A national collaborative aimed at improving care for women during birth is reducing the number of third and fourth degree perineal tears.
The joint collaboration between Women’s Healthcare Australasia (WHA), the NSW Clinical Excellence Commission and Safer Care Victoria involves using a bundle of techniques during and after birth.
Third and fourth degree perineal tears can have short and long-term consequences for women. They require surgery and can result in increased length of hospital stay post birth, increased pain and potential faecal incontinence. They can also impact future births.
The maternity team at West Gippsland Healthcare Group (West Gippsland) is among 35 health services involved in the project and has shared their experience so far.
Impressive results at West Gippsland Healthcare Group
Warrick Pill and Heidi Vale, West Gippsland Healthcare Group
‘Since joining the project six months ago we have improved care for women during birth through a new approach to perineal management.’
‘Early results at West Gippsland show that the third degree tear rate in first time mothers having a normal vaginal birth has reduced from 7.9 per cent to 4.4 per cent. The team even received a Maternity Team Exemplar Award for their efforts.’
‘As part of the collaborative, we collected baseline maternity data to better understand the contributing factors that lead to serious tears. Ongoing weekly team meetings and quality improvement coaching have been a great support to our quality improvement journey.’
‘In addition to improved outcomes for patients we’ve also seen an improvement in compliance of staff. Over six months compliance with the bundle of care has increased from 20 per cent to more than 95 per cent. ‘
‘Through collecting and tracking statistical data, we’ve also identified specific areas of non-compliance which we’ve been able to address. Focusing on communication we’ve targeted barriers to achieving consistency in perineal care through a positive and supportive education program.’
‘Since joining the national collaborative the team has become a more cohesive group and identified areas for improvement going forward.’
About the project
More than 35 hospitals across Australia are involved in the collaborative. Participating services are implementing a bundle of care, designed by consumer representatives and an expert panel, to ensure the measures are safe and clinically achievable.
The collaborative enhances maternity care during birth through five interventions:
- Application of warm perineal compress for all births at the commencement of active second stage
- Hands on care with the fetal shoulders through the entire birth, including after assisted births and following an episiotomy
- Improving episiotomy technique – appropriate timing and ensuring pre-suture angle is optimally 60 degrees
- The initiation of rectal examination after all vaginal births has been instituted. This ensures no “button-hole’ tears in the rectum are missed
The grading of all perineal trauma by two experienced clinicians has been implemented and is being routinely practiced. This ensures that serious tears are not missed.