This scaling up programme is a collaboration between the RCOG, Croydon Health Services NHS Trust, the Royal College of Midwives (RCM) and the London School of Hygiene and Tropical Medicine (LSHTM), with funding provided by The Health Foundation.
The fourth and final region is now rolling out the care bundle. Each region consists of four participating maternity units who have nominated themselves and committed to participating in the project. Local champions from each unit attended a Skills Development Day at the College and then, using a train-the-trainer approach, are cascading this training to their midwifery and obstetric colleagues.
In the past 10 years, rates of Obstetric Anal Sphincter Injury (OASI) have increased in England. Experiences in some maternity units have shown that some of the underlying problems related to this rise in OASI include:
- Inconsistencies in approaches to preventing OASIs
- Inconsistencies in training and skills
- Lack of awareness of risk factors and long-term impact of OASIs
- Variation in practice between health professionals
In light of this, the OASI care bundle team have developed and piloted an intervention package, including a care bundle and guide, a multidisciplinary skills development module for health care professionals, and campaign materials (such as leaflets and newsletters designed to raise awareness). The OASI Care Bundle Project received funding from the Health Foundation Scaling Up Programme to implement this intervention in 16 maternity units across England, Scotland and Wales.
To reduce overall OASI rates through an increase in the use of standardised prevention practice.
Watch: Croydon University Hospitals NHS Trust on scaling up OASI prevention
Recruitment of the sites is now complete, with both a Midwifery and an Obstetric Champion volunteering to lead the programme from within each hospital. Support from local clinical champions, opinion leaders and professional organisations, as well as patient and public involvement and continuous monitoring and feedback, will help ensure that interventions are acceptable to women and health care professionals.
The programme will run for 2.5 years. The evaluation of the programme will include an evaluation of the impact of the OASI care bundle on clinical practice and clinical outcomes. Results will be shared through a report and launch event.
This project focuses on OASI resulting from labour and vaginal birth. The project excludes the management and prevention of OASI resulting from gynaecological/urological procedures. It also excludes considerations on repair techniques and related co-morbidities.
Evidence for the project
- Carrol F, Knight H, Cromwell DA, Gurol Urganci I, van der Meulen J. Patterns of maternity care in English NHS trusts 2013/2014; 2016.
- Gurol-Urganci I, Cromwell DA, Edozien LC, Mahmood TA, Adams EJ, Richmond DH, et al. Third- and fourth-degree perineal tears among primiparous women in England between 2000 and 2012: time trends and risk factors.BJOG 2013;120:1516–25.
Find out more
For more information about the OASI care bundle Scaling Up Programme, please email Alexandra Hellyer or call +44 20 7772 6347.