Scandal of the mothers left to suffer in silent shame for years with shattering childbirth injuries medics failed to spot

Bethanie Parsons vividly remembers the moment she realised something had gone terribly wrong during the birth of her first child.

After hours of pushing, she was told her baby’s heart rate was slowing and a doctor said forceps were needed to get her baby out quickly. There was no time for pain relief.

‘The doctor inserted the forceps without waiting for a ­contraction,’ she says. During a contraction the uterus tenses to help push the baby through the birth canal.

Bethanie, 28, recalls: ‘I was pulled down the bed as they wrenched my baby out.’ Both her partner Josh, 33, a plumber and on-call firefighter, and mother-in-law had to hold Bethanie ‘to stop me being dragged off the bed by the force of the pulling’, she says.

Bethanie’s screams from the labour ward at St Mary’s Hospital on the Isle of Wight were so loud her mother heard them from the hospital car park.

Straight after the delivery, ­Bethanie was told she had a ­‘routine’ (the doctor’s description) second-degree tear – where the skin and muscle between the vagina and anus splits.

But as doctors began to stitch up the injury, they realised the tear had, in fact, ripped through the muscles that keep the back passage closed and into the lining of the bowel.

It was a not a second-degree tear, but a fourth-degree tear: the most severe kind, known as an obstetric anal sphincter injury (OASI).

This affects around 44,000 new mothers every year. But, as many discover, the fact that such vital muscles are ­damaged as a result of an OASI can have life-changing repercussions.

The day after giving birth, ­Bethanie began losing bowel ­control, soiling herself if she didn’t get to the bathroom in time.

‘I had less than a minute to get to the loo,’ she says. ‘But because it was my first child, I thought at first that it was something that came with being a new mother.’

So Bethanie didn’t seek help – and was ‘too mortified to raise it’ at two emergency appointments arranged to deal with heavy bleeding that she was still ­experiencing weeks after giving birth.

She was asked briefly if she had any bowel ‘issues’ at her six-week check. But she didn’t mention her faecal incontinence, still thinking this was a ‘normal part of recovery and something that came with being a new mother – my primary focus was on the bleeding’.

This is common – most women think incontinence is normal or don’t get asked, and those who raise it are often told it’s hormonal or temporary, according to research in the British Journal of General Practice in 2024.

‘It was very embarrassing but I thought that’s just what I had to deal with from now on,’ says ­Bethanie. She continued to suffer in silence – fearful of travelling more than 30 minutes from her home in case she got caught short.

But it inevitably led to accidents – once, when she was trying to get her then toddler son to nursery.

‘I rang my husband Josh in tears as the nursery workers asked why we were late and my little boy replied, “Mummy’s pooed ­herself,”’ recalls Bethanie.

More women than ever are ­having to endure similar indignity, as OASIs become increasingly common.

A review of studies, published in the journal Midwifery last July, found that rates of OASIs among first-time mothers tripled in ­England between 2000 and 2012, rising from 1.8 per cent to around 6 per cent, with as many as 20 per cent of those given forceps ­deliveries affected.

Partly, this increase reflects the rise in older first-time mothers (with a 9 per cent rise in new mothers aged 35 and above over the past two decades), as tissue is less stretchy with age, increasing the risk of tears. But also the fact that women are giving birth to bigger babies (tens of thousands weighing 4kg – 8lb 13oz – or more are born in England each year), with high birth weight linked to a greater risk of severe tears.

However, experts warn that the ­figures must also be seen against the background of report after report pointing to failings in maternity care and needless ­suffering. Last summer, the National Maternity and Neonatal Investigation was launched by Baroness (Valerie) Amos, to examine ­standards at 12 NHS maternity trusts and recommend ways to improve maternity care generally.

Announcing her interim findings in December, Lady Amos described the situation as ‘much worse than anticipated’ – this despite the fact that there have been no fewer than 748 recommendations to reform NHS maternity care made over the past decade, something Lady Amos described as ‘staggering’.

