Pregnant women in England There is a growing risk of serious injury during childbirth, according to the NHS.
number of mothers with third or fourth degree perineal tears during childbirth increased from 25 out of 1,000 in June 2020 to 29 out of 1,000 in June this year – an increase of 16%.
Such traumas can have a “life-changing” impact on women's physical and mental health, causing post-traumatic stress disorder and making them fearful of having another child.
Maternity experts blame the rise in the most serious forms of tears on poor NHS care, staffing shortages in NHS maternity wards and aging mothers.
Women are also at risk because hospitals do not always properly assess the risk of rupture using the assessment method recommended by obstetricians, midwives and MPs.
“Behind these figures are the heartbreaking stories of women who have suffered unimaginable trauma in a moment that should be full of joy,” said Helen Morgan, the Liberal Democrat health spokeswoman who won National Health Service Figures of England from the House of Commons Library.
“The Conservatives' neglect of maternity services has been inexcusable, putting mothers and babies at risk. But Labor risks putting action on the issue on the back burner.”
The figures mean that almost 3% of all women giving birth in England suffered a serious tear. Such injuries damage the woman's anal sphincter and cause long-term pain, birth trauma and incontinence.
The revelation of the rise comes after huge concerns about the poor quality of care for pregnant women in the NHS prompted Wes Streeting, the health secretary, to launch an investigation into maternity and newborn care and create a working group to recommend improvements.
Poor detection and treatment of third- and fourth-degree tears are among the mistakes made by NHS staff that help explain why errors in maternity care cost the service more than £1 billion a year.
For example, the University of Sussex NHS Trust in August agreed to pay £500,000 in damages woman who was left traumatized for life after her fourth-degree tear was misdiagnosed as a second-degree tear when she gave birth at the Princess Royal Hospital in Haywards Heath in August 2021.
This misdiagnosis meant the unnamed woman developed a rectovaginal fistula and experienced toileting difficulties, sexual dysfunction and post-traumatic stress disorder, which affected her relationships with her child, family and friends and meant she was unable to return to work full-time.
Third and fourth degree tears are known on the NHS as 'obstetric anal sphincter injuries' (OASI) as they affect the perineum and anal sphincter or, in fourth degree tears, the rectum as well.
Chloe Oliver, chief executive of birth injury charity Mothers With Anal Sphincter Injuries During Childbirth, said: “OASI injuries are more common during the long second stage of labour, in first-time mothers. [when] baby lying back to back, forceps delivery if baby weighs more than 4 kg at birth and if mother is of Asian descent.”
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Tears are also more likely when doctors use forceps or a suction device to help get the baby out.
Oliver added: “OASI injuries are life-altering and can have a devastating impact on quality of life. Symptoms may include: pelvic pain; difficulty controlling urine, feces and breathing; problems bonding and breastfeeding; psychosexual dysfunction; relationship or career breakdown; and mental health problems including postpartum depression, anxiety, post-traumatic stress disorder and secondary tokophobia, fear of another pregnancy and childbirth.”
A recent report from the National Maternity and Perinatal Development Audit found that 3.29% women gave birth vaginally in England, Scotland and Wales in 2023, suffered some kind of perineal tear.
Dr Rani Thakar, president of the Royal College of Obstetricians and Gynecologists (RCOG), said: “For most women, the tears are relatively minor and heal quickly. However, if a woman has a deeper tear, known as a third or fourth degree tear, it will need to be treated in the operating room and will take longer to recover.”
All maternity units should use the OASI Care Package, which the RCOG helped develop, to assess the risk that an expectant mother might experience a tear, she added. However, this does not always happen, experts say.
Department Health A Social Care spokesman said: “Giving birth can be an incredible moment in a woman's life, but injuries, including perineal tears, can leave mothers deeply traumatized.
“This government inherited an ineffective maternity care system, which is why we have launched a rapid national maternity inquiry, are setting up a national task force and are continuing to build perinatal pelvic health services to reduce the rate of perineal ruptures.”
