Serious perineal tears during childbirth in England have climbed to nearly 29 per 1,000 births in 2024, up from 23.5 per 1,000 in 2021 — a rise of more than 20% in three years, according to data cited by the Liberal Democrats.

These figures refer to obstetric anal sphincter injuries, or OASI — tears to the tissue and muscle at the back of the vagina that extend into the anal sphincter itself. These are the most severe perineal injuries a woman can sustain during vaginal delivery. Nationally, the average rate sits at 2.9% across NHS trusts, but the gap between trusts is wide — ranging from zero to 8%. First-time mothers face the highest risk: they experience these injuries at 6.1%, compared with just 1.7% in women who have given birth before. The concentration of harm in first-time births is the clearest signal that technique and prevention during delivery matter greatly.

A Target Moving in the Wrong Direction

This upward trend directly contradicts NHS England's national maternity safety ambition: to halve perinatal mortality rates between 2010 and 2025, and to cut the rate of stillbirths, neonatal deaths, maternal deaths, and intrapartum brain injuries by half over the same period. The 2025 iteration of Saving Babies' Lives, published in April 2025, reaffirmed those commitments. Yet 2025 has now passed, and the perineal trauma numbers are moving upward, not downward.

The NHS has tracked maternity injuries through the maternity safety thermometer — a measurement system that records four categories of physical harm — since 2015. This tool should have surfaced the worsening OASI trend early. The wide variation between trusts (0–8%) suggests the problem is not evenly distributed. It may reflect differences in how staff are trained in perineal protection, differences in staffing levels, and whether clinicians use proven preventive techniques such as the HOOP approach (hands-on or poised) and warm compresses during the final moments of delivery.

The variation between trusts points to a core issue: this is not a problem that cannot be solved. It is a problem of uneven execution.

What Sweden's Success Can Teach

NHS England has previously looked to Sweden as a model for maternity reform. Sweden achieved roughly a 50% reduction in serious birth injury claims over six to seven years — a result the national maternity review cited as proof that large-scale improvement was possible. How did they do it? Not through new machines or drugs, but through standardised training in perineal protection techniques, mandatory competency assessments for all staff, and detailed feedback to individual clinicians about their performance.

England adopted the OASI Care Bundle in 2017, drawing directly on that Swedish model. Yet uptake has been patchy across trusts, and the current data shows the gains have not held. The gap between Sweden's sustained improvement and England's rising injury rate is not purely a clinical question. It is a question about how well NHS England can implement and monitor a proven programme across dozens of hospitals with different resources, leadership, and cultures.

The Longer Shadow of Birth Injury

OASI carries consequences that reach far beyond the delivery room. These injuries are a leading cause of faecal incontinence in women, with effects on mental health, work, and quality of life that can persist for years. From a fiscal angle, litigation costs tied to maternity harm — including OASI — represent one of the largest single categories of NHS clinical negligence spending, running into hundreds of millions of pounds annually. That financial pressure is one reason NHS England's maternity safety programme has framed injury reduction as both a clinical and financial necessity.

The Better Births progress report, published in 2020, documented incremental progress on mortality measures at that time. Six years later, in 2025, the perineal trauma numbers are moving in the opposite direction. That gap between ambition and outcome raises a harder set of questions.

The NHS maternity service faces structural headwinds: sustained workforce pressure, midwifery vacancy rates that remain unresolved, and a pattern of reform programmes that succeed in small pilots but falter when rolled out across the whole system. The OASI trend does not exist in isolation. It sits within this broader fragility. Over the next 12 to 18 months, NHS England will need to decide whether to recalibrate its targets, accelerate the clinical bundle programme with real resources behind it, or confront the question of whether current workforce levels can support the safety ambitions the service has set.