You are currently using an unsupported browser which could affect the appearance and functionality of this website. Please consider upgrading to the latest version or using alternatives such as Mozilla Firefox, Google Chrome or Microsoft Edge.

RCOG welcomes updated NICE Intrapartum Care guidance

2 Oct 2023

The National Institute of Care Excellence (NICE) has published updates to the clinical guidance: Intrapartum care for healthy women and babies.

The updates include a new recommendation that all women who have had a vaginal birth should be offered a post birth rectal examination, which is something that the RCOG and Royal College of Midwives (RCM) recommend in the OASI Care Bundle.

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. The OASI Care Bundle is made up of four elements, including the routine examination of the vagina and rectum after a vaginal birth.

If an OASI is not diagnosed and repaired immediately following childbirth, women and birthing people are at greater risk of experiencing symptoms such as chronic pain, sexual dysfunction and difficulty or inability controlling the bladder or bowel.

Dr Ranee Thakar, President of the Royal College of Obstetricians and Gynaecologists, said:

“Too many women currently suffer these injuries during childbirth, which can mean long-term complications. This is a welcome update from NICE that includes a key recommendation from the OASI Care Bundle, one that we’ve been calling for to improve the perinatal care of women and people. My hope is that the NICE guidance can be used alongside the OASI Care Bundle as complementary guidance to improve the care of women and people, to reduce the number of OASIs and prevent long-term complications.

“The RCOG looks forward to working with our members and NHS partners to support implementation of this important guideline, to help ensure all women have access to timely support when they need it.”
Lizzie Phillips, Pelvic Health Specialist Midwife, Midwifery clinical lead of OASI2, said:

"Miss a severe tear at birth and the best window for repair has also gone. Improving routine examination after vaginal birth is a vital step to detecting an OASI. Repair an OASI immediately after birth and the individual's long term pelvic health, her mental wellbeing and the quality of her future is all improved. 

“Women have told us they want to be empowered to care for their bodies around birth. They want clear communication from their midwife, with accessible information to educate themselves with techniques they can choose from to reduce the risk of OASI and improve outcomes for their body, their baby and their birth.

“We hope that all maternity units can use the OASI Care Bundle and resources provided by OASI2 to improve their detection of OASI and continue to reduce their local rates of severe tears, improving individual lives in the process."


Notes to Editors

  • Clinical and research
  • Pregnancy and birth