Severe Perineal Tears - the OASI Care Bundle
A programme designed to improve the maternal experience of vaginal childbirth and reduce incidences of perineal trauma is currently being rolled out for trial in sixteen maternity units across the UK.
Perineal Inury
Perineal injuries during childbirth, especially those causing damage to the anal sphincter muscles, can cause long-term, distressing and life-changing symptoms for the woman affected. The rate of these obstetric anal sphincter injuries (OASIs) appears to be increasing and there are calls for better training and awareness.
Severe perineal tears, also called third or fourth degree tears, require prompt repair in an operating theatre by a skilled surgeon. Without this, the mother can be left with wind and faecal incontinence for years to come.
OASI Care Bundle
The Royal College of Obstetricians and Gynaecologists, in conjunction with the Royal College of Midwives, London School of Hygiene and Tropical Medicine, and Croydon NHS Trust, has devised a 'care bundle' aimed at reducing the likelihood of pregnant women suffering a severe perineal injury during the birth of their baby.
There are three interconnected elements to the programme, focused on implementing four interventions during the birth which, in combination, should improve the mother's experience of the birth.
These interventions, based on a review of previous experience, are as follows:
- Inform the woman about steps to reduce her risk of experiencing a severe tear
- The midwife or obstetrician to provide manual protection of the perineum during the birth in spontaneous and assisted births
- A medio-lateral episiotomy to be used when appropriate
- Automatic examination of the perineum, including a digital rectal examination, after all vaginal births. Any such injury to be recorded accurately according to RCOG guidelines
The implementation of these strategies is supported by a campaign to raise awareness and the training of 'champions' in each participating unit who will support the introduction of the programme in their units.
This trial of the programme will be evaluated to assess whether the care bundle is feasible and sustainable and what the outcomes have been in terms of rates of severe perineal injuries. The aim is to develop a standardised method of delivery which reduces rates of perineal injury and which can be utilised in all maternity units.
The importance of diagnosis
When post-natal examination does not take place, it is possible that the woman may have suffered a severe tear during the birth of her baby which has gone un-noticed. In this instance, a repair will not take place as an injury is not known to have occurred.
Medical Negligence
If you are suffering the appalling side-effects of a severe perineal tear due to a diagnosis failure, speak to a specialist solicitor to find out if it would be appropriate to make a claim for compensation.
Glynns Solicitors is a medical negligence legal practice with considerable experience of supporting claims for perineal injury. Contact us to discuss your situation.
Please call us on 0800 234 3300 (or from a mobile 01275 334030) or complete our Online Enquiry Form.
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