Obstetric anal sphincter injury (OASI) is recognised as the most common cause of anal incontinence (AI) in childbearing-aged women (Marsh 2011), encompassing symptoms of flatus incontinence, passive soiling, incontinence of liquid or solid stool and faecal urgency. These symptoms can cause social and hygienic problems that lead to:
- isolation, limiting occupational and social activity
- negative effect on sexual function and consequent impact on relationships
- reduced self-esteem and reduced quality of life
(Leigh & Turnberg 1982, Boreham et al 2005, Lo et al 2010, Keighley et al 2016)
In the UK approximately 5.9 per cent of women will sustain an OASI, with UK data demonstrating a tripling of incidence over the past decade, possibly because of increased awareness and improved methods of detection (Gurol-Urganci et al 2013). However, it has also been suggested that changes in practice of the use of Manual Perineal Protection (MPP) — from ‘hands on [the perineum]’ to ‘hands off’ — and a reduction in episiotomies may also have contributed to this rise (Ismail et al 2015). In view of this rising incidence, and Denmark’s and Norway’s success in reducing their incidence of OASI from just over 4 per cent to just over 1 per cent by introducing interventions including MPP, an OASI Care Bundle was launched across the UK to see if the incidence of such trauma can be reduced (Gurol-Urganci et al 2020, Bidwell et al 2020).
Care bundles are a small set of evidence-based interventions for a defined patient population and care setting that, when implemented together, result in significantly better outcomes than when implemented individually (Institute for Healthcare Improvement (IHI) 2015). Ideally, a care bundle should be concise and straightforward, comprising a set of three to five practices or precautionary steps (IHI 2015). Each of these components is an intervention or practice in its own right, ideally with a sound evidence base. The focus should be on how to deliver the best care and a care bundle should not introduce any practices or techniques that are not in standard practice in at least some settings.
In summary, the OASI Care Bundle is a Health Foundation-funded initiative supported by both the Royal College of Midwives (RCM) and the Royal College of Obstetricians & Gynaecologists (RCOG). The OASI Care Bundle offers all women four elements (see Figure 1) that, when performed together and supported by an educational programme, may reduce the rate of third- and fourth-degree tears (RCOG 2010, Hals et al 2010).
Webb S. MIDIRS Midwifery Digest, vol 30, no 4, December 2020, pp 414-417
Thakar R, Gurol-UrganciI, Bidwell P et al. Midwifery, vol 90, November 2020, 102802
Reprinted with permission. ©2020 Published by Elsevier Ltd
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