Quality statements

The Third and Fourth Degree Perineal Tears Clinical Care Standard includes seven quality statements describing the key components of care that women can expect during pregnancy, labour and birth, as well as the care they should receive if they experience a third or fourth degree perineal tear. 

Quality statements

This clinical care standard includes seven quality statements describing the key components of care that women can expect to receive to reduce their risk of a third or fourth degree perineal tear during pregnancy, labour and birth. It also describes the care women should receive if they experience this type of tear, including accurate identification, repair, postoperative care and longer-term follow-up care. It supports the provision of high-quality, evidence-based care, taking into account the context in which care is provided, local variation and the quality improvement priorities of the individual health services.

Follow the links below to read each quality statement in full.

  1.  Information, shared decision making and informed consent

  2.  Reducing risk during pregnancy, labour and birth

  3.  Instrumental vaginal birth

  4.  Identifying third and fourth degree perineal tears

  5.  Repairing third and fourth degree perineal tears

  6.  Postoperative care

  7.  Follow-up care post-discharge

Goal 

This standard aims to reduce unwarranted clinical variation in rates of third or fourth degree perineal tears. It also aims to ensure that women who experience a third or fourth degree perineal tear receive appropriate care to optimise their physical and psychological recovery.

Scope 

This clinical care standard applies to all pregnant women who are planning a vaginal birth, and to women who experience a third or fourth degree perineal tear. It applies to care provided during pregnancy, labour, birth and the postpartum period, as well as post-operative and longer-term follow-up care.

Pathway of care 

This standard applies to care provided in the following care settings:

  • Private obstetric (specialist) care
  • Private midwifery care
  • Care provided by general practitioners (GPs) and GP obstetricians 
  • Public hospital maternity and high-risk maternity care, including continuity of care models 
  • Remote area maternity care
  • Community and home-based care 
  • Postnatal clinics specialising in the treatment of third and fourth degree perineal tears.

In the document, the term ‘clinician’ refers to all types of healthcare providers who deliver direct clinical care to women including:

  • Aboriginal and Torres Strait Islander health workers
  • Doctors (including obstetricians, gynaecologists, GPs, GP obstetricians, and colorectal surgeons)
  • Midwives
  • Nurses (including specialist continence nurses and women’s health nurses)
  • Physiotherapists 
  • Psychologists.

What is not covered

This standard does not cover:

  • Surgical procedures for third and fourth degree perineal tears, or any complications that arise from this surgery 
  • Delayed complications associated with a previous third or fourth degree perineal tear 
  • Other obstetric injuries or complications.