The initial findings of her investigation included ‘a lack of empathy’ from medical teams and women feeling ‘blamed and guilty’ for failures in care. She wrote: ‘Nothing prepared me for the scale of unacceptable care that women and families have received and continue to receive.’

The failure to prevent – and then to help women affected by – OASIs is symptomatic of this inadequacy of care.

Bethanie believes the rushed delivery of her son was a major factor in causing the damage that’s changed virtually every part of her life.

Doctors and midwives usually wait for a contraction before ­pulling with forceps – the idea being that they utilise the force of the contraction to help get the baby out (at the same time, the vagina and surrounding tissues soften and stretch to allow for the baby’s emerging head).

But pulling without a natural contraction can mean having to pull harder – at a time when the tissues around the baby’s head aren’t properly stretched – increasing the risk of severe tears.

And ‘there is evidence that the use of forceps is associated with a higher risk of tearing’, says Professor Julie Cornish, a consultant colorectal surgeon at Cardiff and Vale University Health Board.

Yet despite the use of forceps – and an OASI – no one asked ­Bethanie at any of her postnatal checks (including when her stitches were examined) whether she was having problems with her bowel control, even though they’re common after this sort of birth injury.

‘So many women live with these symptoms because no one ever told them they weren’t normal,’ says Professor Cornish.

‘If you don’t ask about bowel control at postnatal checks – and the women won’t tell you – the injury gets lost so the real damage is never picked up.’

And that damage ruins lives, she adds: ‘Typically, when I first see a woman, she’s with her ­partner. Next time, she’s on her own. The time after that, they’ve separated.

‘It has huge implications for mental health, sex life, work and family life.’

There are two ring-shaped sphincter muscles around the anus – either may be torn during labour, says Professor ­Cornish, who is also vice president of MASIC, a charity that supports women who have sustained ­serious ­childbirth injuries.

‘They form rings around the back passage – the external sphincter which you can control voluntarily, and the internal sphincter which works automatically. When these are damaged, women lose the ability to control faeces and wind.’

There are four types of perineal tear – a first-degree tear involves only the vaginal skin and should heal naturally. A second-degree tear includes the vaginal tissue and the muscle between the vagina and anus; stitches are needed, usually by a midwife.

A third-degree tear includes the anal sphincter muscle controlling the bowel, and should be repaired in theatre by a doctor with anaesthetic. And a fourth-degree tear includes the rectal lining as well as the sphincter muscle; this requires surgery under a spinal or general anaesthetic,

Astonishingly, serious injuries affecting the sphincter can – and do – get missed by doctors. A study published in the journal Midwifery in July 2025 found that a quarter of first-time mothers who’d delivered vaginally – most of whom were thought to have not torn – who were then scanned with ultrasound were found to have ­damage to the sphincter ­muscles that control the bowel.

Left untreated, this damage can leave women with a lifelong loss of bowel control: Professor Cornish says some only develop symptoms years later around the menopause when oestrogen drops and muscles weaken.

Others never recover properly if the tear was missed or ­inadequately stitched.

‘I saw a lady recently with a third-degree tear from 21 years ago,’ says Professor Cornish.

‘She’s been leaking waste four times a week all that time, and can’t go out for dinner with her family. She was told she had IBS; multiple doctors never connected it to her birth injury – so neither did she.’

Generally, the earlier the injury is spotted and treated, the better the outcome.

When severe tears are repaired immediately, around seven in ten cases are symptom-free 12 months later. But for the three in ten of these women who develop ongoing incontinence, symptoms may persist for years – even ­permanently – without further treatment, such as physiotherapy or surgery, says Professor Cornish. Often, something can be done to help women – if only they can find the right help.

