Severe third- and fourth-degree perineal tears can lead to long-term physical and psychological injuries for women. Outcomes can be improved through consistent evidence-based care, as outlined in the Australian Commission on Safety and Quality in Health Care (ACSQHC) Third and Fourth Degree Perineal Tear Clinical Care Standard (April 2021).
Building on the success of our Better births for women collaborative, we developed a clinical audit to help Victorian maternity services implement the ACSQHC Third and Fourth Degree Perineal Tears Clinical Care Standard. The standard is evidence-based and woman-centred to promote informed and shared decision-making for better birthing outcomes.
In July 2021, the Perineal protection project expert working group convened for the first of five meetings. The expert working group comprised a lived-experience expert and nine multidisciplinary clinical experts from across Victoria with a vested interest in improving perineal care for women before, during and after vaginal birth.
In March 2022, the Perineal protection project expert working group met for its final meeting to reflect and celebrate the outputs of the project. Despite the Covid-19 pandemic, Code Brown response, clinician fatigue, and maternity sector staffing pressures, the expert working group achieved its aim to develop a clinical audit to assess current practice against the Third and Fourth Degree Perineal Tears Clinical Care Standard.
The expert working group developed, tested, and refined:
- The Perineal protection clinical audit:
- Audit support resources:
- Perineal protection audit sample calculator
- Perineal protection clinical audit data collation sheet with traffic light system
- Progressive data collation sheet
- Perineal protection resources
- Perineal assessment record
- Curated resources to support implementation
Resources for clinicians:
- ACSQHC Talking about tears - A video for clinicians
- BTA Antenatal Perineal Support During Childbirth - Information and Discussion Guide
- BTA Antenatal A4 Poster: Perineal Tears
Resources for consumers
- ACSQHC Third and fourth degree perineal tears: A video for women
- ACSQHC Perineal tears: How to reduce the risk (Easy English)
- ACSQHC Perineal tears: How to get better (Easy English)
- BTA THINKNATAL: Perineal Support During Childbirth video (2:53min)
- WHA Reducing third and fourth degree perineal tears (English version) - translated into 6 languages
- BTA THINKNATAL: Pelvic Floor Video (2:43 mins)
- BTA THINKNATAL: The Pelvic Floor During Pregnancy Video (3:20 mins)
- National Continence Program: Pelvic floor muscle training for women (12 page booklet, available in multiple languages)
- Continence Foundation of Australia: Pelvic floor muscle exercises (Easy English)
Early in the project, the expert working group highlighted a gap in clinical practice associated with clinician confidence and competence in ability to provide effective debriefing post severe perineal injury, the practice gap was further emphasised by the consumer-advisors birth experience. The clinical care standard details the need for debriefing post a third-or-fourth degree perineal tear; drawing on lived experience and clinical expertise the expert working, led by the consumer-advisor developed, tested, and refined the Perineal Tear Debrief Guide to improve debrief provided to women post severe perineal tear. The guide uses open disclosure practice and is supported by:
- ACSQHC Open disclosure - what to expect if you experience harm during health care?
- ACSQHC Preparing and participating in open disclosure discussions (Info for consumers and carers)
- ACSQHC Open Disclosure - What happens if you are harmed during health care (Easy English)
On Wednesday 13 April 2022, SCV hosted the Perineal Protection Clinical Conversation to promote the project outputs and learn from the expert working group consumer-advisor and Chair who generously shared her birth story. Over 50 participants from across Victoria joined the webinar to learn more about perineal protective practices.