12. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not seen any indications that something has gone wrong.
13. Mrs D complains the Trust sutured her incorrectly. She says the Trust sutured undamaged skin which led to severe pain, an infection and a ridge of tissue to develop. She says when the sutures were removed she felt an immediate release and her pain reduced.
14. The Trust said there is no indication it sutured the episiotomy site incorrectly and its records indicate the site was healing well
15. GMC guidelines say clinicians must provide a good standard of care. When assessing and treating patients, clinicians must promptly provide suitable and effective treatment based on the best available evidence.
16. Mrs D told us of her concern the midwife recorded the two sutures had no purpose. We appreciate this must have come as a shock. Our adviser said an episiotomy involves making a cut on the vaginal skin. The edges of the vaginal skin are then sutured together to promote healing. Our adviser said the location the midwife described and demonstrated on the diagram is consistent with the episiotomy repair the Trust had carried out.
17. We recognise it must have been worrying for Mrs D to learn the midwife describe the sutures as joining undamaged skin. Our adviser said the different areas of an episiotomy site heal at different rates. They said it is likely the tissue in that area had already largely healed by the time the midwife carried out the review. They said this does not indicate the original repair was inappropriate.
18. We think the Trust’s action here in line with GMC guidelines to provide a good standard of care and arrange suitable treatment. It appears sutures on the right side of the vaginal skin, near the bottom are usual following an episiotomy repair. The skin is likely to have appeared healthy to the midwife as it had already healed.
19. We acknowledge Mrs D’s concern she developed an infection in the area where the sutures were. Our adviser said infection after episiotomy repair is very common as the area is naturally exposed to bacteria, making infections more likely. They said the fact the infection developed around the sutures does not indicate the Trust placed the sutures incorrectly.
20. Mrs D told us she felt immediate pain relief, once the midwife removed the sutures. Our adviser said this is likely to have been due to swollen tissue around the site, being relived of tension when the sutures were removed. They said this does not indicate the Trust incorrectly placed the sutures.
21. We appreciate Mrs D’s concern about the small ridge of tissue attached to the episiotomy site. We understand this still causes her discomfort. Our adviser said it is usual following an episiotomy for scarring and uneven healing to develop. They said the small ridge of tissue is consistent with a repair that has not healed evenly and developed scarring. Our adviser said this does not indicate the sutures were placed incorrectly.
22. We recognise how distressing it must have been for Mrs D to experience physical symptoms during a time when she was tending to her baby. We do not wish to diminish how these complications impacted her physically and emotionally. We hope our work here offers Mrs D reassurance these issues are recognised complications of episiotomy repair and do not indicate the repair was inappropriate.
23. It is understandable, in light of the midwife’s comments, that Mrs D is concerned the Trust sutured her incorrectly. On the balance of probabilities, we do not think the Trust sutured Mrs D incorrectly. The advice we received suggests the repair was consistent with a standard episiotomy repair. We have seen no indication the Trust has failed to act in line with the GMC guidelines. As there are no indications the Trust did anything wrong here, we will be taking no further action.
24. We are very sorry to hear of the distressing symptoms Mrs D suffered following the episiotomy repair. We have seen the physical issues Mrs D experienced can occur even when the repair has been carried out appropriately, and we hope this provides her with some reassurance. We thank Mrs D for bringing her complaint to us.