Follow-up care post-discharge

After leaving hospital, you should receive follow-up care to promote your physical and emotional recovery and to provide advice for future pregnancies. Arrangements for this care should begin while you are in hospital.

In the weeks after your baby is born, you should be offered a follow-up appointment with an experienced member of your healthcare team who is familiar with your history. They will check that your injury is healing and discuss any other problems you are experiencing. They can help you if you have concerns about pain, incontinence, sexual activities, exercise, or relationship difficulties because of your injury. You may also feel sad or tearful for a period after this type of injury.

To support your recovery, a number of specialist services may be offered, such as:

• Clinics that specialise in treating women with third and fourth degree perineal tears
• Specialist doctors like obstetricians or colorectal surgeons
• Healthcare professionals with experience in pelvic floor health, such as a physiotherapist
• Psychological services.

Your GP or other primary care provider can provide follow-up care and refer you to other services if required. Information about your care and the recommended follow-up will be provided to them in a discharge summary from the hospital.

It is important to talk to your support person or partner, as they may also need help to understand how to support you while you recover and to look after their own health and wellbeing. You may choose for both of you to go to your appointments.

It is also recommended that you talk to a healthcare professional about your future plans for another pregnancy.

Women who experience a third or fourth degree perineal tear need individualised, specialist follow-up care from clinicians with relevant expertise and experience. In the weeks after birth, ensure that the woman has a follow-up with a clinician who has relevant expertise and is familiar with her medical history, to assess and support the woman’s physical, emotional and psychological recovery.

Offer and arrange for post-discharge care in a multidisciplinary perineal clinic or other services appropriate to her clinical needs and injury, such as:

• Clinics that specialise in treating women with a third or fourth degree perineal tear
• Specialist medical practitioners, including obstetricians, gynaecologists or colorectal surgeons
• The GP who will provide ongoing care and referral, if needed
• Clinicians who specialise in pelvic floor function and postnatal rehabilitation for women with a third or fourth degree perineal tear, such as physiotherapists
• Healthcare professionals with specialist expertise providing care to women with third and fourth degree perineal tears, such as midwives
• Nurses with specialist expertise in continence management
• Psychologists with expertise or experience in postnatal mental health or birth trauma.

Any issues that may affect future births, and the woman’s concerns about these should also be considered. Acknowledge that, if the woman’s support person or partner witnessed a traumatic birth, it may affect their health and wellbeing. Offer them an opportunity to debrief and refer them for support if required.

GPs and other primary care clinicians, will provide health care to the woman after discharge. Ensure that adequate information is recorded in discharge summaries about the birth and the woman’s ongoing care needs including monitoring for late onset symptoms or signs of faecal incontinence, dyspareunia, postnatal anxiety or depression, or relationship difficulties, and provide appropriate referral options.

Women with faecal incontinence will need support to effectively manage their condition. As such problems may emerge sometime after birth, inform women that support is available if needed and encourage them to report symptoms.  

Advise women that a third or fourth degree tear does not exclude a subsequent vaginal birth. Advise them to discuss future birth planning with a maternity healthcare provider who has experience in caring for women with previous third or fourth degree tears, who can provide counselling about future pregnancies and discuss the woman’s preferences.

Ensure that policies, procedures, protocols and referral pathways promote comprehensive care, using a multidisciplinary team-based approach. This should include access to services appropriate for women with third and fourth degree perineal tears, including physiotherapy for pelvic floor rehabilitation, continence management, psychological support and surgical expertise, including in specialised multi-disciplinary clinics. A discharge summary should be forwarded to the woman’s general practitioner, which details the follow-up care and referrals needed.