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

Abstract

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.

Antenatal, Intrapartum and Postpartum Interventions for Preventing Postpartum Urinary and Faecal Incontinence: An Umbrella Overview of Cochrane Systematic Reviews

“…Ref. [ 18 ] studied women’s experience of the OASIS Care Bundle. Their findings suggest that the four elements of the OASIS Care Bundle are acceptable to women.…”

Care bundles for women during pregnancy, labour/birth, and postpartum: a scoping review

“…The other trial records also related to one trial on a single clinical condition, for example, a randomised trial of a care bundle for the detection and prevention of obstetric haemorrhage 24 and a trial protocol record for the evaluation of the Scaling Up Safer Bundle 25 . Similarly, although two qualitative studies were identified, both exploring women's experiences of a perineal protection care bundle 26,27 , data are presently limited to meaningfully enable the conduct of a qualitative evidence synthesis. The qualitative studies relate to the UK OASI Care Bundle and an Australian developed perineal protection bundle, both of which for the most part include the same elements.…”

Authors’ reply re: OASI Care Bundle

“…2 For example, women told us that they experienced a hands-on approach protecting the perineum as very positive and that good communication with the midwife was key to a calm birth. 5 We are now performing the OASI2 study that evaluates the sustainability of the OASI-CB and its implementation in a wider group of units (www.rcog.org.uk/ oasi2). Based on multi-stakeholder discussions and lessons learned from the original OASI-CB project, 6 we updated the OASI-CB manual and antenatal discussion guide and improved our training materials.…”

“…Women were – and still are – at the very heart of the development, evaluation and implementation of the care bundle 2 . For example, women told us that they experienced a hands‐on approach protecting the perineum as very positive and that good communication with the midwife was key to a calm birth 5 …”