RCM/RCOG statement of support for the OASI Care Bundle

on 22 May 2019 OASI - Obstetric anal sphincter injuries

The Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists are very proud of the work achieved by the OASI Care Bundle, the first project of its kind, and would like to encourage all healthcare professionals to adopt the care bundle into their practice to improve health outcomes for women.

The OASI Care Bundle was effective in preventing severe perineal trauma: the overall OASI rates reduced from 3.3% to 3.0%, this effect was more significant when adjusted for clinical risk factors. This result is due to the hard work and dedication of the OASI champions at the 16 participating units. 

The OASI champions were inspiring and were able to see real change in their units, as one champion reflected ‘you get those clinicians who come back to you telling you amazing stories, “I did it and it really works”’.

The key messages from the project are:

  • There is a general need and interest to better manage perineal care
  • Most improvement in OASI rates was seen in spontaneous vaginal births
  • Exploratory interviews with women suggest that the care bundle is acceptable and that women feel it is important to understand more about perineal trauma antenatally.
  • The project identified barriers (e.g. deskilling in perineal management) and enablers (e.g. senior buy-in) to adoption of the care bundle. These findings can be translated to other Quality Improvement projects within maternity.
  • Key to the project was the hard work and time given by the local OASI champions within the units.

Both the RCM and RCOG are committed to continued activities of the OASI Care Bundle. These include forthcoming publications in peer-reviewed journals, conference presentations and plans to spread the OASI Care Bundle to further maternity units across England, Scotland and Wales. This work demonstrates that training and awareness can improve outcomes for women and, the value of this work is illustrated by the key stakeholders from the project:

Louise Silverton, CBE, former Director for midwifery of the RCM, said: “This project has been designed about improving outcomes for women and working with women, communicating with women, that’s what’s so important.”

Miss Ranee Thakar, clinical lead for the OASI project, said: “It’s about collaboration, and only if we work together can we actually improve outcomes for women.”

Will Warburton, Director of Improvement at the Health Foundation, said: “Anal injury during childbirth is deeply traumatic and can be life changing for those women who experience it. The Health Foundation is pleased to have funded this important quality improvement partnership between the RCOG and the RCM, with maternity professionals working collaboratively with women to listen to their experience, improve communication and prevent injury.”