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Women’s experiences of the OASI Care Bundle; a package of care to reduce severe perineal trauma

Research output: Contribution to journalArticlepeer-review

Posy Bidwell, Nick Sevdalis, Louise Silverton, James Harris, Ipek Gurol-Urganci, Alexandra Hellyer, Robert Freeman, Jan van der Meulen, Ranee Thakar

Original languageEnglish
Pages (from-to)1807-1816
Number of pages10
JournalInternational Urogynecology Journal
Issue number7
Accepted/In press2021
PublishedJul 2021

Bibliographical note

Funding Information: The Project had women’s involvement throughout inception, implementation and evaluation. In addition, the Project was supported by an Independent Advisory Group, which included user representatives. Component 1 of the OASI Care Bundle (the antenatal information sheet) was co-produced with women’s groups to ensure that the content was appropriate. Skills development days included accounts from women living with the effects of an OASI. On completion of the Project, women and representatives from relevant support organisations were included in events that disseminated the findings. Publisher Copyright: © 2021, The Author(s). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

King's Authors


Introduction and hypothesis: Obstetric anal sphincter injury (OASI) is a severe form of perineal trauma that can occur during vaginal birth. Long-term morbidities include anal incontinence and psychosocial disorders. To reduce these injuries within England, Scotland and Wales, the OASI Care Bundle was introduced to 16 maternity units (January 2017–March 2018). The OASI Care Bundle comprises four elements: (1) antenatal information, (2) manual perineal protection, (3) medio-lateral episiotomy (when indicated) and 4) recognition and diagnosis of tears. As part of the project evaluation, a qualitative study was conducted to explore women’s experiences of the OASI Care Bundle. Methods: Semi-structured interviews were conducted with women (n = 19) who received the OASI Care Bundle as part of their maternity care. This was to explore their experience of each element. A thematic analysis of the interview data was performed. Results: Three themes were identified: (1) memories of touch, whereby women reported that a ‘hands-on’ approach to perineal protection was a positive experience; (2) midwife as a supportive guide, where women reported that good communication facilitated a calm birth and post-birth diagnosis; (3) education: women need more information about perineal trauma. Conclusion: This study contributes to the literature through its exploration of women’s experiences of perineal protection techniques and diagnosis of perineal trauma. Interviewed women indicated that they did not experience any of the care bundle elements as an intrusion of their physical integrity. Additionally, an urgent need was identified for more information about perineal trauma in terms of risk, prevention and recovery.

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