While interrupted by the pandemic, bushfires and cyber-attacks, our major partnership with a committed group of maternity services has reduced severe perineal tearing during birth by 45 per cent.

Severe perineal lacerations (third- or fourth-degree tears) can have devastating long-term or lifelong impacts on physical and psychological wellbeing. Many of these tears are avoidable.

The Better Births for Women collaborative embedded consistent, reliable use of hands-on technique, warm perineal compresses and other preventive practices to improve outcomes for women.

Using our Partnering in Healthcare framework, we included consumer voices across the participating teams and in leadership roles.

Results for the collaborative show severe tearing was prevented for at least 155 women.

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 the second stage of labour
• hands on technique, to support the perineum, with gentle verbal guidance
• episiotomy performed when indicated (during instrumental delivery and at 60 degrees)
• genito-anal examination of all women post birth
• grading of perineal tears 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 and achieving outstanding results for women.