Birth injury - angry and considering complaint to GMC

[Benjysmammy]

I recently delivered at a major London hospital. Induction, long labour, baby's heart rate dipped, wound up in theatre for forceps delivery. I'm grateful that I was delivered of a healthy baby. However the episiotomy performed started at the three o'clock position, rather than the six o'clock position (if that makes sense) and the cut sheared through my right labia, stopping just short of severing it completely and then turned out away from the vaginal opening at the six o'clock position. This didn't become obvious until days after delivery when the hematoma that had formed under the stitches caused them to burst and the labia detached and was left hanging off by a thread of skin. I have just undergone revision surgery to put it all back together and am far from thrilled with the results though I was warned that they might just have to cut it off rather than reattach it so I suppose I should be grateful. I get that childbirth is not for the fainthearted and I didn't expect to come through it completely unscathed but I am angry and do not believe that this is normal - for a start the internet (which knows everything) seems to say nothing of having your labia detached during childbirth. I would like the doctor to stop offering what I feel are arse covering platitudes and admit that she made a simple mistake. She said in my follow up meeting that 'no one has complained about me before' and 'this is how I perform all episiotomies'. I'd like a sanity check, am I overreacting in making a complaint to the GMC - I'm not into bashing the medical profession for no reason. I doubt very much it is her usual practice but in that case I'd like her to admit that and just say sorry - I was rushing to get your baby out - or I just plain started the cut too high, don't know why but oops I'll try not to do that to anyone else - or if she really does do this routinely then to be retrained?

Gosh. No advice but lots of sympathy. Sounds horrendous and I'm sure it's not unreasonable to take this further if only to understand what has happened here. .

I think it is good to complain for all of the reasons you state. If her practice is wrong and she needs retraining and I have not got a clue on that one, then it should come to light while the process is being investigated. Her actions sound a little defensive, bringing up that no one complained about her and this is how I always do it but it would be better if experts investigated. You could contact AIMS for advice.

www.aims.org.uk

I've had a couple of episiotomies and was sliced at an angle rather than straight down (I guess sort of 5 or 7 o'clock rather than 6!) but it certainly didn't slice through my labia!

Just saying "that's the way I do it" does seem inadequate as an explanation to me.

I'm a little confused, an episiotomy in the 6 o clock position is not usual as there is a bigger risk of it extending down and becoming a third or 4th degree tear so when I do them it's always at what we call right mediolateral, or as I'm lookin at it starting between 8/9 o clock and extending diagonally down?

Sounds horrible. Poor you.
In terms of next steps have you asked for a debrief with a midwife and/or a consultant? You could ask via the PALS service at the hospital.
You could also make a formal complaint.

The GMC is concerned with protecting patients from future harm rather than getting explanations for individual cases. So might not be the most straightforward way to get a review and an apology from a doctor. They also work at the pace of a snail. Despite urging the contrary doctors go on the defensive as soon as there is a GMC investigation (their advisers can be very conservative about explanations, reflection and apologies). Maybe hold GMC in your pocket if you are not assured by the hospital that they have properly reviewed your case and the actions of the doctor.

What on earth was her logic in cutting in that direction? I would expect a clear and concise explanation for her doing it the way she did, at the very least.

I had an episiotomy on both births.
Second pic is where i had it, I did end up tearing slightly further & needed stitches to my labia, tbh I think a wee bit was trimmed off as was torn.

Sorry totally tmi there, but I don't think damage to labia is totally unheard of, just very unfortunate that it did happen.

Thanks for the replies, I'm not sure I explained what happened properly. It was a mediolateral, not midline episiotomy, but instead of starting at the bottom of the labia and cutting to the side on an angle (like in picture two above) the cut started much higher - half way between the top and bottom of the right labia and firstly went straight down to the bottom of the labia leaving the labia hanging off and then went off to the side. I looks like almost two separate cuts, one which cuts off half the labia vertically and a second which is a very standard medio-lateral episiotomy - crude diagram attached showing cut line! I have already complained to the hospital but just got a sort of 'oh well, yes very unfortunate, but these things happen' sort of response and it's the individual doctor telling me it is normal that I'm really upset about.

That does look like a strange cut.

I would initially respond to the hospital saying you are not satisfied by their response to your complaint and asking what the next step of complaint is.

It sounds like it would be helpful to get a second opinion from another Obstetrician as to whether this is an acceptable type of cut. If the doctor isn't a Consultant then you could suggest meeting with their Consultant, if a Consultant you could request to see the senior/ lead Consultant.

