{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T21:11:18Z","timestamp":1792444278838,"version":"4.5.0"},"reference-count":42,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2020,9,8]],"date-time":"2020-09-08T00:00:00Z","timestamp":1599523200000},"content-version":"unspecified","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Health Foundation","award":["Scaling-Up Programme (award number 7674)"],"award-info":[{"award-number":["Scaling-Up Programme (award number 7674)"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2020,6,30]]},"published-print":{"date-parts":[[2020,9]]},"abstract":"\n Introduction<\/jats:title>\n Obstetric anal sphincter injuries (OASI) can have severe debilitating consequences to women and health systems. The OASI Care Bundle quality improvement programme was introduced in 16 maternity units across England, Scotland and Wales (January 2017 to March 2018) to address increasing OASI rates.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n To explore clinicians\u2019 (midwives\u2019 and obstetricians\u2019) perspectives of the OASI Care Bundle with respect to (1) acceptability, (2) feasibility, and (3) sustainability.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n A qualitative exploratory study using focus groups methodology.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n A total of 16 focus groups were conducted in 16 maternity units in England, Scotland and Wales where the OASI Care Bundle was implemented. Focus groups took place approximately 3 months following initial implementation of the care bundle in each unit.<\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n A total of 101 clinicians participated, with an average of six per focus group. Participants volunteered to take part and compromised of 37 obstetricians and 64 midwives (including eight students). The majority were female and the mean age was 36.5 years.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Four main themes emerged: \u2018Implementation strategies\u2019, \u2018Opportunities to use the OASI Care Bundle\u2019, \u2018Does current practice need to change?\u2019 and \u2018Perceptions of what women want\u2019. Midwives were more likely than obstetricians to report themes alluding to \u2018what women want\u2019 and variations in intrapartum perineal protection techniques. Both professional groups reported similar views of other themes, in particular regarding the supporting clinical evidence. Gaps were identified in clinicians\u2019 knowledge and experience of intrapartum perineal management.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Adoption of the OASI Care Bundle was associated with a number of cognitive and interpersonal factors, such as personal values, interprofessional working and how the intervention was launched; which both facilitated and impeded adoption. The \u2018what women want\u2019 theme has implications for maternal autonomy and needs further exploration. Our findings can be used by similar initiatives to reduce perineal trauma both nationally and internationally.<\/jats:p>\n <\/jats:sec>\n \n Trial registration number<\/jats:title>\n \n ISCTRN 12143325;\n https:\/\/doi.org\/10.1186\/ISRCTN12143325<\/jats:ext-link>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjopen-2019-035674","type":"journal-article","created":{"date-parts":[[2020,9,9]],"date-time":"2020-09-09T13:00:25Z","timestamp":1599656425000},"page":"e035674","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":20,"title":["Exploring clinicians\u2019 perspectives on the \u2018Obstetric Anal Sphincter Injury Care Bundle\u2019 national quality improvement programme: a qualitative study"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8506-9880","authenticated-orcid":false,"given":"Posy","family":"Bidwell","sequence":"first","affiliation":[{"name":"Royal College of Obstetricians and Gynaecologists, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ranee","family":"Thakar","sequence":"additional","affiliation":[{"name":"Croydon University Hospital, Croydon, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6517-3485","authenticated-orcid":false,"given":"Ipek","family":"Gurol-Urganci","sequence":"additional","affiliation":[{"name":"Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James M","family":"Harris","sequence":"additional","affiliation":[{"name":"Centre for Nursing, Midwifery and Allied Health Professional Research, University College London Hospitals NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise","family":"Silverton","sequence":"additional","affiliation":[{"name":"Royal College of Midwives, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Hellyer","sequence":"additional","affiliation":[{"name":"Royal College of Obstetricians and Gynaecologists, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Freeman","sequence":"additional","affiliation":[{"name":"University Hospitals Plymouth NHS Trust, Plymouth, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward","family":"Morris","sequence":"additional","affiliation":[{"name":"Royal College of Obstetricians and Gynaecologists, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivienne","family":"Novis","sequence":"additional","affiliation":[{"name":"Royal College of Obstetricians and Gynaecologists, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7560-8924","authenticated-orcid":false,"given":"Nick","family":"Sevdalis","sequence":"additional","affiliation":[{"name":"Centre for Implementation Science, King's College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,9,9]]},"reference":[{"key":"2026062608010993000_10.9.e035674.1","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1111\/jmwh.12283","article-title":"Obstetric anal sphincter injury and anal incontinence following vaginal birth: a systematic review and meta-analysis","volume":"60","author":"LaCross","year":"2015","journal-title":"J Midwifery Womens Health"},{"key":"2026062608010993000_10.9.e035674.2","doi-asserted-by":"crossref","DOI":"10.1186\/s12905-015-0249-3","article-title":"Autoethnography and severe perineal trauma--an unexpected journey from disembodiment to embodiment","volume":"15","author":"Priddis","year":"2015","journal-title":"BMC Womens Health"},{"key":"2026062608010993000_10.9.e035674.3","doi-asserted-by":"crossref","first-page":"486","DOI":"10.3109\/01443615.2014.911835","article-title":"Management of obstetric anal sphincter injuries (OASIS) in subsequent pregnancy","volume":"34","author":"Evans","year":"2014","journal-title":"J Obstet Gynaecol"},{"key":"2026062608010993000_10.9.e035674.4","unstructured":"NHS Litigation Authority . 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