Pregnant women in England are facing an increasing risk of sustaining serious injuries during childbirth, according to new NHS data.
Figures show that the rate of third- and fourth-degree perineal tears has risen from 25 in every 1,000 births in June 2020 to 29 in every 1,000 by June this year — a 16% increase.
These injuries, known medically as obstetric anal sphincter injuries (OASI), can have life-changing consequences, affecting both the physical and mental wellbeing of new mothers. They can lead to chronic pain, incontinence, post-traumatic stress disorder, and a deep fear of future pregnancies.
Childbirth specialists have linked this sharp rise to understaffing in NHS maternity wards, poor-quality care, and an increase in maternal age and weight. Experts also warn that hospitals are failing to properly assess the risk of severe tearing by not consistently applying the OASI care bundle recommended by obstetricians, midwives, and MPs.
Helen Morgan, the Liberal Democrat health spokesperson who obtained the figures from the House of Commons library, said: “Behind these figures are heartbreaking stories of women suffering unimaginable trauma at a moment that should be full of joy. The Conservatives’ neglect of maternity services was unforgivable, putting mothers and babies under threat. But Labour risks kicking action on this problem into the long grass.”
The data shows that nearly 3% of all women giving birth in England experience serious perineal tears, which can damage the anal sphincter and rectum, leading to long-term complications.
The findings emerge amid growing concern over the quality of NHS maternity care. Health Secretary Wes Streeting has launched an inquiry into maternity and neonatal care and established a national taskforce to recommend urgent improvements. Errors in maternity care currently cost the NHS over £1 billion annually.
One recent case illustrates the consequences of misdiagnosis. In August, University Hospitals Sussex NHS Trust agreed to pay £500,000 in damages to a woman whose fourth-degree tear was wrongly identified as a second-degree tear when she gave birth in 2021. The error left her with lifelong complications, including a rectovaginal fistula, chronic pain, and postnatal trauma.
Chloe Oliver, chief executive of the charity Mothers with Anal Sphincter Injuries in Childbirth, explained that such injuries are more likely with a prolonged second stage of labour, first-time births, forceps deliveries, babies in a back-to-back position, or those weighing more than 4kg. She also noted that women of Asian ethnicity face a higher risk. “OASI injuries are life-changing and can have a devastating impact on quality of life,” she said. “Symptoms can include pain, incontinence, sexual dysfunction, bonding difficulties, and serious mental health issues.”
A report by the National Maternity and Perinatal Audit found that 3.29% of women who gave birth vaginally in England, Scotland, and Wales in 2023 suffered some degree of perineal tear.
Dr Ranee Thakar, president of the Royal College of Obstetricians and Gynaecologists (RCOG), stressed the importance of proper assessment. “For most women, tears are relatively minor and heal quickly. However, if a woman experiences a deeper tear, known as a third- or fourth-degree tear, this needs to be repaired in an operating theatre and their recovery will take longer.”
The Department of Health and Social Care acknowledged the issue, stating: “Childbirth can be an incredible moment in a woman’s life, but suffering from injuries, including perineal tears, can leave mothers deeply traumatised. This government inherited a failing system of maternity care which is why we opened the rapid national maternity investigation, are setting up a national taskforce and continue to put in place perinatal pelvic health services to reduce the rates of perineal tears.”
The rise in severe birth injuries highlights the urgent need for better staffing, training, and consistent use of assessment tools to protect mothers from preventable trauma during childbirth.
