Serious perineal tears during childbirth in England have risen to nearly 29 per 1,000 births as of 2024, up from 23.5 per 1,000 in 2021 — a climb of more than a fifth in three years, according to data cited by the Liberal Democrats.

The figure refers to obstetric anal sphincter injuries (OASI) — third- and fourth-degree perineal tears — the most severe end of a spectrum that already carries significant morbidity. Nationally, the average incidence of severe perineal trauma sits at 2.9%, but the distribution is wide, ranging from zero to 8% across NHS trusts. The disparity is starker by parity: first-time mothers sustain these injuries at a rate of 6.1%, compared with 1.7% in multiparous women, underlining how much of the risk is concentrated in nulliparous births.

A Target That Has Not Moved

The rising injury rate lands squarely against NHS England's national maternity safety ambition: to halve perinatal mortality rates between a 2010 baseline and 2025, and to halve the incidence of stillbirths, neonatal deaths, maternal deaths, and intrapartum brain injuries in the same timeframe. The 2025 iteration of Saving Babies' Lives, published in April 2025, reaffirmed those commitments. Whether the mortality-focused elements of that ambition will be met is a separate question, but the trajectory on perineal trauma points in the opposite direction.

The NHS has tracked maternity harms through the maternity safety thermometer — a measurement tool that records the occurrence of four categories of physical harm — since at least 2015. That infrastructure exists, in principle, to surface exactly this kind of trend early. The widening inter-trust range (0–8%) suggests the problem is not uniform and may partly reflect variation in clinical technique, staffing levels, and the use of preventive manoeuvres such as the HOOP (hands-on or poised) approach and warm compresses at crowning.

What Sweden's Experience Suggests

NHS England has previously drawn on Sweden's experience to frame its reform ambitions. Sweden achieved a roughly 50% reduction in serious birth injury claims over six to seven years, a trajectory the national maternity review cited as evidence that large-scale improvement was achievable. That reduction was driven by standardised training in perineal protection techniques, mandatory competency assessments, and granular audit feedback to individual clinicians. The key variable was not new technology but consistent procedural discipline at the point of delivery.

England adopted elements of that model — the OASI Care Bundle, rolled out from 2017 — but uptake across trusts has been uneven, and the current data suggests the gains have not held or scaled. The gap between Sweden's achieved reduction and England's worsening numbers is not simply a clinical puzzle; it is an implementation and governance question.

Why This Matters Beyond the Delivery Room

Obstetric anal sphincter injuries carry consequences well beyond the immediate postpartum period. They are a leading cause of faecal incontinence in women, with downstream effects on mental health, employment, and quality of life that persist for years. Litigation costs linked to maternity harm — including OASI — represent one of the largest single categories of NHS clinical negligence expenditure, running into hundreds of millions of pounds annually. That fiscal pressure is one reason NHS England's maternity safety programme has consistently framed injury reduction as both a clinical and financial imperative.

The Better Births four-years-on progress report, published in 2020, documented incremental progress on mortality metrics at that point but was measured in its optimism. Six years on, the perineal trauma numbers are moving in the wrong direction as 2025 — the deadline year for the halving ambition — has now passed.

The broader context here is one of structural fragility: an NHS workforce under sustained pressure, midwifery vacancy rates that have not been resolved, and a pattern of reform programmes that achieve proof-of-concept in pilots but stall at system-wide rollout. The OASI trend does not sit in isolation. It sits inside that pattern. Whether NHS England will recalibrate its targets, accelerate the clinical bundle programme, or face harder questions about workforce capacity is the operative question for maternity policy over the next 12 to 18 months.