Over the course of 2017, the OASI Care Bundle Project was introduced across England, region by region, aiming to reduce the occurrence of severe perineal tears in women giving birth. What does it entail?
What are OASIs?
OASIs are otherwise referred to as severe perineal tears and can occur when a woman is giving birth vaginally.
Most women receive a tear of some degree during childbirth but, for an unfortunate few, the injury is more extensive and can cause significant and life-changing symptoms.
Perineal tears are graded according to severity and the most severe tears are graded as 3rd or 4th degree tears. This refers to injuries that extend from the vagina, across the perineum, additionally damaging the muscles of the anus.
What are the long-term effects of OASIs?
Some women receive prompt treatment for their perineal tears and make a good recovery.
For others, however, the experience can prove more distressing, leaving them with little or no control over the passing of wind and faeces.
Many of these women suffer extreme urgency when needing to go to the toilet and find that their lives come to revolve around their toilet requirements. Some women suffer incontinence and may require a colostomy. This can severely affect their ability to travel any significant distance or to undertake many types of employment.
Understandably, the psychological impact of these injuries can also be severe and debilitating.
What is the OASI Care Bundle Project?
Evidence seems to suggest that severe perineal tears have been increasing in England over recent years and there is a recognition of the need to address this distressing issue.
The Royal College of Obstetricians and Gynaecologists, in conjunction with the Royal College of Midwives, Croydon Health Service and the London School of Hygiene and Tropical Medicine, has developed a ‘Care Bundle’ to try to reduce the occurrence of severe perineal tears.
Issues underlying the occurrence of perineal trauma
Risk factors such as the size of the baby, the use of instruments to assist the birth and the fact that it is the woman’s first time giving birth are all believed to increase the chance of a severe tear occurring.
The RCOG has, however, identified other factors, within the healthcare system, that may contribute to the occurrence of severe tears and which need to change.
These problems are as follows:
- Inconsistencies in approaches to preventing OASIs
- Inconsistencies in training and skills
- Lack of awareness of risk factors and long-term impact of OASIs
- Variation in practice between health professionals
Features of The Care Bundle
The resulting Care Bundle Project is currently undergoing a two-and-a-half year pilot project across the country, introducing an intervention package aimed at reducing the number of severe perineal tears which occur in the participating maternity units.
The Care Bundle consists of the following four features:
- Informing the woman about OASIs and how to reduce her risk
- Using manual protection of the perineum during the birth if appropriate, but especially with instrumentally-assisted births
- Introducing an episiotomy if appropriate
- Examining the woman’s perineum after the birth, including a digital, rectal examination
The outcomes of the project will be evaluated and shared.
Medical Negligence in Childbirth
Diagnosis of a severe tear is vital if a woman is not to suffer long-term symptoms. The emphasis in the care bundle on post-partum examination is key if a tear has, in fact, occurred.
If a severe tear is missed due to a failure to examine or a failure to recognise the signs, the relevant medical practitioners may be considered to have acted negligently.
Speak to a solicitor
If you are suffering the appalling, long-term effects of a misdiagnosed severe tear, you may be entitled to make a claim for compensation. Contact us to discuss your experience with a specialist, medical negligence solicitor.
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If you, or your family member, has suffered a birth injury tear, please call us now for free, no obligation advice on 0800 234 3300 (or from a mobile click to call 01275 334030) or complete our Free Online Enquiry.
