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RCM and RCOG announce the launch of the OASI Care Bundle Quality Improvement Project

11 January, 2017

RCM and RCOG announce the launch of the OASI Care Bundle Quality Improvement Project

The Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists (RCOG) are excited to announce the launch of the OASI Care Bundle Quality Improvement Project this month. It is the hope of both of the royal colleges that this programme will reduce rates of obstetric anal sphincter injuries (OASI).

The long term consequences of severe perineal trauma can be extremely debilitating, affecting a woman’s physical and emotional health and day-to-day quality of life. Severe perineal trauma is difficult to completely avoid. However, evidence-based interventions both in the UK and internationally have been shown to significantly decrease injury rates.

The OASI Care Bundle project is being carried out by the RCOG’s Lindsay Stewart Centre in partnership with Croydon Health Services NHS Trust, the London School of Hygiene & Tropical Medicine and The Health Foundation. It is a service evaluation which aims to standardise practice in a way that is acceptable to women, midwives and obstetricians. The care bundle was piloted in two hospitals with promising results and funding has allowed the project team to ‘scale up’ the project to a further 16 sites in England, Wales and Scotland.

Over the past 6 months, the project team has been working with these sites to set up the first phase of the project. The first cohort, comprising 4 sites, will begin roll-out this month and the remaining 3 cohorts will begin roll-out every 3 months throughout 2017.

The project is multifaceted and involves a care bundle, a multidisciplinary skills development module and an awareness campaign. The OASI care bundle is a set of evidence-based interventions, which has been agreed by an expert panel of midwives and obstetricians that, when used together, may reduce the incidence of OASI. The elements of the care bundle have been largely influenced by successful programmes in Norway which have shown a 50% reduction in rates of OASI: 1


  • The woman is aware of the care bundle.
  • Episiotomy, when indicated, at 60 degrees at crowning.
  • Use of manual perineal protection whenever possible. The only instance where it may not be possible to use MPP, is when women are labouring in water or, on a birthing stool, all other positions should allow for the attending clinician to visualise the perineum and use their hands to support it at time of delivery.
  • Perineal examination, including a per rectum examination, carried out following all vaginal deliveries.


An estimated 32,800 women are potentially eligible for the care bundle. The primary outcome is OASI rates and these will be measured using data from the maternity information system (MIS) at each participating unit. Implementation outcomes will be evaluated using qualitative methods and will explore both clinicians’ and women’s views of the use of the care bundle. The project team will evaluate the integration of the care bundle into routine practice as well as assess the acceptability and feasibility of the intervention. Results will be shared through a report and launch event.

For information, please visit: https://www.rcog.org.uk/OASICareBundle


This project focuses on OASI resulting from labour and vaginal birth. The project excludes the management and prevention of OASI resulting from gynaecological/urological procedures. It also excludes repair techniques and related co-morbidities.


[1] Laine K et al. Incidence of obstetric anal sphincter injuries after training to protect the perineum. BMJ Open. 2012.

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