Getting evidence into obstetric and midwifery practice: reducing perineal trauma.

Abstract

PROBLEM: Frequent obstetric perineal morbidity in a hospital setting with service providers inexperienced in getting evidence into practice. DESIGN: Clinical practice improvement methodology in a tertiary referral obstetric unit. STRATEGIES FOR CHANGE: To cease active instruction to push in the second stage of labour; encourage the adoption of the left lateral position when delivering on a bed; use of the vacuum extractor rather than forceps where instrumental delivery indicated. EFFECTS OF CHANGE: Improved perineal outcomes with a 21.5% increase in intact perineum rate and a 100% reduction in fourth degree perineal tears. LESSONS LEARNED: Clinical practice improvement methodology is a useful tool for getting evidence into practice, resulting in improved clinical outcomes.