O5 - First do no harm: a single site pre-post implementation study of a perineal protection bundle

Nigel Lee, Jyai Allen, Rebecca Jenkinson, Yu Gao, Sue Kildea

Research output: Contribution to conferenceAbstract


Background In 2018 a perineal protection bundle was introduced to 28 hospitals across Australia aimed at reducing rates of severe perineal trauma (SPT). Pre/post implementation studies of similar programs in other countries have reported outcomes that vary between significant and no reduction in SPT rates. Other consequences such as increased use of episiotomy, contribution to women’s experiences of disrespectful care and loss of midwifery autonomy have also been reported in bundle studies. To date, no studies have examined the effect of the bundle implementation in Australia on the incidence of perineal trauma. Aim To measure the difference in SPT, second degree and episiotomy rates in midwifery led births following the introduction of the perineal protection bundle. Methods Retrospective data was extracted from the perinatal database of a tertiary hospital that had introduced the full perineal bundle. Data for all singleton cephalic vaginal births conducted by midwives during the pre (2011 – 2017) (n=20155) and post-implementation period (2018 – 2020) (n=6273) were analysed. Covariates identified in the literature were explored using univariate analysis, those found to be significant (p=0.05) were included in the multivariate analysis. Results Following adjustment for independently contributing factors the likelihood of women experiencing SPT did not differ significantly between the pre and post implementation periods. There were significant increases in the use of episiotomy in nulliparous women and the rate of 2nd degree tears in multiparous women. Implications for practice This study adds to the growing body of literature which questions the effectiveness and safety of perineal protection bundles.
Original languageEnglish
Number of pages2
Publication statusPublished - 2023
EventAustralian College of Midwives National Conference: Be the Change - Adelaide, Australia
Duration: 12 Sept 202314 Sept 2023


ConferenceAustralian College of Midwives National Conference


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