Bidwell Posy, Thakar Ranee, Gurol-Urganci Ipek, Harris James M, Silverton Louise, Hellyer Alexandra, Freeman Robert, Morris Edward, Novis Vivienne, Sevdalis Nick
Royal College of Obstetricians and Gynaecologists, London, UK
Croydon University Hospital, Croydon, UK.
BMJ Open. 2020 Sep 9;10(9):e035674. doi: 10.1136/bmjopen-2019-035674.
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.
To explore clinicians' (midwives' and obstetricians') perspectives of the OASI Care Bundle with respect to (1) acceptability, (2) feasibility, and (3) sustainability.
A qualitative exploratory study using focus groups methodology.
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.
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.
Four main themes emerged: 'Implementation strategies', 'Opportunities to use the OASI Care Bundle', 'Does current practice need to change?' and 'Perceptions of what women want'. Midwives were more likely than obstetricians to report themes alluding to 'what women want' 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' knowledge and experience of intrapartum perineal management.
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 'what women want' 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.
ISCTRN 12143325; https://doi.org/10.1186/ISRCTN12143325.
产科肛门括约肌损伤（OASI）会给女性和卫生系统带来严重的衰弱性后果。2017年1月至2018年3月期间，英格兰、苏格兰和威尔士的16个产科单位引入了OASI护理包质量改进计划，以应对不断上升的OASI发生率。
探讨临床医生（助产士和产科医生）对OASI护理包在（1）可接受性、（2）可行性和（3）可持续性方面的看法。
采用焦点小组方法的定性探索性研究。
在英格兰、苏格兰和威尔士实施OASI护理包的16个产科单位共进行了16次焦点小组讨论。焦点小组讨论在每个单位首次实施护理包约3个月后进行。
共有101名临床医生参与，每个焦点小组平均6人。参与者自愿参加，包括37名产科医生和64名助产士（包括8名学生）。大多数为女性，平均年龄为36.5岁。
出现了四个主要主题：“实施策略”、“使用OASI护理包的机会”、“当前的做法是否需要改变？”以及“对女性需求的看法”。助产士比产科医生更有可能报告涉及“女性需求”和产时会阴保护技术差异的主题。两个专业群体对其他主题的看法相似，特别是关于支持性临床证据。在临床医生的产时会阴管理知识和经验方面发现了差距。
采用OASI护理包与一些认知和人际因素相关，如个人价值观、跨专业合作以及干预措施的推出方式；这些因素既促进了也阻碍了采用。“女性需求”主题对产妇自主权有影响，需要进一步探索。我们的研究结果可供国内和国际上类似的减少会阴创伤的倡议使用。
ISCTRN 12143325；https://doi.org/10.1186/ISRCTN12143325
