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    Women having their first birth vaginally in Victoria are four times more likely to experience a severe perineal laceration (third- or fourth-degree tear) compared to those having a subsequent birth vaginally (Victorian perinatal services performance indicators 2018–19 report).

    This can have devastating long-term or lifelong impacts on physical and psychological wellbeing. Many of these tears are avoidable.

    We partnered with the Institute for Healthcare Improvement (IHI) and 14 health services to improve birth outcomes for all women giving birth in Victoria, using the IHI’s proven Model for improvement.

    Using the ‘Partnering in healthcare’ framework, we included consumer voices and representatives across the participating teams, and in leadership roles for this program.

    Drawing on work undertaken by Women’s Healthcare Australasia, in their development of the WHA CEC Perineal Protection Bundle, we tested and spread evidence-based care bundles to reduce third- and fourth-degree perineal tear rates.

    Work focused on five clinically endorsed interventions:

    • application of warm perineal compress during labour 
    • hands on to support the perineum, with gentle verbal guidance   
    • episiotomy performed when indicated (during instrumental delivery and at 60 degrees) 
    • genito-anal examination on all women post birth  
    • grading of perineal tear and review by experienced clinician.

    Phase 1 ran from June 2019 – March 2020, before being paused due to the COVID-19 pandemic. Phase 2 commenced in November 2020 and concluded in May 2021, with the majority of services continuing their participation.


    The Better births for women collaborative concluded in May 2021. Despite unprecedented circumstances, including a global pandemic and devastating bushfires, the participating health services achieved exceptional outcomes for Victorians. Safer Care Victoria would like to extend our sincere gratitude to those who contributed to this work under such exceptional circumstances.

    The 12 Victorian health services that completed both phases of the Better births for women collaborative sought to reduce the rate of 3rd and 4th degree perineal tears across the state. Data collected throughout the collaborative indicates that 155 women were prevented from having a severe perineal tear. Data also shows the rate of severe tearing dropped by 45%, from an average rate of 4.41% to 2.44%. This is a remarkable achievement and a life changing outcome for 155 Victorian women and their families. 

    Who was involved?

    Ballarat Health Services Northern Health
    Barwon Health St John of God Bendigo Hospital
    Bass Coast Regional Health St Vincent's Private Hospital
    Central Gippsland Health Service (Sale) South West Healthcare Group (Warrnambool)
    Djerriwarrh Health Services Western District Health Service (Hamilton)
    East Grampians Health Service (Ararat) Western Health
    Kilmore and District Hospital Wimmera Health Care Group (Horsham)
    Amy Dawes, founder of the Australasian Birth Trauma Association   

    Resources for health services

    Perineal Protection Bundle – How to guide

    This how to guide supports services wanting to reduce their rates of harm from perineal tears using the Perineal Protection Bundle. The guide describes the five components that form the WHA CEC Perineal Protection Bundle that when implemented together, have been shown to reduce third- and fourth-degree perineal tears.

    Partnering in healthcare framework

    Our Partnering in healthcare framework and self-assessment tool will help services involve women and their families, respond to their needs and expectations and deliver care that is safe, woman-centred, equitable and effective.

    Victoria’s Mothers, Babies and Children report 2019

    The Victoria’s Mothers, Babies and Children report from the Consultative Council on Obstetric and Paediatric Mortality and Morbidity (CCOPMM), provides access to comprehensive data on all maternal, perinatal and paediatric mortality and morbidity, including stillbirth.

    Perinatal services performance indicators 2019-20

    The Victorian Perinatal services performance indicators report provides benchmarking data on a range of clinical indicators, including the rate of 3rd and 4th degree perineal tears.

    A 100,000 Lives initiative

    100,000 Lives - every life is a story worth telling

    Together with health services, consumers and experts we're improving healthcare for 100,000 Victorians.

    Get in touch

    Maternity and newborn learning health network
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