{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T18:34:26Z","timestamp":1779129266823,"version":"3.51.4"},"reference-count":14,"publisher":"BMJ","issue":"10","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2013,9,23]]},"published-print":{"date-parts":[[2013,10]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To re-evaluate previously published findings from an uncontrolled before\u2013after evaluation of an intervention programme to reduce the incidence of anal sphincter tears. A key component of the programme was the use of a hands-on technique where the birth attendant presses the neonate's head during the final stage of delivery while simultaneously supporting the woman's perineum with the other hand.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Interrupted time-series analysis using segmented regression modelling.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Obstetric departments of five Norwegian hospitals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>All women giving births vaginally in the study hospitals, 2002\u20132008.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The main data source was the Medical Birth Registry of Norway. We estimated the change in incidence of anal sphincter tears before and after implementation of the intervention in the five intervention hospitals, taking into account the trends in incidence before and after implementation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Incidence of anal sphincter tears and episiotomies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 75\u2005543 registered births at the five included hospitals. We found a 2% absolute reduction in incidence of anal sphincter tears associated with the hospital intervention programme, representing almost a halving in the number of women experiencing serious anal sphincter tears. This is a substantially smaller estimate than previously reported. However, it does represent a highly significant decrease in anal sphincter injuries. The programme was also associated with a significant increase in episiotomies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The intervention programme was associated with a significant reduction in the incidence of obstetric anal sphincter tears. Still, the findings should be interpreted with caution as they seem to contradict the findings from randomised controlled studies of similar interventions.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2013-003355","type":"journal-article","created":{"date-parts":[[2013,10,24]],"date-time":"2013-10-24T00:35:03Z","timestamp":1382574903000},"page":"e003355","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":21,"title":["The impact of an intervention programme employing a hands-on technique to reduce the incidence of anal sphincter tears: interrupted time-series reanalysis"],"prefix":"10.1136","volume":"3","author":[{"given":"Atle","family":"Fretheim","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan","family":"Odgaard-Jensen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John-Arne","family":"R\u00f8ttingen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liv Merete","family":"Reinar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siri","family":"Vangen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tom","family":"Tanbo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2013,10,22]]},"reference":[{"key":"2024051511010515000_3.10.e003355.1","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1097\/AOG.0b013e3181e2f50b","article-title":"Trends in risk factors for obstetric anal sphincter injuries in Norway","volume":"116","author":"Baghestan","year":"2010","journal-title":"Obstet Gynecol"},{"key":"2024051511010515000_3.10.e003355.2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e318142cdf4"},{"key":"2024051511010515000_3.10.e003355.3","unstructured":"Nasjonalt r\u00e5d for f\u00f8dselsomsorg. Sfinkterskader ved f\u00f8dsel b\u00f8r reduseres i Norge. Nasjonal handlingsplan [Sphincter injuries related to birth should be reduced in Norway. National action plan]. Oslo: Sosial- og helsedirektoratet, 2006."},{"key":"2024051511010515000_3.10.e003355.4","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31816c4402"},{"key":"2024051511010515000_3.10.e003355.5","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1097\/AOG.0b013e3181eda77a","article-title":"A multicenter interventional program to reduce the incidence of anal sphincter tears","volume":"116","author":"Hals","year":"2010","journal-title":"Obstet Gynecol"},{"key":"2024051511010515000_3.10.e003355.6","unstructured":"Shadish WR Cook TD Campbell DT . Quasi-experiments: interrupted time-series designs. Experimental and quasi-experimental designs for generalized causal inference. Boston: Houghton Mifflin, 2002:171\u2013206."},{"issue":"(Suppl 1)","key":"2024051511010515000_3.10.e003355.7","doi-asserted-by":"crossref","first-page":"S18","DOI":"10.1186\/1478-4505-7-S1-S18","article-title":"SUPPORT tools for evidence-informed policymaking in health 18: planning monitoring and evaluation of policies","volume":"7","author":"Fretheim","year":"2009","journal-title":"Health Res Policy Syst"},{"key":"2024051511010515000_3.10.e003355.8","doi-asserted-by":"publisher","DOI":"10.1080\/00016340601111364"},{"key":"2024051511010515000_3.10.e003355.9","doi-asserted-by":"crossref","first-page":"2352","DOI":"10.4045\/tidsskr.11.0643","article-title":"Use of manual techniques for perineal support in Norwegian maternity departments","volume":"131","author":"Fretheim","year":"2011","journal-title":"Tidsskr Nor Laegeforen"},{"key":"2024051511010515000_3.10.e003355.10","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2710.2002.00430.x"},{"key":"2024051511010515000_3.10.e003355.11","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1111\/j.0730-7659.2005.00373.x","article-title":"Episiotomy rates around the world: an update","volume":"32","author":"Graham","year":"2005","journal-title":"Birth"},{"key":"2024051511010515000_3.10.e003355.12","doi-asserted-by":"crossref","unstructured":"Carroli G Mignini L . Episiotomy for vaginal birth. Cochrane Database Syst Rev 2009;(1):CD000081.","DOI":"10.1002\/14651858.CD000081.pub2"},{"key":"2024051511010515000_3.10.e003355.13","doi-asserted-by":"crossref","unstructured":"Aasheim V Nilsen AB Lukasse M . Perineal techniques during the second stage of labour for reducing perineal trauma. Cochrane Database Syst Rev 2011;(12):CD006672.","DOI":"10.1002\/14651858.CD006672.pub2"},{"key":"2024051511010515000_3.10.e003355.14","first-page":"477","article-title":"Traditional care of the perineum during birth. A prospective, randomized, multicenter study of 1,076 women","volume":"47","author":"Mayerhofer","year":"2002","journal-title":"J Reprod Med"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2013-003355","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,15]],"date-time":"2024-05-15T18:01:18Z","timestamp":1715796078000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2013-003355"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,10]]},"references-count":14,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2013,10]]}},"alternative-id":["10.1136\/bmjopen-2013-003355"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2013-003355","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,10]]}}}