Last week NHS Resolution published a thematic review of Obstetric Anal Sphincter Injury (OASI) Claims within England and Wales having analysed claims over a 10-year period. Their opening statement sets the tone: –
“Obstetric Anal Sphincter Injuries (OASIs) are amongst the most significant and challenging complications of childbirth, with lasting effects on women’s physical, psychological, and social wellbeing”.
At Enable Law we welcome this review. It not only raises awareness of OASI, but also identifies critical areas where care can improve to better support women who suffer perineal trauma.
What is an OASI and why does it matter?
OASI refers to severe perineal tears sustained during vaginal delivery, often involving the anal sphincter and sometimes the rectal lining. These injuries can lead to:
- Faecal incontinence
- Faecal urgency
- Persistent pain
- Sexual dysfunction and psychological trauma
What the NHS Resolution revealed
The NHS Resolution review sets out that nearly 6 in 10 women who experience serious perineal tears during childbirth and brought a claim had their injuries initially misdiagnosed. Whilst an OASI injury is not necessarily a result of negligent care itself, an immediate diagnosis and repair gives the best chance of avoiding symptoms of incontinence and improve the long-term outcome.
- A total of 247 claims were reviewed, with 149 being concluded with damages totalling £40.6million being paid. These figures reflect not only the financial impact but also the profound harm suffered by women.
- 58% of women had their injuries graded as less severe than they actually were, with most initially assessed as second-degree tears when they had in fact sustained third- or fourth-degree injuries requiring specialist repair.
- 61% of claimants had assisted births, with forceps used in 54% of all cases. This evidences how significant the use of instruments is in increasing risk.
- First time mothers accounted for 84% of claims.
These statistics are critical in understanding key themes that clearly highlight where better training and care is needed.
Key areas for improvement
The review identifies six key areas to reduce risk and improve care:
- Safer Assisted Births
Train obstetricians in gentle, controlled instrumental delivery techniques, including correct use of ventouse/forceps and episiotomy when needed. - Supervision & Support
Ensure midwives and junior doctors receive adequate supervision during complex deliveries, especially rotational births. Promote perineal protection throughout. - Accurate Diagnosis
Provide training on systematic vaginal and rectal examinations, including the pill-rolling technique, to detect OASI promptly for optimal repair and outcomes. - Clinician Education
Raise awareness of OASI symptoms, risk factors, and their social and psychological impact. Support teams to follow proper assessment pathways and escalate concerns. Ensure repair training and supervision. - Awareness of Rectovaginal fistula
This is an undetected or repaired fourth degree tear. Whilst it is rare, it has a devastating impact on women and clinicians should be aware of this potential complication and presenting symptoms. - Consistent Management Pathways for missed OASI
Standardise care for missed OASI cases across units to improve consistency and long-term outcomes.
The impact behind the statistics
The review ultimately highlights the devastating consequences of missed or mismanaged OASI injuries: women living with faecal incontinence, unable to return to work, facing intimacy issues, and struggling with psychological trauma. Many undergo repeated surgeries, physiotherapy, and invasive tests, often with uncertain outcomes. Sadly, on many occasions this could have been prevented in absence of negligent care.
It concludes “These insights underscore the urgent need for targeted education, robust clinical pathways, and consistent national guidance to prevent avoidable harm.
While this review marks progress in raising awareness of OASI and key themes, it is clear there is so much more to do. With improved training, these injuries can be prevented. And when they do occur, early recognition and treatment can make all the difference in recovery.
At Enable Law, we regularly support women whose lives have been profoundly affected by missed or mismanaged OASI injuries. The findings of this review reflect what many of our clients tell us: that the harm is not only physical, but deeply psychological and life-changing.
Claire Leslie, Partner at Enable Law, says:
“This review from NHS Resolution highlights the very real and lasting impact that OASI injuries can have on women’s lives. While the statistics are deeply concerning, they also clearly show where improvements can and must be made. Early recognition, accurate diagnosis, and consistent follow-up care are essential in preventing long-term harm. We welcome the focus on education, training, and robust clinical pathways – these are vital steps in ensuring women are properly supported during and after childbirth.”
How Enable Law can help
At Enable Law, we have a dedicated team of specialist solicitors with extensive experience supporting women who have suffered injuries such as OASI. We understand how difficult it can be to talk about deeply personal symptoms, which is why we work with sensitivity, compassion, and care.
If you or a loved one has been affected and would like to understand your options, our team is here to help. We offer free, confidential discussions with no obligation to proceed. You can speak with one of our experts by calling 0800 044 8488 or fill in the form and a member of our team will call you back at a time that suits you.
