Birth Injury Expert Witness Evidence: Pelvic Health, Maternal Injury and Rehabilitation Needs

Birth injury claims require careful medico-legal analysis, but they also require sensitivity. The consequences of maternal injury following pregnancy, labour or delivery can be deeply personal, affecting continence, mobility, intimacy, confidence, parenting, employment and quality of life.

For solicitors, the issue is not only whether an injury occurred. It is also necessary to understand how that injury has affected the claimant’s function, what rehabilitation has been accessed, what further treatment may be required, and what needs are likely to remain.

Harrison Associates provides expert witness and case management services for complex injury claims. Our work is grounded in clinical expertise, but also in an understanding of the litigation process, rehabilitation planning, functional assessment and the importance of clear, proportionate evidence. In maternal birth injury claims, this means considering both the clinical diagnosis and the lived consequences for the injured person.

Maternal birth injury and the medico-legal context

Maternity claims remain a significant area of clinical negligence. NHS Resolution reported that £1.3 billion of total clinical negligence payments in 2024/25 related to maternity claims. While many birth injury claims concern neonatal injury, maternal injuries following pregnancy, labour or delivery also require careful expert analysis.

Maternal birth injury may include obstetric anal sphincter injury, pelvic floor dysfunction, bladder or bowel incontinence, prolapse, pelvic girdle pain, diastasis recti, caesarean section scar complications, chronic pelvic pain, sexual dysfunction and pain affecting daily activities. These injuries may not always be visible. A claimant may be living with bowel symptoms, urinary symptoms, pain, reduced confidence, sexual dysfunction, difficulty lifting or carrying, difficulty returning to work, or difficulty managing childcare and daily routines. Some symptoms may also feel private or difficult to disclose, meaning the full impact may not be immediately apparent from the records alone. From a medico-legal perspective, the expert’s role is to assist the court by explaining the clinical presentation, the rehabilitation history, the claimant’s current functional restrictions, likely prognosis and reasonable future needs.

Obstetric anal sphincter injury and pelvic health evidence

Obstetric anal sphincter injury, often referred to as OASI, involves severe perineal tearing during vaginal birth, including third- and fourth-degree tears. The Royal College of Obstetricians and Gynaecologists explains that OASI can occur during vaginal birth and is also referred to as severe perineal tearing or third- and fourth-degree tears.

RCOG patient information states that third- or fourth-degree tears occur in around 3 in 100 women having a vaginal birth in the UK, with higher rates for first vaginal births. Where symptoms persist, the consequences can be significant. The claimant may experience faecal urgency, bowel leakage, urinary symptoms, pain, reduced sexual function, fear of further childbirth, avoidance of activity and loss of confidence.

Specialist pelvic health physiotherapy evidence can assist by explaining the claimant’s current presentation, treatment history, functional restrictions, rehabilitation options and prognosis. It can also assist solicitors in understanding whether symptoms are consistent with the injury history and whether further rehabilitation may improve function.

The role of the physiotherapy expert witness evidence

In birth injury litigation, expert evidence may be required from a number of disciplines, including obstetrics, midwifery, neonatology, paediatric neurology, urology, colorectal surgery, psychiatry, psychology, care and occupational therapy. Physiotherapy and pelvic health evidence adds a practical rehabilitation perspective.

A pelvic health physiotherapy expert may assist with:

1. identifying current functional limitations;
2. assessing pelvic floor dysfunction, continence issues, pain and mobility restrictions;
3. commenting on postnatal rehabilitation needs;
4. considering prognosis and likely recovery trajectory;
5. recommending treatment, therapy, equipment or onward referral;
6. explaining the impact on childcare, domestic activity, employment and social participation;
7. supporting quantum evidence where ongoing rehabilitation, care or support needs are claimed.

This evidence is particularly important where clinical records confirm an injury but do not fully explain its day-to-day consequences. A well-structured expert witness report should translate clinical findings into clear evidence of functional impact.

Featured Expert: Imogen Williams

Harrison Associates is able to provide expert witness evidence from Imogen Williams, a Specialist Pelvic Health Physiotherapist and Expert Witness based in Cardiff.

Imogen has a 16-year background in physiotherapy, with experience managing musculoskeletal conditions and supporting patients to return to functional activities following injury or surgery. Her clinical expertise includes pelvic floor dysfunction, bladder and bowel incontinence, prolapse, pelvic girdle pain, diastasis recti and rehabilitation following obstetric anal sphincter injury. Her practice also includes experience with chronic pelvic pain, vaginismus, bladder pain syndrome, birthing injuries, psychological trauma associated with birth injury, Pilates-based rehabilitation, acupuncture knowledge and caesarean section scar therapy.

Imogen has worked in both NHS and private practice, including as a Clinical Specialist Physiotherapist in Pelvic Health and as a Team Lead Physiotherapist in Musculoskeletal Outpatients. She is HCPC registered, a member of the Chartered Society of Physiotherapy and a member of the Pelvic, Obstetric and Gynaecological Physiotherapy specialist interest group.

This combination of pelvic health, musculoskeletal and rehabilitation experience is particularly relevant where solicitors need expert evidence on functional impact, treatment needs, prognosis and the practical consequences of maternal birth injury.

Why early rehabilitation evidence matters

Early rehabilitation evidence can help identify whether appropriate treatment has been accessed, whether further intervention is clinically justified and whether the claimant’s current limitations are likely to improve. In some maternal birth injury claims, the patient may have had fragmented treatment, delayed referral to pelvic health physiotherapy or limited follow-up. CQC’s maternity reporting has identified continuing concerns across maternity services, including staffing levels, skill mix and whether women’s concerns are listened to.

