The OASI Care Bundle
As part of the programme, a multidisciplinary team of national UK experts, supported by national professional organisations, developed a ‘care bundle’, which is a set of interventions likely to improve outcomes when implemented together. The elements of the care bundle were selected based on recommendations from existing UK guidelines.
The elements of the OASI bundle included:
i) Informing women about OASI and identifying what can be done to minimise her risk
ii) Performing an episiotomy (a cut in the perineum to assist birth and prevent tears) when required
iii) Using the hands to support the perineum at the time of birth, and
iv) A thorough rectal examination after birth to detect tears, not all of which will be immediately obvious.
All elements of the care bundle are underpinned by good communication with the woman before, during and after birth.
We developed and piloted an intervention package which brought together the care bundle, a skills development module for clinicians and campaign materials to raise awareness among clinicians and women.
Sixteen maternity units in England, Scotland and Wales were recruited to the study, 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, helped ensure that the interventions were acceptable to women and health care professionals.
The programme ran for two-and-a-half years. The evaluation of the programme included an analysis of the impact of the OASI Care Bundle on clinical practice and outcomes, and the acceptability of the care bundle to women and clinicians. The results were published in August 2020 and are available to download below.
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.
Read the study protocol here
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.
Impact of a quality improvement project to reduce the rate of obstetric anal sphincter injury: a multi-centre study with a stepped-wedge design
Exploring clinicians’ perspectives on the ‘Obstetric Anal Sphincter Injury Care Bundle’ national quality improvement programme: A qualitative study
Find out more
For more information about the OASI Care Bundle, please OASICareBundle@rcog.org.uk or call +44 20 7772 6224.