What is OASI?
OASI stands for obstetric anal sphincter injury.
85% of women will sustain some degree of perineal trauma during a vaginal birth and 1 in 20 first time mums are affected by this injury.
Despite these statistics, it’s not often talked about by healthcare professionals, amongst pregnant women or friends or even by midwives during pregnancy.
What types of injury are there?
First degree – injury to the perineal skin or vaginal mucosa (innermost layer of the vaginal wall).
Second degree – injury to perineum involving the perineal muscles but not involving the anal sphincter.
Third degree – injury to the perineum involving the anal sphincter complex:
3a – less than 50% of external anal sphincter thickness torn.
3b – more than 50% of external anal sphincter thickness torn.
3c – both external anal sphincter thickness and internal anal sphincter torn.
Fourth degree – injury to perineum involving the anal sphincter complex (external and internal) and the anorectal mucosa (the area of lining connecting the rectum to the anus).
Buttonhole tear – a tear that only involves the anal mucosa with an internal anal sphincter complex.
Effects
Sadly perineal tears and anal sphincter injuries can have profound effects on a woman including urinary and bowl incontience, pain, discomfort or pain during sexual intercourse, pelvic floor dysfunction and psyhcological impact. All can effect a woman’s ability to socialise, work, carry out everyday activities, care for her baby and impact relationships.
Statstics show that 52% of women say they were embarassed by the symptoms of their injury, 78% were affected by traumtic memories of the birth and 45% suffered post-natal depression as a result of their injury. This needs to change.
Campagins & Support
In recent years there has been an increase in people campaiging for perineal injuries to be more widely talked about.
Geeta Nayar has campaigned for women to be listened to and for there to be better care during and after childbirth in relation to perineal injuries having suffered OASI herself. You can read her story here.
The MASIC Foundation are also a fantasic chairty who advocate for women who have suffered perineal injuries during childbirth. They aim to reduce the incidence of birth injury as well as helping new mothers who may be suffering in silence from its symptoms which are too often hidden in society.
The organisation aims to:
- Raise public awareness and support injured women.
- Support research and prevention.
- Educate the medical profession.
Negligence
Suffering an OASI injury does not necessarily mean that you have experienced medical negligence. While OASI injuries are a known risk associated with vaginal birth, timely diagnosis, appropriate treatment and ongoing support remain essential.
Unfortunately, in some cases there may be grounds for a medical negligence case if there was a delay in diagnosing the injury, the type of injury was incorrectly diagnosed and incorrectly treated (for example a fourth degree tear was misdiagnosed as second degree tear) or the woman was not counselled correctly about her options for birth including a caesarean section (a c- section).
Women who have previously suffered OASI and remain symptomatic should, in accordance with NICE guidance, be offered appropriate counselling about their future birth options, including a c-section. In some cases, a failure to provide this information may mean that a woman is unable to make a fully informed decision about delivery and this can potentially form part of a medical negligence claim.
Kirsty Dakin Specialist Medical Negligence Solicitor, said “I have supported women who have suffered OASI, and the effects can be devastating especially when there is a lack of understanding and support from healthcare professionals. Myself and organisations like MASIC are committed to changing this narrative.”
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