In honesty I don't think the gmc is the way to go, at least not yet.

By the way I think it's great that you are pursuing this to try and help future women, if the doctor is practising poorly.

My episiotomy was exactly as shown in the second picture FannyFifer put on, I can't imagine the logic to doing one like you had op! Given the fact that you've suffered significant damage, made a complaint and had a meeting and been totally fobbed off and that the doctor has told you she always does it this way I would definitely complain to the gmc.

Gosh how awful OP. Yes take it further. I wonder looking at that if she slipped when making the cut?

Sorry, further clarification, have seen a midwife and two GPs who have all said that it was not a normal episiotomy. The senior consultant at the hospital who reviewed it effectively refused to comment on the basis that she wasn't there at the time and didn't see what happened, so I am just left with the doctor who delivered telling me it is what she usually does (I don't really believe her, I think she doesn't want to admit a mistake) but this is is why I'm considering a complaint to the GMC. I'm grateful for all the replies.

Sounds horrendous op. Have you been through the correct channels for complaining? Each trust has different but it's usually you writing a letter, getting a response via meeting/letter and if you're not happy with their response you can contact the ombudsman to look into it further. Alternatively to that, if you have the finances I would be seeking legal advice from a specialist solicitor.
I don't think it's good enough that the other consultant won't comment as 'he wasn't there '. It seems like all your notes and evidence needs to be reviewed by an independent obstetrician. Do you have photographs? It may also be useful for you to get copies of your notes to see what is written in there (there is a charge but you are entitled to do this).
I'm not familiar with the gmc complaints process so can't comment on that.
From what you have said, I would be seeing a solicitor.

I would also seek legal advice. I suspect the other consultant would be protecting his colleague.
I had an episiotimy recently.. Horrid thing. I think mine was done at the wrong angle too .. Mine seems in between a lateral and a medilateral. It looks like I came v close to tearing my bum hole.

How horrible OP. I'm in the midst of possibly complaining over a traumatic birth, it's a really distressing thing. I haven't had an episiotomy but that does look like a weird cut, I'd definitely take it further.

Really awful OP I am sorry to hear that.

I just gave birth too and had an emergency forceps delivery in theatre too. My cut was exactly like in the picture posted (seeing it makes me feel sore again) - the first picture - an angled cut into my muscle basically. The healing was so painful and it radiated pain, but it's healing very well and visibly I can't see anything really). Yours sounds very very traumatic and I think you are right to make your enquiries/complaint. I hope you get sorted soon X

I am sorry to hear about your experience but I just wanted to mention that the tear along your labia may have happened spontaneously. I have seen this a couple of times in a 19 yr midwifery career. It is a shame that this hasn't been explored with you.

I think you need to complain again to the hospital and then escalate to the Health Ombudsman. You can also make a separate complaint against the particular doctor to the GMC and/or the Royal College of Obstetricians and Gynaecologists.

I had an episiotomy and although I'm not sure of the angle it was neat, didn't affect my labia and was sewn up beautifully. I know that's no help to you but hopefully highlights like pp that the cut you've had clearly isn't normal. Why on earth would she cut that high.

I hope you get somewhere with your complaints. Don't let it go. Xxx

I suffered from birth trauma due to there being no fucking doctors, midwives or beds available on the delivery or antenatal ward. I reported to pals who 6 months later gave a wishy washy 'sorry you feel you suffered from poor care' apology.

I had to have repair work privately and my surgeon has escalated complaint to gmc. That was a year ago and still waiting to hear outcome.

I'd recommend going through pals first and then escalating if you don't get the answers you need.

Good luck

That does sound upsetting, OP. You've got a lot going round in your mind right now, it sounds traumatic and you're trying to make sense of it, right? I felt like you do after I had my son, very violated, no one listened and I had no answers for anything.

I had an episiotomy, it was medio-lateral, the normal way. I also tore off of it (figured it out myself though!) which now looks like an upside 'Y'.

At first glance when I checked, I thought I had been cut twice without consent. I was ready to complain, then thought 'maybe I tore?' I had no idea as they told me nothing about my injuries.
I also found out I had 2 labial lacerations as well which looked (on the diagram in my notes) like the line going down in the diagram you've drawn. So it may be they were spontaneous? I also had stitches on top wall inside and had no idea why! And although it didn't happen to me, I have seen torn labias as well, and know it can happen naturally. Given that it was a forcep delivery...

I'm sorry if this is long-winded, but the doctor saying 'that's how I always do it' is probably because she's referring to where she cut, rather than the whole injury - have you put this to her? That you do not know how the injuries happened, whether they were natural or not?

