The Australian Commission on Safety and Quality in Health Care has released a national Third and Fourth Degree Perineal Tears Clinical Care Standard to help reduce the risk of serious perineal trauma in childbirth.

In Australia, perineal tears are often a taboo topic, even though this birth injury affects up to 5 per cent of women having a first vaginal birth and is above the reported average in the OECD.

In 2017, 2.5 per cent of vaginal deliveries without instruments in Australia resulted in a third- or fourth-degree tear, whereas across the OECD, the figure was 1.4 per cent. 

This new Clinical Care Standard aims to help to ensure that women receive appropriate treatment and support throughout their childbirth experience.

Professor Anne Duggan, Commission Clinical Director, said that both health professionals and women need to feel comfortable talking about perineal tears, since the risk of a third- or fourth-degree tear can potentially be reduced with evidence-based, woman-centred care.

“Minor perineal tears are common during vaginal births, and most heal well, but some women experience a more serious tear that requires surgical repair.

“With third- and fourth-degree tears, there may be short and long-term complications affecting a woman’s physical, psychological and sexual wellbeing.

“We want women to understand that they can talk to their healthcare team to prepare for childbirth, and to know that if a serious tear occurs, high-quality care is available to help them recover well and reduce the likelihood of long-term,” said Professor Duggan.

In a statement, the Australian Physiotherapy Association (APA) welcomed the new standards but says funding is still limited for women needing antenatal and postnatal care.

APA member and women’s health physiotherapist Natalie McConochie, a contributor to the Clinical Care Standard, says improving education is the first step.

“Perineal tears and birth trauma have often been considered a taboo topic, but starting these conversations early during the pregnancy can help improve understanding and empower women to make more informed decisions.

“It is possible to reduce the risk, and even prevent some third- and fourth-degree perineal tears with the right preparation during pregnancy. During recovery, prioritising pelvic floor health is vital. Women’s and pelvic health physiotherapists can assist during all stages. 

“Pelvic floor muscle training is really important in both antenatal and postnatal care, to prepare for the birth and to promote recovery. As women’s health physiotherapists, our goal is to get our patients back to their confident and healthy selves,” says Ms McConochie. 

Rebecca Liberatore, a senior physiotherapist, agrees the initiative is an important step in delivering patient-centred care as an expected standard for all women giving birth.

“Women should be informed of the risks of birth and how to mitigate these.

“Women should be given standardised care with access to appropriate services such as pelvic floor physiotherapy, no matter where they deliver.

“Pelvic floor physiotherapy plays a huge role in helping these women through their pregnancy, post-partum journey and beyond.

“I hope I no longer hear the phrase If only I had known how a pelvic floor physio could have helped me before and after I had my baby.”