Third and Fourth Degree Perineal Tears Clinical Care Standard

This national standard describes best practice care for the prevention, recognition and management of third and fourth degree perineal tears.

Third and Fourth Degree Perineal Tears Clinical Care Standard 

Third and fourth degree perineal tears affect about 3% of all Australian women who have a vaginal birth, and 5% of women having their first vaginal birth. 

Rates of third and fourth degree perineal tears, vary up to 12-fold across Australia. This clinical care standard aims to reduce unwarranted clinical variation in these rates, and ensure that women who experience a third or fourth degree perineal tear receive care to optimise their physical and psychological recovery. This standard uses a woman-centred approach to ensure that women are informed about their risk and supported to make decisions about their care. 

Contents of the standard and resources 

The Third and Fourth Degree Perineal Tears Clinical Care Standard is made up of seven quality statements and a set of indicators for safe and appropriate care.

  • For women, the standard describes the care a woman should expect during pregnancy, labour and birth, to help them make informed decisions about their care.

    • Find information about reducing risk and recovering from a third or fourth degree tear, a video based on women's experiences and other information for women

  • For clinicians, the standard provides guidance about providing high-quality, evidence-based care to women during pregnancy, labour and birth.

Webcast recording and other videos

Webcast launch – video recording

The Commission hosted a webcast to launch the standard on 21 April 2021.

The launch and panel discussion hosted by Professor Anne Duggan, Acting Chief Medical Officer, provides an overview of the new standard, and discusses some of the evidence driving the need for change.  

Expert panellists include obstetrician Associate Professor Emmanuel Karantanis, midwifery expert Professor Hannah Dahlen, physiotherapist Natalie McConochie, and Janelle Gullan, a woman who experienced a third-degree perineal tear. 

Other videos available include Talking about tears - a video for clinicians and a video featuring women's experiences and advice to other women Third and fourth degree tears during labour and birth - a video for consumers.

Quality statements

Background

The standard was developed in response to a recommendation in the Second Australian Atlas of Healthcare Variation, for a clinical care standard to improve national consistency in best practice care for the prevention, recognition and management of third and fourth perineal tears. 

The Atlas found that in 2012–14, the number of Australian women who had a third or fourth degree perineal tear ranged from 6 to 71 per 1,000 vaginal births in different areas across Australia. There was up to a 12-fold variation between areas. Australian rates of these tears are above the reported average for countries in the Organisation for Economic Cooperation and Development. 

Consultation and endorsement

The standard was developed in collaboration with a topic working group of clinicians, researchers and consumers. Public consultation was conducted in December 2019.  

The standard is endorsed by key professional organisations and colleges including the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), the Australian College of Midwives (ACM) and the Australian Physiotherapists Association (APA). 

Perineal tears: A literature review

The Commission engaged the Burnet Institute to carry out a literature review on third and fourth degree perineal tears to support the development of the clinical care standard.