OASI Care Bundle to be rolled out in more maternity units

By OASI Care Bundle to be rolled out in more maternity units on 19 December 2019 Maternity Services Midwives NHS Midwifery RCM RCOG - Royal College of Obstetricians and Gynaecologists OASI - Obstetric anal sphincter injuries Physiological Birth Multi Disciplinary Working The Health Foundation

The Royal College of Midwives (RCM)and the The Royal College of Obstetricians and Gynaecologists (RCOG) and the are delighted to announce that the OASI Care Bundle Project will be rolled out in 20 new maternity units across England, Wales and Scotland.

The OASI Care Bundle was developed using evidence-based practice to reduce the incidence of obstetric anal sphincter injury (OASI) among women giving birth. 

The project started as a pilot study, and subsequently was scaled up and implemented in 16 maternity units across England, Scotland and Wales from January 2017 to May 2018.

The OASI Care Bundle includes information for women, an episiotomy at the correct angle when required, using the hands for perineal protection during birth and a thorough examination after birth to detect tears. This was alongside good communication between healthcare professionals and women to enable a slow controlled birth.

Implementation of the OASI Care Bundle within each maternity unit was led by obstetric and midwifery champions. The introduction of the care bundle was supported by multidisciplinary training using specially developed materials and videos.

With additional funding from the Health Foundation, the next stage – OASI2 – will build on the successes to date with implementation in more maternity units in 2020. It is hoped the OASI Care Bundle will eventually be rolled out nationwide.

An OASI is any injury to the anal sphincter muscle during childbirth. It can lead to complications, such as anal and urinary incontinence, and can severely affect a woman’s physical and mental health.


Birte Harlev-Lam, Executive Director for Professional Leadership at the Royal College of Midwives, said;

“The RCM very much welcomes this additional funding from the Health Foundation which will enable the OASI project to be rolled out across more maternity units in the UK.

"Increasing awareness amongst midwives and the wider multidisciplinary team is so important, particularly as the long-term consequences of perineal trauma for women can be debilitating. This project has also enabled midwives to have those crucial conversations with women so they are aware of the risks and also aware that evidence based intervention can work in decreasing injury rates and improve outcomes.”

Dr Edward Morris, President of the Royal College of Obstetricians and Gynaecologists, said:

“We are absolutely thrilled to bring the OASI Care Bundle Project to more maternity units, healthcare professionals and women across the country. Reducing the OASI rates is absolutely key to ensure women have the safest possible birth, with the best possible outcome.”

Dr Ranee Thakar, Vice President of the Royal College of Obstetricians and Gynaecologists and Clinical Lead for the OASI Care Bundle, said:

“Over the last decade, the number of women with an OASI has increased. Implementation of the care bundle reduced rates of OASI. The next stage of the project, OASI2, will enable us to continue our efforts of raising awareness, sharing best practice, and driving improvements in maternity care, so that women receive high quality, multidisciplinary care and avoid the harm caused by these injuries.”

Professor Michael Keighley, President of MASIC, said: 

“We are delighted with the additional funding to extend the OASI Care Bundle Project which we hope will become a national initiative. The project has been brave enough to warn mothers of the risk of these injuries and their consequences, undertaken measures to ensure a better diagnosis so that these injuries can be repaired at birth, and most importantly has reduced incidence through use of perineal protection and ensuring a safe episiotomy when needed.”

Claire Rowan, midwifery OASI champion, Queen Elizabeth University Hospital (QEUH), said:

“Our team at the QEUH, Glasgow entered into the OASI Project hoping to improve the life of even just ONE woman by preventing an Obstetric Anal Sphincter Injury. What we actually achieved was a reduction in our average OASI from 4.2% to 1.9% - amazing! We feel this success, the improved multidisciplinary working relationships and the decrease of morbidity in our women is invaluable and we are so grateful to Ranee and the OASI Team for their support. Here’s to OASI2 and further success in decreasing perineal trauma in Glasgow!” 

Kate Brian, Women’s Voices Lead, Royal College of Obstetricians & Gynaecologists said:

 "It is fantastic that OASI2 will be able to build on the foundations of the OASI Care Bundle, which placed a focus on engaging with women. It’s crucial that women are well informed about perineal trauma and this initiative aims to reduce it and enable women to speak freely and ask questions about this aspect of their pregnancy and childbirth experience."


Note to Editors

The OASI Care Bundle was effective in preventing severe perineal trauma: the overall OASI rates reduced from 3.3% to 3.0%. These results will be published in a study, in a peer-reviewed journal in the near future. 

The rates of recorded obstetric anal sphincter injuries (OASI) among women who give birth for the first time have tripled in the NHS from 1.8% 2000 to 5.9% by 2011, equivalent to around 70,000 women affected.

To help raise awareness, the OASI Care Bundle has released an information hub on perineal tears and episiotomies in childbirth and a series of powerful videos of women who discuss their experiences.

The OASI Care Bundle is a partnership between the Royal College of Obstetricians and Gynaecologists (RCOG), the Royal College of Midwives (RCM), Croydon Health Services NHS Trust, the London School of Hygiene and Tropical Medicine (LSHTM), and King’s College London (KCL).

For more information about the project, please visit the website: www.rcog.org.uk/OASICareBundle


To contact the RCM Media Office call 020 7312 3456, or email [email protected]

Note to editors

The RCM is the only trade union and professional association dedicated to serving midwifery and the whole midwifery team. We provide workplace advice and support, professional and clinical guidance and information, and learning opportunities with our broad range of events, conferences and online resources. For more information visit the RCM website at https://www.rcm.org.uk/.


About the RCOG
The Royal College of Obstetricians and Gynaecologists is a medical charity that champions the provision of high quality women’s healthcare in the UK and beyond. It is dedicated to encouraging the study and advancing the science and practice of obstetrics and gynaecology. It does this through postgraduate medical education and training and the publication of clinical guidelines and reports on aspects of the specialty and service provision.