I'm sorry, I'm trying to make sense of your injury for you in a way as I know how I felt when I first saw the unexplained damage done to me, it was very traumatic to see. On top of that I never knew why I was cut. It's bullshit!

I would continue with the complaint until you get answers. Have you asked for a debrief to help explain your injuries? Then you can decipher from that what happened, it may help.

Please forgive me if this is not helpful. I really hope you get what you need. This is why I think it's important to actually tell women WTF has gone on and why after they have their baby, and not have to play mini detective to find out what happened, to prevent unnecessary emotional trauma!

Sorry, I re-read and want to add more...

Sorry, further clarification, have seen a midwife and two GPs who have all said that it was not a normal episiotomy. The senior consultant at the hospital who reviewed it effectively refused to comment on the basis that she wasn't there at the time and didn't see what happened

I also went to the GP about my injuries. They gave me the wrong answers; they told me I was cut because it would have ended up being a 3rd or 4th degree tear otherwise. NO. My son was a 6 pounder with a small head circumference. It would have been highly unlikely.
I also got told by a different GP I was cut as I would have torn ecause my son was "shooting out" as on my notes it apparently took 6 minutes for my son to come out. My discharge notes are wrong. It was not 6 minutes. Neither of them were there. And the NHS do not necessarily do episiotomies to prevent tears (only in cases of maybe big baby or assisted deliveries). So they were both wrong. What I'm saying is that GPs, in my experience, do not know anything about childbirth so do not go on their every word! They've not got the same knowledge as obs or midwives.

As I assume you've not been told the nature in which your injuries happened, the midwife is taking your word for it, that you were cut that way, and so is obviously saying it's wrong - it would be wrong if you were cut that way, though.

And what the senior consultant may mean by 'she was not there' is that... she didn't see how the injuries occurred. Whether by cut or naturally, is what she means. So she can't really say much.

If you decide to have a birth debrief, there is a page in your notes that has your injuries on with a diagram showing what was stitched and the degree of them, laceration, graze, tear, episiotomy etc. For me to see that was such a relief because they didn't tell me anything when I had my son. It was torture.
He's three now and I only just found out what happened and why in July this year. It would have put my mind at ease SO much sooner had they just showed me the bloody diagram they were colouring in whilst I was oblivious to what they were doing to me! But it seems to me that they think writing what's happened and what injuries you have in your notes and then closing it to be filed away for no one to see is a good fucking idea for some reason! You have a right to know and you have a right to see your own bloody medical and birth notes! It's diabolical to be honest! I wasn't even a fucking metre away from them lying on the bed being stitched up, surely they could have mentioned what happened to me!

(Obviously my son's birth and what happened has now made me look out to help other women who may be going through the same trauma I did - it's horrible being left in the dark about it!)

Go down to '1.16 Care of the woman after birth' - that is what they are meant to do, if they didn't, complain, because it has caused you emotional distress.

www.nice.org.uk/guidance/cg190/chapter/1-recommendations#second-stage-of-labour

I just wanted to thank you all for your comments and support. In response to the suggestions that I might have torn naturally in this way, I'm was told this was not the case by the doctor who performed the episiotomy. She said immediately after the birth when she was stitching me up that I had no tearing or extension of the episiotomy and she didn't revise this position when she examined me two weeks later. My notes which I've reviewed clearly state that I had an episiotomy but no additional tearing nor any extension of the episiotomy tear. You could also see quite clearly that the section what was left hanging off was edged by dead straight surgical cuts which run straight into the episiotomy scar, basically I had a big triangle of open wound and a very long triangular piece of flesh hanging down. The only thing that has made any sense to me is the surgeon who did my repair surgery having now suggested that it was caused because the forceps may have 'rotated everything' and everything was so distended that she couldn't tell where my labia were and cut too high. Though this is not what the doctor said to me, she just said, infuriatingly, that it was normal. I think I am going to just pursue a formal complaint with the hospital and then if I'm not given a satisfactory explanation, something better than it's just normal to be left with you external genitalia hanging off after an episiotomy that I'll go the GMC with the complaint.

I can't add to anything about what happened to you, sounds awful, but thought I would post as I'm currently taking legal action against the NHS for permanent disability caused by misdiagnosis. If you have buildings & contents insurance, you may have legal cover included, I did and it is paying for all my legal fees at the moment, so could be worth a shot if you decide to go down that route.
I hoper you get the answers you are looking for