In a litigation context, this reinforces the importance of careful record review, detailed clinical history, consideration of rehabilitation access and a clear assessment of current function.

Where symptoms are ongoing, expert evidence may need to consider:

1. whether the patient was referred for an appropriate pelvic health assessment;
2. whether further physiotherapy is indicated;
3. whether symptoms are likely to improve with specialist intervention;
4. whether future flare-ups, treatment or surgery may affect function;
5. whether there are long-term restrictions affecting work, childcare or domestic life;
6. whether care, equipment, therapy or practical support is reasonably required.

A clear expert report can help solicitors distinguish between diagnosis, treatment history, current function and future need.

Birth injury, rehabilitation and quantum

In maternal birth injury claims, the value of expert evidence often lies in the detail. A claimant may be independently mobile, but still struggle with lifting, carrying, prolonged standing, intimate care, continence management, fatigue, pain or childcare tasks. These difficulties may not be obvious on a brief review.

A pelvic health physiotherapy expert can assist by considering how the injury affects everyday life, including:

1. personal care;
2. toileting and continence management;
3. sexual function and intimacy;
4. childcare and parenting tasks;
5. housework and domestic routines;
6. sleep and fatigue;
7. mobility and exercise;
8. work and return-to-work planning;
9. confidence, social participation and emotional well-being.

For solicitors preparing schedules of loss, this evidence can help support claims for therapy, treatment, care, domestic assistance, equipment and future rehabilitation. It can also assist in understanding whether the claimant’s difficulties are temporary, fluctuating or likely to remain long-term.

The human impact of maternal injury

The legal issues in a maternal birth injury claim cannot be separated from the human impact. A claimant may be trying to care for a baby while managing pain, continence symptoms, fatigue, anxiety, loss of confidence or reduced mobility. She may also be trying to explain symptoms that feel private, embarrassing or difficult to discuss. This is where expert evidence has a practical value. It can help solicitors, insurers and the court understand how the injury affects real life: not only the clinical diagnosis, but the way the injury changes routines, relationships, employment, parenting and independence.

At Harrison Associates, our approach is professional, evidence-based and human. We understand that expert evidence must be objective and defensible, but it must also recognise the person behind the claim.

How Harrison Associates supports solicitors

Harrison Associates provides expert witness and case management services in complex injury cases. Our work supports solicitors by identifying the right expert for the issues in dispute and by providing evidence that is clear, balanced and suitable for medico-legal scrutiny.

In maternal birth injury claims, we can assist with expert witness evidence addressing current presentation, functional impact, rehabilitation needs, prognosis and future recommendations. Where wider support is required, our case management expertise can also assist with rehabilitation planning, care coordination and practical support following serious injury.

Birth injury claims require sensitivity, technical understanding and clear evidence. The claimant’s experience must be properly understood, but the opinion must also remain clinically reasoned, proportionate and defensible. Specialist pelvic health and rehabilitation evidence can help bridge the gap between clinical diagnosis and the practical reality of living with the injury.

For solicitors handling birth injury, maternal injury, OASI, pelvic floor dysfunction or postnatal rehabilitation claims, Harrison Associates can provide expert witness evidence focused on the issues that matter: function, rehabilitation, prognosis and future need.

Helpful public resources

• Royal College of Obstetricians and Gynaecologists: OASI Care Bundle
  Information on obstetric anal sphincter injury, including third- and fourth-degree tears, and the national care bundle developed to reduce severe perineal trauma during vaginal birth.
  https://www.rcog.org.uk/about-us/quality-improvement-clinical-audit-and-research-projects/the-oasi-care-bundle/the-oasi-care-bundle/
• Royal College of Obstetricians and Gynaecologists: Third- and fourth-degree tears/OASI patient information
  Patient-facing information explaining third- and fourth-degree tears, repair, recovery and what to expect after an OASI.
  https://www.rcog.org.uk/for-the-public/browse-our-patient-information/care-of-a-third-or-fourth-degree-tear-that-occurred-during-childbirth-also-known-as-obstetric-anal-sphincter-injury-oasi/
• Royal College of Obstetricians and Gynaecologists: Green-top Guideline No. 29
  Clinical guidance on the diagnosis, management and treatment of third- and fourth-degree perineal tears.
  https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/third-and-fourth-degree-perineal-tears-management-green-top-guideline-no-29/

• NHS Resolution: Annual report and accounts 2024/25
  Annual data on clinical negligence claims, including maternity-related claims and payments.
  https://resolution.nhs.uk/wp-content/uploads/2025/07/E03358428-NHS-Resolution-ARA-24-25-Web-accessible.pdf
• NHS Resolution: Annual statistics
  Claims data factsheets and annual statistics covering NHS Resolution claims.
  https://resolution.nhs.uk/resources/annual-statistics/
• Care Quality Commission: State of Care 2024/25 — maternity focus
  Public reporting on maternity services, including service quality, staffing, safety and women’s experience of care.
  https://www.cqc.org.uk/publications/major-report/state-care/2024-2025/focus/maternity
• NICE: Caesarean birth guidance NG192
  Clinical guidance on caesarean birth, including decision-making, procedural aspects and care after caesarean birth.
  https://www.nice.org.uk/guidance/ng192
• Pelvic, Obstetric and Gynaecological Physiotherapy: Patient information
  Patient information from the CSP professional network for pelvic, obstetric and gynaecological physiotherapy.
  https://thepogp.co.uk/patient_information/
• Birth Trauma Association
  UK charity providing support and information for women and families affected by traumatic birth.
  https://www.birthtraumaassociation.org/
• Make Birth Better
  UK organisation providing information, campaigning and professional education around birth trauma.
  https://www.makebirthbetter.org/