A new thematic review published by NHS Resolution highlights serious and recurring problems in the diagnosis and management of Obstetric Anal Sphincter Injuries (OASIs) during childbirth. Examining 10 years of compensation claims, the report shows that many women have suffered life-changing injuries that could have been avoided due to misdiagnosis, delayed treatment, and inadequate care.
What is an Obstetric Anal Sphincter Injury (OASI)?
An OASI is a severe perineal tear, classified as a third or fourth-degree tear, that can occur during vaginal birth. These tears involve damage to the anal sphincter muscles.
When an OASI is correctly identified and repaired at the time of birth, many women recover well. However, if the injury is missed, misdiagnosed, or poorly repaired, the consequences can be serious and long-lasting.
NHS Resolution findings
The NHS Resolution review examined OASI claims made between 2011 and 2022. In total, 237 claims were included in the overall analysis, with 93 cases reviewed in greater detail.
The findings showed:
- Total claim costs amounted to £60 million, with an average annual cost of £6 million.
- £40.6 million was paid in damages.
These figures do not include the additional costs associated with the long-term, debilitating effects of OASI on many women’s lives, which often require multiple investigations and complex surgical treatments.
Key findings from the review include:
- The majority of OASI claims involved deliveries conducted by midwives or non-consultant grade doctors, highlighting the need for targeted training and support.
- 61% of OASI claims followed an assisted birth, with forceps used in 54% of these cases. The report emphasised the need for further education and training in instrumental deliveries.
- In 30% of instrumental births, an episiotomy (surgical cut made in the perineum) was not performed, even though it can help reduce the risk of OASI.
Missed and misdiagnosed OASI
The most common reason women brought successful medical negligence claims was due to a failure to diagnose OASI.
- 58% of claims involved misdiagnosed tears
- Most were incorrectly recorded as second-degree tears
- The average delay in diagnosis was 294 days
In many cases, rectal examinations were not performed before or after suturing, despite it being essential to find hidden injuries and ensure the stitches are placed correctly.
Long-term symptoms after OASI
Women affected by undiagnosed or poorly managed OASI often experience multiple, life-altering symptoms. Among the claims reviewed, the most frequently reported symptoms were:
- Faecal incontinence (80%)
- Faecal urgency (77%)
- Pain (74%)
- Psychological trauma (47%)
- Sexual dysfunction (26%)
Many women underwent invasive tests, including scans of the anal muscles and pressure assessments, and 33% required an examination under anaesthesia. Among those needing surgery, 19% had an anal sphincter repair, 12% underwent a colostomy, and 7% had fistula repair. Pelvic floor physiotherapy was the most frequently used non-surgical treatment.
Key areas for improvement in maternity care
The review identified urgent areas for improvement, including:
- Safer assisted vaginal births
- Better supervision of junior doctors and midwives
- Improved diagnosis and grading of perineal tears
- Increased awareness of long-term OASI complications
- Clear pathways for managing missed OASI
Speak to a Medical Negligence solicitor
If you or a loved one has experienced a birth injury, you will understand how profoundly it can affect your life. Pursuing a claim can help provide answers, clarify what happened, and ensure you access the care and support you need, as well as ensuring that changes can be made to improve patient safety.
Our specialist medical negligence solicitors have extensive experience handling OASI and other maternity injury claims. Most importantly, we understand how difficult it can be to talk about these injuries and we are here to make sure you feel heard, supported, and understood.
Please get in touch if you’d like a confidential, no-obligation conversation with one of our medical negligence experts.
