Despite the number of women who experience ongoing physical and psychological complications resulting from Obstetric Anal Sphincter Injuries (OASIS) and Anal Incontinence (AI), currently there is no national structured process of assessment and care pathway for these women and health professionals to access necessary specialist care. There is a need to map current service provision for women who sustain OASIS/AI both for immediate care following the birth and for access to specialist referral for ongoing symptoms. Such information is necessary to inform nationwide NHS service improvement and referral pathway development, to alleviate unnecessary worry for women and clinicians and to increase healthcare efficiency by streamlining services to women at actual risk of ongoing complications. This will also help reduce financial burden on the NHS by avoiding the costs of long-term treatment. A nationwide understanding of OASIS service provision will also afford an opportunity to develop a collaborative research group to allow future UK wide cohort studies to be undertaken and provide higher level evidence on the longer term outcomes of OASIS/AI.
Midwife Sara Webb aimed to map and describe services that are provided across all NHS Trusts for women with OASIS/AI and to provide a comprehensive understanding of the services, referral pathways and degree of variability currently available. Using online questionnaires to all NHS Trusts in England, Sara Webb was able to survey anal incontinence and OASIS services in order to inform nationwide service transformation and to establish a collaborative network of NHS Trusts for future OASIS/AI research.
A Spanish Specialist Perineal Midwife network has been set up to join the UK group established by CLAHRC WM with the aim of improving OASIS and perineal trauma care and research internationally.
Contribution of CLAHRC West Midlands
The lead researcher was supported throughout by CLAHRC as the service developed. Following interest expressed by a midwife in Spain, CLAHRC funded the researcher on a visit to the hospital there to present the model and train staff, and the collaboration has continued.
Sara Webb has also established a specialist perineal midwife network to advance discussion and research on the topic; the CLAHRC Midwives’ Forum has been instrumental in helping dissemination.
What happened next?
The first dedicated OASIS/Perineal Trauma Midwife-led clinic in Spain has been established, with a second hospital interested in setting up a similar service. Sara Webb and Magarita Manresa in Spain are collaborating on a grant application that, if successful, will fund a pilot study for testing a perineal wound assessment tool in both the UK and Spain as first stage in a multi-site, international study. A Spanish Specialist Perineal Midwife network has been set up to join the UK group established by CLAHRC WM with the aim of improving OASIS and perineal trauma care and research internationally.