In their critical review of the OASI Care Bundle that was implemented and evaluated in approximately 55,000 women between 2016 and 2018 in 16 hospitals of the National Health Services (NHS) in England, Scotland and Wales (Gurol-Urganci et al., 2020; Bidwell et al., 2018), Thornton and Dahlen raise a number of critical points that lead them to question the rationale for this care bundle as well as the underlying evidence. A criticism is that the implementation of the care bundle may cause "unintended harm". In fact, the OASI Care Bundle was found to reduce OASI rates by 20 without affecting the caesarean birth rates or episiotomy use (Gurol-Urganci et al., 2020). While we do not dispute the use of the suggested term "severe perineal traum" instead of OASI, we caution that severe perineal trauma might exclude women with severe vaginal injuries without anal sphincter involvement and also button hole tears, both injuries which can have serious consequences.
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