Beyond perceptions: evaluating South Asian background and its association with obstetric outcomes

Background: Perineal lacerations are common complications of vaginal delivery and can lead to pain, infection, incontinence, dyspareunia, and impaired pelvic floor function. These injuries occur more often after operative vaginal deliveries (OVDs). Clinicians at St. Joseph’s Medical Center (SJMC) raised concerns that severe third- and fourth-degree lacerations may be higher than expected and disproportionately affect South Asian women, a population that may be at increased risk of obstetric anal sphincter injuries (OASIs) due to shorter perineal body length and unique pelvic anatomy. Methods: A retrospective review of 937 randomly selected delivery records from 2018–2025 at SJMC in Stockton, California was conducted. Ethnicity was verified by chart review and patients were contacted when necessary, and data was stratified by ethnicity to evaluate associations with caesarean delivery, OVDs, and perineal lacerations. Results: South Asian women accounted for nearly 40% of all caesarean deliveries, over 40% of OVDs and perineal tears. Notably, of the Asian population group, South Asians experienced 100% of the severe 4th degree perineal tears reported. And, from the entire eligible study population, South Asians contributed to nearly 17% of severe perineal tears. Conclusions: Although provider bias persists in viewing South Asian women as higher risk, the data suggest SJMC obstetricians maintain low overall adverse outcomes while identifying a subgroup that may benefit from further study.