Key Highlights
- A third-degree tear extends into the muscle that controls the anus and a fourth-degree tear extends further into the lining of the anus. According to Guardian analysis of NHS figures obtained via a freedom of information request, Asian women suffered third- and fourth-degree tears at a rate of 2,831 tears per 100,000 deliveries during 2023-24.
- This compares with rates of 1,473 per 100,000 for white women and 1,496 per 100,000 for black women. Risk to women of severe bleeding after giving birth at five-year high in EnglandRead moreSuch injuries can result in life-changing physical and mental harm, including bowel incontinence, post-traumatic stress disorder and chronic pain. Geeta Nayar, a senior associate at Irwin Mitchell and advocate for the MASIC Foundation, which supports women who have suffered severe injuries during childbirth, and the Birth Trauma Association, said the reasons Asian women were at a greater risk of severe tearing during childbirth were “multifactorial – from anatomical and physiological differences to structural systemic issues”. Lia Brigante, a professional policy adviser at the Royal College of Midwives, said that although women of Asian ethnicity had been shown in several western-based studies to face a higher risk of perineal trauma, “this knowledge isn’t consistently reaching frontline staff, as many women tell us their midwife or doctor seemed unaware they were at higher risk”. Brigante said: “The reasons for this disparity are complex and remain unexplained.
- Difference in care, rates of instrumental births, nutrition and inequalities in how women’s needs are recognised during labour may all contribute.
- However, there is not enough evidence to fully understand why this gap exists.”She added: “Every woman deserves personalised care and honest conversations about possible risks and options available.
- Asian women must be supported with evidence-based practices and feel heard and respected throughout labour and birth.”Nayar, who is south Asian and experienced a third-degree tear when giving birth to her daughter that left her with permanent injuries, added that the focus needed to be on what could be positively changed to improve outcomes.
