90% of women who birth vaginally will suffer some degree of perineal tear, with a higher incidence in first time mothers.
Up to 5% of these women will suffer obstetric anal sphincter injuries (OASIs) leading to long-term morbidity, including incontinence and fistulae. Daily, over 1,000 women in the UK require perineal suturing. In addition to significant impact on patients, legal claims for perineal injury are a growing burden for medical bodies.
This represents a growing, world-wide unmet need in patient care. As is the case with other issues in women’s health this has been minimised and normalised…
Women are told that it’s normal to still be in pain months after birth. Hannah Dahlen’s work describes the experience of Mila.
She went to her GP to find a solution to be told it was normal:
“It was really the most excruciating pain. So, I couldn’t sit, nothing. I felt terrible, so I had to be in bed a lot. I couldn’t go back to work.”
In increasing desperation she paid for a private specialist appointment who told her “It was probably something psychological” and it would all be “fine”.
Nine months later, after the cause of her pain was correctly identified, Mila underwent surgery to finally address the ongoing issues caused by poor quality suturing (Dahlen et al, 2022).
Skill and compassion for the true impact of perineal injury are lacking in the current system. Peripear is working towards education and prevention for all women and birthing people.
Key statistics
Every year 100 Million women experience perineal injuries globally!
45% of births will lead 2nd degree or above with the cost and impact increasing with severity.
Commonly reported outcomes include:
Loss of confidence in their body!
Painful sex!
Reduced sexual pleasure and sensation!
Anxiety around having further children!
Anal and urinary incontinence!
45% - 1st degree
Perineal mucosa skin only, may not require suturing.
40% - 2nd degree
Skin and muscle of the perineal body, suturing recommended – short term risks: poor suturing leading to infection, misalignment of anatomy, psychological impact, loss of sexual sensation, lubrication and pleasure depending on healing, treatment and location.
5% - 3rd + 4th degree
Skin, muscle and anal sphincter – longer term risks including faecal incontinence/fistula/serious infection/ long term bowel issues and major psychological impact.
Personal stories
“I’d give birth again tomorrow, but I never want to be stitched again.”
Midwife (UK)
He said, I'm just going to have a look. And then with that, then just started to try to stitch me up.” I'd had the most chilled out labour, I wasn't like stressy, I didn’t swear, I didn't cry. But when he did that. It traumatised my partner. He said. You went the whole of that labour. Nothing he said. And then he come in for two seconds….
Mum of 3 (UK)
“9 months to fully assess the healing of my tear. Unlike the books had said, things were not fine.”
First-time mum (UK)
“Our sex life diminished”
Mother (UK)