OASI Care Bundle: First do no harm

19 Apr, 2020

In the past 10 years it appears that obsteric anal sphincter injuries (OASI) have been increasing. The RCOG in partnership with the RCM and others, have developed and upscaled a pilot intervention package, a ‘care bundle’ designed to prevent and reduce OASI. The OASI care bundle, a collection of interventions from warm compresses applied to the perineum, to medio lateral episiotomy being used when necessary, may have already been implemented in your unit.

Margaret Jowitt, steering group member, author and childbirth activist explores the evidence behind the bundle, and whether the interventions recommended may actually cause more harm than good. She argues that there is not enough evidence to support implementation of the OASI care bundle and explains why some of its recommendations could even cause injury.



  1. Katherine Hales

    Thank you Margaret this is very welcome and comprehensive critique of a recommendation which does not sit well with many midwives. It feels counter-intuitive to use the invasive hands on techniques recommended and the introduction of the guideline seemed rushed and ill considered.

  2. Carolyn

    Thank you for this – I feel concerned about this being yet another think pushing towards far more defensive practices. I’m an obstetrician who avoids epis the significant majority of the time I’m assisting a woman with ventouse (and will happily do so in whatever position she prefers!). I refuse to change practice without good reason but can’t help worrying about the times a woman in my care will suffer an injury and the medicolegal impact of this

    • Margaret Jowitt

      Sorry it’s taken me so long to reply. To be honest, it has also taken me far too long to see that many of these clinical initiatives are aimed at reducing litigation. I’m so glad you do ventouse in different positions. We (ARM) had a wonderful article many years ago about an obstetrician who used ventouse to bring the baby down, then removed it and the woman was able to complete the birth by maternal effort (as it is so quaintly known!). These sort of things make such a difference. It’s worth knowing that a family is less likely to use legal means to redress damage if they feel they have been listened to. (and the converse)


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