Medical Negligence Lawyer Raises Awareness Of Obstetric Anal Sphincter Injury In Bid To Help Other Women

A mum has revealed the lifelong impact a serious injury she suffered during childbirth has had - and backed a major awareness campaign. 

Geeta Nayar, from North London, suffered a third-degree perineal tear and nerve damage when her first child was delivered by forceps. 

Geeta, a medical negligence lawyer at law firm Irwin Mitchell, underwent surgery for her injury also known as an obstetric anal sphincter injury (OASI). However, surgery failed, and the day after her traumatic delivery she started suffering symptoms including incontinence.

However, despite several further procedures, 15 years after giving birth, Geeta, aged 46, continues to suffer with debilitating symptoms including incontinence, pain and scar tissue. 

Geeta raises awareness of OASIs and support available

Geeta, who is married to Ed, aged 49, represents others affected by OASI in legal cases.

She is now using Birth Trauma Awareness Week to speak for the first time about her experience and the support available to women.

Research from the birth injury charity The MASIC Foundation found around one in 20 first-time mums suffer an OASI during childbirth. However, further studies have found ethnicity also plays an issue, with women of Asian heritage at up to six times greater risk of suffering an OASI during their first natural delivery than white women. 

Expert Opinion

“When we got married we were overjoyed to be expecting our first child. We’d painted the nursery bright yellow, and my birth plan had been meticulously prepared. We were excited about what the future held.

“After several hours it was clear I had stopped making any progress. I was exhausted with pain and there was a change of shift. It was at this point the situation started to deteriorate.

“I was concerned about the safety of my daughter, but any request to discuss options such as being moved to theatre were just dismissed.

“The situation continued to deteriorate until, there was marked foetal distress and what followed can only be described as a nightmare. Panic ensued, there were several failed attempts at trying to deliver my daughter by a ventouse suction cup followed by an extremely forceful and traumatic forceps delivery. My daughter was born with deep cuts to her face and I sustained a tear involving the entire length of the external and internal anal sphincter, and nerve damage.

“I was left completely traumatised by the experience. Instead of holding and feeding my daughter I was taken to theatre for several hours for an attempted repair. This unfortunately failed and I suffered my first episode of incontinence the very next day.” Geeta Nayar

Birth trauma injury: Geeta Nayar's story

Geeta was discharged three days later. However, once home she had no medical support and struggled to leave the house because of her injuries.

Geeta visited her GP several times. It was only several months later she was referred to a specialist perineal trauma unit. Following tests, the full extent of her injuries, including that her nerves had been damaged and initial surgery had failed was established. 

Geeta has since undergone several procedures but still lives with her symptoms. 

Expert Opinion

“I went from being a resilient, independent woman to needing significant help.

“While my friends were meeting in the park and attending baby groups, I was barely able to leave the house. I struggled on, but the situation was dire. It was only when I finally saw a specialist several months later I was told for the first time how serious my injuries were.

“It was horrifying to hear, but also, a relief to finally understand why my symptoms were so severe and debilitating. Since then I have undergone further surgical repairs which have also failed but I simply have had to adjust the way I live to cope.” Geeta Nayar

OASI and MASIC's work supporting women

In 2015 Geeta was contacted by Professor Keighley, a leading colorectal surgeon looking into the impact of OASI injuries. The MASIC Foundation was formed the following year and is the only multi-disciplinary charity to support women who have suffered perineal injuries during childbirth. The MASIC Foundation is calling on the NHS to implement a seven point plan to reduce birth injuries including increased training, awareness for pregnant women as well as specialist clinics and psychological support. 

Research shows women of Asian heritage up to six times more likely to suffer obstetric anal sphincter injury

While undertaking research into OASI injuries, Geeta came across statistics that documented ethnicity as a significant risk factor and that Asian women have the highest risk of third and fourth degree perineal injuries.

Expert Opinion

“A 2019 paper in the International Urogynaecological Journal reported those who had sustained an OASI, and had responded to the study, were up to six-and-a-half times more likely to be of Asian ethnicity. The cause for this is disputed but one explanation is variation in perineal body length. However, there is very little research on it. It’s just an accepted statistic, of which I was one of.

“If you ask any woman whether she would want to be told of a risk factor that may affect her six times as much, I’m sure the answer would be a resounding yes.

“Had my ethnicity been taken into account and I’d been told of my greater risk of perineal injury as an Asian woman having her first child, and the healthcare professionals whose care I was under knew of these risk factors, I strongly believe the outcome may have been different.

“What happened to me was despite being born in this country and with a sound knowledge of the medical system.

“Now imagine those difficulties being compounded by having a poor grasp of the language, or living in a community where talk of issues such as incontinence is completely taboo. The cultural, language and structural barriers to understanding and accessing adequate care can be insurmountable.

“It's taken me many years to come to terms with and find the courage to speak about what happened to me. The issue of birth trauma is still relatively taboo, but I hope by speaking out I can help other women. Support from organisations such as The MASIC Foundation and The Birth Trauma Association is available, no-one should have to go through this experience alone.

“While it’s too late for me and I’ll always be affected by what I’ve been through, it’s vital that other women are aware of the risks of OASI injuries in childbirth so they can make informed decisions about their care and potentially avoid years of trauma, surgery and loss.” Geeta Nayar

Support available for women affected by OASI

Birth Trauma Awareness Week runs from 16-22 July. More information on The MASIC Foundation can be found on its website. 

Find out more about Irwin Mitchell's expertise in supporting families affected by birth injury at our dedicated birth injuries section. Alternatively to speak to an expert contact us or call 0370 1500 100.