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NHS England publishes implementation guidance for Perinatal Pelvic Health Services

19 Oct 2023

NHS England have today published implementation guidance for Perinatal Pelvic Health Services (PPHS), aimed at improving care pathways for women needing support after birth. The newly published PPHS implementation guidance recommends that the OASI Care Bundle is rolled out across all maternity units.

An obstetric anal sphincter injury (OASI), also known as a severe perineal tear, is a type of birth injury that can happen during a vaginal birth. The OASI Care Bundle is a set of interventions likely to reduce the risk of a severe tear and improve outcomes for women, developed by the RCOG and Royal College of Midwives. The OASI Care Bundle is made up of four elements, including the routine examination of the vagina and rectum after a vaginal birth.

Dr Ranee Thakar, President of the Royal College of Obstetricians and Gynaecologists, said: “Too many women currently suffer pelvic injuries during childbirth, which can mean long-term complications including difficulty controlling the bladder and bowel, chronic pain and painful intercourse. This guidance represents an important milestone in the development of vital Perinatal Pelvic Health Services, created to improve access to early intervention and support for women and people experiencing symptoms of pelvic floor dysfunction.

“We are delighted that this service specification sets out how PPHS will work with maternity units to implement the joint RCOG and Royal College of Midwives’ Obstetric Anal Sphincter Injury (OASI) Care Bundle. As a College we look forward to supporting the implementation of this important guidance, working with our membership and our NHS partners to help ensure all women have access to high-quality pelvic floor health information, education and care.”

In October 2023, the National Institute of Care Excellence also published updates to the clinical guidance: Intrapartum care for healthy women and babies, including a new recommendation that all women who have had a vaginal birth should be offered a post birth rectal examination, as recommended in the OASI Care Bundle.

Research undertaken in 2022 by the Royal College of Obstetricians and Gynaecologists showed there remain significant barriers to women and people seeking help, including a lack of knowledge about pelvic floor health and embarrassment discussing the symptoms of pelvic floor dysfunction. The RCOG is committed to continuing to raise awareness, and to supporting women to seek help, as set out in our Pelvic Floor position statement.


  • Policy and governance
  • Clinical and research
  • Pregnancy and birth