Yet there are real hurdles to getting this. Post-birth bladder and bowel problems are treated by ­different parts of the NHS – the OASI Care Bundle for bowel injuries, and the Perinatal Pelvic Health Services for bladder and pelvic-floor problems (set up by NHS England in 2024, these are physiotherapy-led clinics that aim to improve the prevention, ­identification and treatment).

Yet many obstetricians who manage women who develop symptoms after a severe tear don’t know who to refer them to, according to a UK study ­published in the journal Colorectal Disease last year.

‘There’s a lack of a clear pathway in many hospitals,’ says Professor Cornish. ‘If you’re not sure what to do with it, you avoid it.’

In Bethanie’s case, it wasn’t until she mentioned the leaking to a friend in December 2020 (her son was then 20 months old) – who encouraged her to ask for help – that she was finally seen by a hospital specialist in June 2021.

She was offered surgery, but it came with a one-in-five risk of needing a colostomy bag. ‘But even given the discomfort and embarrassment I was suffering, I was only 24 and having to have a colostomy bag for life was something I couldn’t contemplate.’ says Bethanie.

Then, in 2022, Bethanie’s consultant put her forward for a trial of a sacral nerve stimulator – a small device implanted under the skin that sends electrical pulses to nerves that control the bowel.

The device sends gentle electrical pulses to the nerves in the lower back, which helps control bowel movements. It’s available on the NHS for severe cases after other treatments have failed.

‘Instead of less than a minute, I now get a couple of minutes to reach the bathroom – it’s been life-changing,’ says Bethanie, who now runs a nail business from home in the Isle of Wight so she can stay close to the bathroom, but she has more flexibility.

There are different solutions for women with other post-birth problems. Each year in the UK roughly 200,000 women are left with ­bladder leaks and almost 50,000 with symptoms such as painful sex and pelvic pain caused by ­prolapse (when one or more ­pelvic organs such as the bladder, bowel or womb slip down and bulge into the vagina).

However, ‘most women don’t know services such as the Perinatal Pelvic Health Services exist’, says Kim Thomas, of the Birth Trauma Association.

Even many GPs and midwives don’t know either.

It means women may miss out on seeing specialist pelvic-health physiotherapists trained to carry out internal vaginal examinations and techniques such as internal manual therapy, scar release and bowel rehabilitation – skills general physiotherapists do not have.

This is something Rebecca ­Middleton, 38, a fund manager from London, discovered after developing pelvic girdle pain ­during her first pregnancy.

The condition, which affects around one in five pregnant women, is caused by the joints of the pelvis becoming unstable in pregnancy, with the surrounding muscles tightening up to protect them.

Rebecca was referred to a ­general physiotherapist, who gave her pelvic-floor exercises, but because her pelvic floor and hip muscles were already clamped tight, every attempt left her in agony and made the pain worse. At a second appointment she was told, ‘You’re too severe to treat . . . get some crutches and go on your way’, recalls Rebecca.

‘I was literally being overtaken by people on Zimmer frames,’ she says. Within two months of her symptoms appearing, she was in a wheelchair.

It was only when she paid to see a private women’s health physio, recommended by the Pelvic ­Partnership, a charity offering support and information, that she was correctly diagnosed and treated with internal massage to relax her pelvic floor muscles.

‘The internal physiotherapy was game-changing – every time you walk out of a session you feel ­better,’ says Rebecca.

‘It was incredibly healing – I felt like I was walking on air.’

For Bethanie, despite the improvement in her physical ­condition, her injuries have had a huge impact on her life.

‘The natural birth left me needing a nerve stimulator for life, with surgery every eight to ten years to replace the battery in the nerve stimulator device,’ she says.

When she became pregnant again in 2023, Bethanie was ­‘terrified’ and ‘didn’t want to give birth naturally again’. She had a caesarean in May 2024.

‘My first birth deeply affected my mental health, causing ­nightmares and constant anxiety to this day,’ she says.

‘And the inadequate care ruined my quality of life. I should never have been left this way.’