Study suggests recommendations to improve recovery and health outcomes after cuts and/or tears experienced during childbirth.
A new study has revealed that many women feel unsupported and had their experiences minimised during the weeks and months after experiencing childbirth‑related perineal trauma (CRPT) - despite the condition affecting around 80% of women who give birth vaginally in England.
Published in Midwifery, the study - which was led by researchers from the University of Birmingham, as part of the Chapter Study programme - explores women’s experiences of postnatal care following tears or episiotomies (cuts) sustained during vaginal childbirth and the physical and psychological impact this can have.
Funded by the National Institute for Health and Care Research (NIHR), researchers conducted interviews and focus groups with 29 women across England who had experienced CRPT within the previous year.
Although common, women reported that perineal trauma is often normalised as an expected part of vaginal childbirth. Many felt this contributed to their injuries being minimised, particularly if they did not have a severe tear. Participants described experiencing pain, reduced mobility, difficulty sitting or using the toilet, continence problems, sexual difficulties and emotional distress but didn’t feel that their experiences were always taken seriously by healthcare professionals.
Drawing on their experiences, the researchers have identified recommendations needed for developing an optimised care pathway to improve maternal experience and outcomes in England, including:
Proactive, routine follow‑up to support perineal recovery.
Healthcare professionals who listen, validate women’s experiences and provide clear explanations of what has happened and treatment options where required.
Regular opportunities for physical examination and reassurance.
Better information before and after birth about recovery, warning signs and when to seek help.
We are calling for a clear, standardised CRPT care pathway that would validate women’s experiences, ensure continuity of information, support timely identification of problems, and provide access to effective treatment to improve long-term maternal health outcomes.
Dr Amy Delicate, from the University of Birmingham and lead author of the study, said: “Despite 8 out of 10 women and birthing people being affected by CRPT during vaginal birth, there is currently no standardised care pathway to optimise care following CRPT.
“Whilst many recover without issue, our findings provide a clearer understanding of how women with CRPT in England experience postnatal care - following all types of perineal trauma - and how current care provision could be enhanced and personalised to improve maternal experience and health outcomes.
“We are calling for a clear, standardised CRPT care pathway that would validate women’s experiences, ensure continuity of information, support timely identification of problems, and provide access to effective treatment to improve long-term maternal health outcomes.”
As well as a lack of standardised and compassionate care, women consistently described current postnatal services as prioritising infant care, leaving maternal health overlooked in comparison. Despite NHS guidance recommending several touchpoints during the early postnatal period, women reported that their perineal recovery was rarely explored in depth at these follow-up appointments.
Among the 29 women who took part:
62% reported experiencing a specific problem related to their perineal trauma.
38% did not seek help from a healthcare professional despite ongoing symptoms.
Many women reported no formal perineal examination after birth, even when they raised concerns.
Previous studies have shown that around 70% of perineal trauma requires suturing or stitches, only the most severe injuries - such as obstetric anal sphincter injury (OASI) - routinely receive structured follow‑up. OASI affects around 3% of women, leaving the vast majority impacted by other forms of perineal trauma without an established or routine care pathway.
Professor Laura Jones, from the University of Birmingham and a co-author of the study, said: “Improving postnatal care for CRPT could significantly enhance physical and emotional wellbeing, reduce longer‑term complications and help women to feel that their experiences are validated and taken seriously by their healthcare professionals.”
Healthcare professionals who provide childbirth-related perineal trauma care were also interviewed in a related study as part of the Chapter programme. In the paper, published in Women and Birth, results of qualitative interviews with 36 healthcare professionals highlighted how improvements to care following CRPT could be achieved through standardising pathways for universal postnatal and specialist perineal trauma care using up-to-date evidence.
The healthcare professional paper also highlighted the need to embed latest evidence about postnatal care into education and training, and better information for women about CRPT.
The Chapter Study programme involves four interlinked work packages, with patient and public involvement (PPI) throughout, with the aim of standardising and optimising the care of women with CRPT.
While national pathway development is ongoing, the research team noted that many of the recommended improvements - such as better communication, proactive assessment and more maternal‑focused care - could be implemented within existing services.
For media enquiries and more information please contact Holly Young, Press Office, University of Birmingham, tel: +44 (0)7815 607 157.
About the University of Birmingham
About the National Institute for Health and Care Research
The mission of the National Institute for Health and Care Research (NIHR) is to improve the health and wealth of the nation through research. We do this by:
NIHR is funded by the Department of Health and Social Care. Its work in low and middle-income countries is principally funded through UK international development funding from the UK government.
Qualitative Research Fellow
Staff profile for Dr Amy Delicate, Qualitative Research Fellow for the Department of Applied Health Sciences, College of Medicine and Health, University of Birmingham.
Professor of Qualitative and Mixed Methods Women’s Health Research
Profile page for Professor Laura Jones, Professor of Qualitative and Mixed Methods Women's Health Research in Applied Health Sciences, University of Birmingham.
