A London mother who says she spent more than two years seeking answers after suffering a serious childbirth injury is calling for women to be listened to, amid research suggesting women of South Asian heritage could face a significantly greater risk of severe perineal tears during childbirth.
When Zara Ishfaq watched friends meet in parks and take their babies to groups, she was experiencing a very different introduction to motherhood.
The 31-year-old accountant from Woodford Green was struggling with pain, changing bowel habits and eventually incontinence following the birth of her first child.
“I was barely able to leave the house,” she said.
What Zara did not know was that she had suffered a serious perineal tear during childbirth, an injury she says would take more than two years to be properly diagnosed.
Now living with ongoing bowel complications and a stoma despite undergoing repair surgery, Zara is speaking publicly about her experience in the hope other women will not spend years trying to convince medical professionals that something is wrong.
Her case also raises questions about maternity care for South Asian women, with previous studies finding women of Asian heritage may be at substantially greater risk of obstetric anal sphincter injuries, known as OASI, during a first vaginal birth.
“The solution starts with listening to women,” Zara said. “If birth injuries are recognised earlier, treated sooner, and taken seriously, fewer women will have to live for years with preventable suffering.”
A traumatic start to motherhood
Zara went into labour with her first child, Aariz, in December 2021.
Her labour lasted three days and during delivery at Whipps Cross Hospital in East London, Aariz’s head became stuck.
Forceps were used and Zara underwent an episiotomy. Aariz, who weighed 7lb 7oz, was born safely, but his mother suffered a significant bleed, losing around two litres of blood.
“The only way to describe my prolonged labour was traumatic,” Zara said.
“Even as a first-time mum I felt something wasn’t right. It was terrifying when Aariz’s head became stuck and I was just hoping he would be okay.”
She was discharged two days later.
But instead of beginning to recover, Zara said she became increasingly concerned about her own health.
On Boxing Day, she attended a post-natal appointment complaining of pain, swelling and a suspected infection. Two days later, feeling
feverish and in increasing pain, she sought medical help again.
She said she was subsequently reassured that her condition appeared to be improving.
“In the days after giving birth I didn’t feel right,” she said. “I was in pain and developed a fever.
“But each time I sought medical advice I was given the impression that nobody seemed to think there was anything to worry about.”
Over the following months, the symptoms changed.
By June 2022, Zara was reporting frequent and loose bowel movements as well as leakage. She was advised to carry out pelvic floor exercises.
Six months later, she was still experiencing problems and had begun wearing an incontinence pad.
For Zara, the consequences extended far beyond the physical symptoms.
“While my friends were meeting in the park and attending baby groups, I was barely able to leave the house,” she said.
“I struggled on, but the situation was dire.”
She said the experience also affected her ability to bond with her baby.
More than two years waiting for an answer
Zara was eventually referred for specialist assessment and was seen in July 2023.
Following further investigations, in May 2024 she received confirmation that the severity of the perineal tear she sustained during Aariz’s birth had been underestimated.
She would require major surgery.
“In some ways I was pleased to finally get a diagnosis,” she said. “It felt like a vindication that what I’d been through was genuine.
“I started to get a sense of understanding as to why my symptoms were so severe and debilitating.”
Zara underwent repair surgery in May 2025 but continues to experience complications and now has a stoma.
She has since had a second child, daughter Elayna, but said her injuries also affected that pregnancy.
Zara suffered hyperemesis, severe sickness, as well as infections and at one stage developed sepsis.
“After giving birth, I went from a strong, independent and resilient woman to someone reliant on others,” she said.
“It’s not just the physical injuries that affect you; it’s the psychological toll of having a reduced quality of life.”
Trust admits severity of tear was underestimated
Zara instructed medical negligence specialists Irwin Mitchell to investigate her care and help secure access to specialist therapies and rehabilitation.
Following legal submissions made on her behalf, Barts Health NHS Trust, which runs Whipps Cross Hospital, admitted a breach of duty in relation to her care.
According to Irwin Mitchell, the Trust accepted Zara suffered a tear during delivery whose severity was underestimated. It also accepted that had the injury been detected earlier, it would have been repaired sooner and, on the balance of probabilities, the serious complications she subsequently suffered would have been avoided.
Madeleine Nugent, the medical negligence lawyer at Irwin Mitchell representing Zara, said the case highlighted both the seriousness of birth injuries and the consequences when they go unrecognised.
“What should have been such a joyous time for Zara welcoming her child into the world ended up in years of worsening pain and complications, many of which we feel could have been avoided,” she said.
The legal team is now working towards a settlement intended to provide Zara with access to specialist support and rehabilitation.
Are South Asian women at greater risk?
Zara has since begun researching birth trauma and wants her experience to encourage greater discussion about injuries that many women
may feel embarrassed or uncomfortable speaking about.
According to research highlighted by birth injury charity The MASIC Foundation, around one in 20 first-time mothers suffer an obstetric anal sphincter injury during childbirth.
Separate research has found women of Asian heritage may be at significantly greater risk of suffering OASI during their first vaginal delivery than white women, with some studies putting the increased risk as high as six-fold.
For Zara, those figures make greater awareness among both mothers and maternity professionals particularly important.
She also believes women need to be better informed about their options during childbirth.
“I started reading more about giving birth to a large baby and found that a caesarean can help prevent some of the injuries I suffered,” she said.
“I wasn’t offered a caesarean but knowing what I know now, if I’d have been offered one, I definitely would have chosen that delivery method.”
Despite everything she has experienced, Zara said she feels fortunate to have her two children.
“I feel so blessed and lucky to have my children and they’re adorable,” she said. “However, that I had to go through the experience I did will always upset me.”
She now hopes speaking openly about incontinence, bowel problems, stomas and birth trauma can help remove some of the stigma surrounding injuries women can suffer during childbirth.
“Too many women are suffering unnecessarily and more needs to be done to improve maternity care but also break the taboo around birth injuries to mums,” she said.
“My story isn’t just about what happened to me, it’s about trying to make sure it doesn’t happen to the next woman and empowering mums to know their bodies and make sure they’re involved in their maternity care.”
