In 2014 the UK Royal Colleges of Obstetricians and Gynaecologists (RCOG), and of Midwives (RCM) responded to an apparent tripling in the rate of severe (3rd and 4th degree) perineal trauma (Gurol-Urganci et al., 2013) (SPT) by recommending a Care Bundle (Royal College of Obstetricians and Gynaecologists RCoM 2016; RCOG. OASI Care Bundle Project Team 2018) with four main elements: 1. antenatal information; 2. manual perineal protection for all vaginal births; 3. episiotomy with a 60° mediolateral angle at crowning when clinically indicated; 4. perineal examination, including per rectum after vaginal birth for all women. The project started as a pilot study and was eventually scaled up and implemented in 16 maternity units in England, Scotland and Wales from January 2017 to May 2018. In December 2019 it was rolled out to more maternity units (Gynaecologists RCoOa 2019). The group also set up an evaluation project (P Bidwell et al., 2018; P Bidwell et al., 2018).
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