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Summary

Women having their first birth vaginally in Victoria are four times more likely to experience a severe perineal laceration (third- or fourth-degree tear) compared to those having a subsequent birth vaginally (Victorian perinatal services performance indicators 2018–19 report).

This can have devastating long-term or lifelong impacts on physical and psychological wellbeing. Many of these tears are avoidable.

We are partnering with the Institute for Healthcare Improvement (IHI) and 14 health services to improve birth outcomes for all women giving birth in Victoria, using the IHI’s proven Model for improvement.

Using the ‘Partnering in healthcare’ framework, we are including consumer voices and representatives across the participating teams, and in leadership roles for this program.

We are testing and spreading evidence-based clinical care bundles to reduce third- and fourth- degree perineal tear rates, focusing on five clinically endorsed interventions:

  • application of warm perineal compress during labour 
  • hands on to support the perineum, with gentle verbal guidance   
  • episiotomy performed when indicated (during instrumental delivery and at 60 degrees) 
  • genito-anal examination on all women post birth  
  • grading of perineal tear and review by experienced clinician.

 

Phase 1 ran from June 2019 – March 2020, before being paused due to the COVID-19 pandemic. Phase 2 commenced in November 2020, with the majority of services continuing their participation.

Update

Initial results from our 14 partnering services (from August 2019 to March 2020) show:

  • we have reduced severe perineal tears by 20 per cent - that’s 22 women who didn’t experience this preventable harm during birth
  • clinicians are increasingly using the hands-on technique and gentle verbal guidance during birth to help prevent severe tears. The average increased from 73 to 82 per cent
  • more women with perineal trauma were assessed by two experienced clinicians to ensure the grading of the trauma was accurate, and that they received appropriate ongoing care. This average increased from around 42 to 60 per cent of women receiving the additional assessment. 

Who's involved?

Ballarat Health Services Northern Health
Barwon Health St John of God Bendigo Hospital
Bass Coast Regional Health St Vincent's Private Hospital
Central Gippsland Health Service (Sale) South West Healthcare Group (Warrnambool)
Djerriwarrh Health Services Western District Health Service (Hamilton)
East Grampians Health Service (Ararat) Western Health
Kilmore and District Hospital Wimmera Health Care Group (Horsham)

Target

Reduce harm to Victorian women by reducing the rate of 3rd and 4th degree perineal tears by 50 per cent, by June 2021

Resources for health services

Partnering in healthcare framework

Our Partnering in healthcare framework and self-assessment tool will help services involve women and their families, respond to their needs and expectations and deliver care that is safe, woman-centred, equitable and effective.

Victoria’s Mothers, Babies and Children report 2019

The Victoria’s Mothers, Babies and Children report from the Consultative Council on Obstetric and Paediatric Mortality and Morbidity (CCOPMM), provides access to comprehensive data on all maternal, perinatal and paediatric mortality and morbidity, including stillbirth.

Perinatal services performance indicators 2018-19

The Victorian Perinatal services performance indicators report provides benchmarking data on a range of clinical indicators, including smoking cessation and detection of fetal growth restriction.

Get in touch

Belinda MacLeod-Smith
(03) 9285 3496

Page last updated: 24 Feb 2021

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