The number of women experiencing serious tears during childbirth in England has jumped significantly. In 2024, nearly 29 out of every 1,000 births involved a severe tear, up from about 23.5 per 1,000 in 2021, according to data cited by the Liberal Democrats.

These are not minor injuries. A serious perineal tear — called OASI — damages the tissue and muscle around the back of the vagina and extends into the muscle that controls bowel movements. These are the most severe tears that can happen during a vaginal birth. On average, the NHS reports a 2.9% rate of these serious injuries, but the numbers vary wildly from hospital to hospital — some see almost none, others see 8%. First-time mothers face the biggest risk: they experience these injuries six times more often than women who have given birth before. That gap matters because it tells us something important: this injury is partly about how birth is managed, not just inevitable biology.

The NHS Made a Promise It's Not Keeping

The NHS committed to cutting serious birth injuries in half by 2025. That deadline has now passed, and the opposite is happening — the number of serious tears is rising. The NHS has tools to spot problems early. It uses a "maternity safety thermometer" that tracks birth injuries across hospitals. Yet despite having this warning system, the rise in serious tears crept up.

But here's what's interesting: the problem is not the same everywhere. Some hospitals have barely any serious tears. Others have many more. That gap suggests this is not a puzzle that cannot be solved. Hospitals that do well tend to use the same techniques: they train staff carefully in how to protect women's bodies during the final moments of delivery, they check that staff are doing it right, and they give individual doctors and midwives feedback about their results. The hospitals that struggle often have not put those practices in place, or have done so unevenly.

Sweden Shows It Can Be Done

Sweden faced the same problem years ago. Rather than accept it as inevitable, hospitals there did something simple but rigorous: they trained everyone in the same perineal protection techniques, made sure every midwife and doctor could do them correctly, and gave staff honest feedback about how they were performing. Over six to seven years, serious birth injuries fell by roughly half.

England decided to copy Sweden's approach. In 2017, the NHS rolled out a similar programme called the OASI Care Bundle. But here is where things fell apart: different hospitals adopted it at different speeds, some more seriously than others. The result: the gains did not hold. England now has worsening numbers while Sweden's improvements have stuck.

Why This Matters Beyond the Hospital

Serious perineal tears have effects that last far beyond recovery from birth. Many women develop bowel control problems for months or even years afterward. These injuries affect women's mental health, their ability to work, and their overall wellbeing. From a money angle, birth injuries cost the NHS hundreds of millions of pounds in compensation claims each year. That is a financial crisis on top of a human one.

The NHS set an ambitious target: halve birth injuries by 2025. That year has come and gone, and the situation has worsened instead of improved. The deeper issue is not hard to spot. The NHS is short of staff, midwifery positions are not being filled, and programmes that work well in small test runs often fail to take off across the whole system. The rise in serious birth tears sits inside this bigger picture of strain.

Over the next year or so, the NHS will need to decide what comes next: strengthen the programme that worked in Sweden with real funding and enforcement, or accept that current staffing levels cannot deliver the safety promises the service has made.