• Collaboration between the Royal College of Obstetricians and Gynaecologists (RCOG), the Royal College of Midwives (RCM), Croydon Health Services NHS Trust, the London School of Hygiene and Tropical Medicine (LSHTM), and King’s College London (KCL).
  • Investigating the mechanisms and strategies that support implementation, sustainability and spread of the OASI Care Bundle, an intervention to reduce the incidence of severe perineal trauma caused through childbirth, in UK maternity units.
  • Producing a locally adaptable ‘implementation blueprint’ and revised care bundle materials (including training, monitoring and promotional tools).

An obstetric anal sphincter injury (OASI) is any injury to the anal sphincter muscle sustained during childbirth. It can result in medical complications such as anal incontinence and significant psychosocial problems, as well as long-term financial consequences for the NHS associated with ongoing treatment.

OASI rates among first-time mothers tripled in England from 1.8% in 2000 to 5.9% by 2011 due to variation in approaches to perineal protection, training gaps and a lack of awareness of risk factors.

The OASI Care Bundle quality improvement project, implemented across 16 UK maternity units in 2017/18, successfully reduced rates of OASI through use of an evidence-based care bundle, which was supported by an awareness campaign and multidisciplinary skills development.

OASI2 is a Spreading Improvement project that will further investigate the mechanisms and strategies that support the sustainability and spread of the OASI Care Bundle, with the primary focus shifting from clinical to implementation effectiveness.

The project team will trial a number of different implementation strategy ‘bundles’ to support scale up of the OASI Care Bundle in 20 new maternity units nationally, and to evaluate its ongoing sustainability in 10 of the original OASI study units by targeting key organisational barriers and enablers.

The aim is to produce a locally adaptable ‘implementation blueprint’ which, combined with revised care bundle educational materials (including training, monitoring and promotional tools), will maximise and sustain local uptake and coverage, as well as improve perineal outcomes for women.

The findings will inform future guidelines on preventing perineal trauma and facilitate national roll out of the intervention within the NHS.

Contact information

For more information about this project, contact Dan Wolstenholme, Director and Senior Programme Manager, Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists (RCOG)

About this programme


Spreading Improvement


This programme offers £1.5 million funding for approximately 15 projects a year. It aims to generate...

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