• Led by Croydon Health Services NHS Trust in partnership with the Royal College of Obstetricians and Gynaecologists (RCOG), the Royal College of Midwives (RCM), and the London School of Hygiene and Tropical Medicine (LSHTM).
  • Aimed to reduce rates of obstetric anal sphincter injury (OASI) following childbirth through use of an evidence-based care bundle, supported by an awareness campaign and multidisciplinary skills development.
  • Phased implementation to 16 maternity units across England, Scotland and Wales.

An obstetric anal sphincter injury (OASI) is any injury to the anal sphincter muscle sustained during childbirth. It can result in medical complications such as anal incontinence and significant psychosocial problems, as well as long-term financial consequences for the NHS associated with ongoing treatment.

OASI rates among first-time mothers tripled in England from 1.8% in 2000 to 5.9% by 2011, with 70,000 women being affected during this period. Research has shown that variation in approaches to perineal protection, training gaps and a lack of awareness of risk factors may contribute to the increased rates.

A team of national experts agreed that there was potential for a ‘care bundle’ of evidence-based actions to be developed. Following a pilot study, this project involved scaling up the OASI Care Bundle in 16 maternity units across England, Wales and Scotland.

Implementation was supported by a multidisciplinary skills development module and an awareness campaign. Sustained leadership and support was provided by the two royal colleges and the project team. Local implementation was facilitated by clinical champions (midwives and obstetricians) within each unit. 

There has been excellent uptake in some units, with a real drive for change. In other units, there has been more of a mixed uptake and level of engagement. The final evaluation will examine how the OASI rates have changed pre- and post- intervention, and will explore what facilitated and inhibited adoption of the care bundle.

The project has highlighted a general need and interest to better manage perineal care. The OASI Care Bundle has women at the heart of the project, and women’s stories were included in the project newsletter, interviews were conducted with women who had received the care bundle, and a series of animated videos were produced. 

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Scaling Up Improvement

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