provided by a general practitioner. The complaint was on the basis that when performing an episiotomy the general practitioner, failed to:

(1) repair the perineum immediately after the episiotomy

(2) wait until the local anaesthetic was in place before suturing

(3) suture correctly resulting in the perineum healing incorrectly, the consumer not being able to have sexual intercourse, and the consumer having pain around her perineum four months after the birth.

Additionally, the complaint was that the GP failed to get treatment for the consumer's altered skin integrity in a timely manner.

The facts were that during the second stage of labour a relatively small medio-lateral episiotomy was performed by the midwife under the supervision of the GP, to expedite delivery owing to concern about foetal well-being. The suturing of the perineum to repair the episiotomy was done about an hour later, and caused the consumer pain. The perineal muscle and skin layers were not perfectly realigned, and a band of scar tissue formed. The consumer experienced pain on intercourse about seven weeks after delivery and continued to experience perineal pain four months after delivery. The GP considered that the episiotomy required surgical repair and referred the consumer to a gynaecologist for this surgery. An appointment was not available for about three months, and the GP advised the consumer about the option of private care. The surgical repair was successful.

The Commissioner reasoned, after receiving independent expert advice from a general practitioner and an obstetrician, that perineal pain, painful intercourse, and some degree of malalignment are well recognised and quite common outcomes of an episiotomy after childbirth, which normally subside spontaneously and which are not necessarily due to inadequate care, as even a faultless technique does not guarantee the absence of these problems.

The Commissioner held that the general practitioner:

(1) by waiting an hour after delivery, and therefore increasing the likelihood that the anaesthetic that had been administered earlier was inadequate, failed to perform the suturing of the episiotomy in a manner consistent with the consumer's needs, and accordingly breached Right 4(3) of the Code

(2) acted expeditiously in referring the consumer to a gynaecologist for repair of her episiotomy, and accordingly did not breach Right 4(3) of the Code.

With regard to the consumer's complaint that the episiotomy had not been sutured correctly and that as a result her perineum healed incorrectly, causing a prolonged period of pain and difficulties with sexual intercourse postnatally, the Commissioner held that as there was doubt about the cause of the adverse outcome he would take no further action on these aspects of the complaint.