Background and history of the OASI Care Bundle project
What is OASI?
An OASI is an obstetric anal sphincter injury which can occur during vaginal birth. The long-term consequences of OASI include anal incontinence and dyspareunia which can result in significant emotional and medical burden to women.
Population-based studies from Scandinavian countries and Canada identified an increase in the occurrence of OASI. In the past 10 years, rates of OASI have also increased in England. This trend towards an increasing incidence of third or fourth degree perineal tears does not necessarily indicate poor-quality care. Tearing is a complex issue which could be influenced by a range of factors including; advanced maternal age at first birth, larger maternal BMI and birth weight of the baby, instrumental delivery and better detection and reporting.
However, as OASI can dramatically impact the short and long-term health of women influencing decisions about future births, prevention and management of OASI is a priority.
Aims of the programme
The initial aims of the programme were:
- To investigate and identify patterns of care, morbidity and outcomes related to women who suffered an OASI in Great Britain
- To raise awareness about the incidence of OASI among all health professionals involved in maternity care
- To review the literature on clinical interventions for the prevention of OASI
- To produce an evidence-based care bundle to support clinical practice
- To pilot the care bundle in a sample of units
This project focused on OASI resulting from labour and vaginal birth. The project excluded the management and prevention of OASI resulting from gynaecological/urological procedures. It also excluded considerations on repair techniques and related co-morbidities.
The programme included the following activities:
Outputs of the OASI project
Analysis of secondary care data
- Edozien L, Gurol-Urganci I, Cromwell D, Adams E, Richmond D, Mahmood T, van der Meulen J.Impact of third- and fourth-degree perineal tears at first birth on subsequent pregnancy outcomes: a cohort study. BJOG. 2014 Jul 9. doi: 10.1111/1471-0528.12886.
- 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.
OASI Care Bundle
Following the OASI ‘Summit’ held at the RCOG on 1 May 2014, the RCOG committed to reducing OASI throughout the UK.
The RCOG have been working with the Royal College of Midwives to increase awareness of OASI incidence and risks among health professionals involved in maternity care and to develop tools to improve the prevention and management of severe perineal tearing. A national group of experts have been involved in the development of the OASI Care Bundle.
A care bundle is defined as a small set of evidence-based interventions for a defined patient segment or population and care setting that, when implemented together, will result in significantly better outcomes than when implemented individually.
The elements of the OASI bundle include communication with the woman to enable a slow controlled birth of the baby, performing an episiotomy (a cut in the perineum to assist birth and prevent tears) when required, using the hands to enable perineal protection at the time of birth and a thorough examination after birth to detect tears not all of which will be immediately obvious.
We have developed and piloted an intervention package which brings together the care bundle, a skills development module, and campaign materials. Over the next couple of years, we will be scaling up this project, implementing the intervention in 16 sites across Great Britain and looking at the outcomes over this period.
Find out more
For more information about the OASI care bundle, please OASICareBundle@rcog.org.uk or call +44 20 7772 6347.