Asian women in England almost twice as likely to suffer severe childbirth tears | Childbirth
Analysis has found that Asian women in the UK are almost twice as likely to suffer the most severe birth injuries during childbirth, and many healthcare professionals are unaware of this greater risk.
Third- and fourth-degree tears, also known as obstetric anal sphincter injury (OASI), are the most severe forms of vaginal tear during childbirth.
Up to 90% of women experience some tear during childbirth, most of these injuries heal quickly and have a relatively minor impact. A third-degree tear extends into the muscle that controls the anus, and a fourth-degree tear extends into the inside of the anus.
Asian women suffered third- and fourth-degree tears at a rate of 2,831 per 100,000 births in 2023-24, according to the Guardian analysis of figures obtained through a freedom of information request. This rate is 1,473 per 100,000 for white women and 1,496 per 100,000 for black women.
Such injuries can cause life-changing physical and mental damage, including bowel incontinence, post-traumatic stress disorder, and chronic pain.
Geeta Nayar, a senior partner at Irwin Mitchell and an advocate for the MASIC Foundation and the Birth Trauma Association, which supports women who sustain serious injuries during childbirth, said the reasons why Asian women are at higher risk of severe tearing during childbirth are: “multifactorial – from anatomical and physiological differences to structural systemic issues.”
Lia Brigante, professional policy advisor at the Royal College of Midwives, said that although many Western studies have shown women of Asian ethnicity to be at higher risk of perineal trauma, “this information is not consistently reaching frontline staff as many women tell us their midwife or doctor is unaware they are at higher risk”.
Brigante said: “The reasons for this disparity are complex and unexplained. Differences in care, rates of instrumental birth, nutrition, and disparities in how women’s needs during labor are recognized can all contribute. But there is not enough evidence to fully understand why this gap exists.”
She added: “Every woman deserves self-care and honest conversation about potential risks and available options. Asian women should be supported by evidence-based practices and listened to and respected throughout labor and birth.”
Nayar, who is South Asian and suffered a third-degree tear while giving birth to her daughter, causing permanent injuries, added that the focus should be on what can be changed positively to improve outcomes. She said: “Adequate information about individual risks, including the increased risk of OASI, needs to be provided to women antenatally in a culturally and linguistically acceptable manner.”
The analysis comes after previous research found the number of mothers who suffered a third- or fourth-degree perineal tear while giving birth to their babies rose from 25 per 1,000 in June 2020 to 29 per 1,000 in June this year, a 16% increase.
Chloe Oliver, chief executive of MASIC, said: “Every day at MASIC we see the impact of OASI birth injuries and the emotional and physical consequences they carry throughout life.”
She added: “One of the key risk factors for sustaining OASI is being of South Asian descent, but like many other risk factors such as forceps delivery, carrying a large baby, advanced maternal age or short maternal height, very few women are aware of their risk because it is not routinely discussed at antenatal appointments.”
“Urgent improvements are needed in prenatal counseling to inform women of their risks and enable them to make an informed choice, together with their healthcare professionals, about the best and safest birth for both mother and baby.”
An NHS spokesperson said: “Every woman deserves safe, high-quality, compassionate and equitable maternity care. We are committed to tackling the inequalities affecting Asian women and other communities and ensuring every mother receives the highest standard of support during pregnancy, birth and the postnatal period.”
