A paper published this week in the British Journal of Obstetrics and Gynaecology (BJOG) explores women’s experiences of a quality improvement initiative to reduce obstetric anal sphincter injury (OASI) during childbirth.
Researchers surveyed women who had a live vaginal birth in 29 maternity units across England, Scotland and Wales, to find out more about their experiences with elements of the OASI Care Bundle. Participating hospitals had been provided with resources for implementing OASI, including recommendations for information that women should receive during pregnancy, guidance on manual perineal protection (MPP) during the birthing process, and a rectal examination after birth.
Respondents were asked about their recollection of receiving information on perineal health ahead of birth, including questions on whether this information was timely and easy to understand, and if it made them fearful of giving birth vaginally. Further questions covered whether women could recall receiving MPP when giving birth, or a post-birth rectal examination, and how they felt about either procedure.
Over 1,200 women responded to the survey. Of these, 684 (57 per cent) said they received antenatal information about perineal health, and most felt that the information was easy to understand and helped them to make their own choices to reduce their OASI risk. However, one in five women who received information agreed that the information made them fearful of giving birth vaginally.
Nearly a third of women (31 per cent) recalled receiving MPP while giving birth, and just over half (55 per cent) recalled receiving a post-birth rectal examination. Of the 377 women who recalled MPP, four in five felt it provided them with support or did not mind the sensation. Of the 664 women who recalled rectal examination, nine in ten did not mind the exam or felt it was uncomfortable but understood its importance.
A previous study has shown that the OASI Care Bundle reduces rates of this type of injury by 20 per cent, without affecting rates of caesarean birth or episiotomy. This new research suggests that implementing the care bundle has not had a negative effect on the experiences of women giving birth.
The OASI Care Bundle initiative was a joint RCOG/RCM collaboration in partnership with the London School of Hygiene and Tropical Medicine (LSHTM), funded by the Health Foundation. RCOG President Ranee Thakar is the project’s clinical lead.
- The full paper can be accessed by RCOG Members and Fellows at: A Care Bundle Aiming to Reduce the Risk of Obstetric Anal Sphincter Injury: A Survey of Women's Experiences - Jurczuk - BJOG: An International Journal of Obstetrics & Gynaecology - Wiley Online Library