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, sometimes referred to as severe perineal tearing. The long-term consequences of OASI include anal incontinence and painful sexual intercourse (dyspareunia) which can result in significant emotional and medical impact on women.
Population-based studies from Scandinavian countries and Canada identified an increase in the occurrence of OASI. Between 2000 and 2011, OASI rates were also shown to have increased in England.
This trend towards an increasing incidence of third or fourth degree perineal tears did 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 birth 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.
Experiences in some maternity units in England highlighted 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 developed and piloted an intervention package, including a care bundle and guide, a multidisciplinary skills development module for health care professionals, and campaign materials designed to raise awareness among clinicians and women).
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 from 2016 to 2018.
Aims of the programme
The initial aims of the OASI Care Bundle project 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.
Video: The project team on scaling up the OASI Care Bundle Quality Improvement Project