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New information resource on obstetric anal sphincter injury launched

News 29 October 2019

New resources for women affected by obstetric anal sphincter injury (OASI), or vaginal tearing during birth, have been developed and published by the Royal College of Obstetricians and Gynaecologists today.

The resources aim to help women better understand vaginal tearing, how to reduce risk of a tear occurring during birth, and how to manage recovery emotionally and physically if a tear does occur.

These have been developed by the OASI Care Bundle Project Team, a project dedicated to reducing severe perineal trauma, OASI Care Bundle Clinical Champions and the RCOG Patient Information Committee.

Nine out of 10 women experience a tear, graze or episiotomy during their first vaginal birth. Most tears heal within six weeks without any long term problems.

About six out of 100 first-time mothers will have a deeper tear involving the anal sphincter muscle, also known as a third or fourth degree tear. This will also occur in two in 100 women who have had a previous vaginal birth.

Every woman is different and recovery varies significantly. Some women may feel pain or discomfort, can find their mobility impaired and a small number of women will suffer anal incontinence, or an inability to control their bowels and/or hold in wind. 

Experiencing complications when giving birth can be very distressing and for some women their mental health may be affected.

The resources outline how women and healthcare professionals can try to prevent tearing and manage their recovery if they do experience it.

 Perineal massage before birth from around 35 weeks of pregnancy is recommended to prevent perineal trauma (mainly episiotomies), and a ‘hands on birth’ may be beneficial for some women where a healthcare professional can support a woman’s perineum as her baby is born.

Pelvic floor exercises may help to improve bladder and bowel control if a woman experiences a tear during birth. It is recommended that women are supported by healthcare professionals, including a physiotherapist, to help recover after a third or fourth degree tear.

 Dr Edward Morris, Vice President for Clinical Quality and President-Elect at the Royal College of Obstetricians and Gynaecologists, said:

“These new comprehensive resources provide women the information they need to understand how to prevent, prepare for and manage tearing during birth. The rates of tearing have increased in England in the last ten years due to variation in practice and lack of training and awareness about the risk factors for perineal trauma. We are committed to lower these rates and improve women’s experiences of childbirth.”

Dr Ranee Thakar, Consultant Obstetrician and Gynaecologist and Clinical Lead for the OASI Care Bundle, said:

“The rising rate of OASI in England is concerning and we have been working hard to implement strategies in maternity units to try to reduce the risk, and provide support for healthcare professionals and women. We feel these resources will be hugely beneficial by providing women with information about vaginal tearing, how they can reduce their risk and support and treatment to help them recover.”

A mother from the MASIC (Mothers with Anal Sphincter Injuries in Childbirth) Foundation said:

“I have been living with the effects of a fourth degree tear for nine years now. When it happened I felt isolated, scared and unsupported. I found no accessible information online. These RCOG resources are invaluable and will empower other women in my situation, to seek appropriate advice and support, as well as reducing the occurrence of these injuries. These resources will prevent other women from suffering in isolation and ignorance, like I did, whilst also supporting health professionals in advising women with OASI."

Note to Editors

For media enquiries, please contact the RCOG press office on +44 (0)20 7045 6773 or email

You can access the new patient information leaflet here, the poster here and the hub here

The OASI Care Bundle Project is a scaling up programme that has developed and piloted an intervention package, including a care bundle and guide, a multidisciplinary skills development module for health care professionals, and campaign materials (such as leaflets and newsletters designed to raise awareness) to reduce the rate of obstetric anal sphincter injury.

It is a collaboration between the RCOG, Croydon Health Services NHS Trust, the Royal College of Midwives (RCM) and the London School of Hygiene and Tropical Medicine (LSHTM), with funding provided by The Health Foundation. Learn more, here

MASIC (Mothers with Anal Sphincter Injuries in Childbirth) Foundation is a charitable organisation which supports mothers affected by OASI, raises public awareness and educates women and healthcare professionals about OASI. Learn more, here

The resources were reviewed during a consultation period by key stakeholders and the public, as well as by the RCOG Women’s Network and Women’s Voices Involvement Panel. These are based on the RCOG Green-top Clinical Guideline The Management of Third- and Fourth-Degree Perineal Tears and expert opinion. 

About the RCOG

The Royal College of Obstetricians and Gynaecologists is a medical charity that champions the provision of high quality women’s healthcare in the UK and beyond. It is dedicated to encouraging the study and advancing the science and practice of obstetrics and gynaecology. It does this through postgraduate medical education and training and the publication of clinical guidelines and reports on aspects of the specialty and service provision.