Midwife and researcher, Nigel Lee, joins me to talk about the Perineal Tear Bundle (bungle?!) that was rolled out in Australian hospitals a few years ago, in a feeble attempt to reduce the incidence of 3rd and 4th degree perineal tears. It consisted of 5 different practices applied to women during birth, in an attempt to reduce 3rd of 4th degree tears. These tears extend to include the muscles around the anus (3rd degree) or into the anal passage (4th degree). We discuss what the evidence says, the issues with most of the elements of the bundle, consent, the rise of episiotomy, what his own research found when interviewing midwives about the Perineal Tear Bundle, what other parts of the world are doing to reduce 3rd and 4th degree tears, and what Australia needs to do in order to improve outcomes. 

Link to Nigel's research: 2021 Allen, J., Small, K., Lee, N. How a perineal care bundle impacts midwifery practice in Australian maternity hospitals: A critical, reflexive thematic analysis. Women and Birth. In press https://doi.org/10.1016/j.wombi.2021.01.012

2018 Lee, N, Gao, Y, Lotz, L and Kildea, S . Maternal and neonatal outcomes from a comparison of spontaneous and directed pushing in second stage. Women and Birth. 32(4), e433-e440.https://doi.org/10.1016/j.wombi.2018.10.005 https://doi.org/10.1016/j.wombi.2018.10.005

2018 Lee, N., Firmin, M., Gao, Y., & Kildea, S. . Perineal injury associated with hands on/hands poised and directed/undirected pushing: A retrospective cross-sectional study of non-operative vaginal births, 2011–2016. International journal of nursing studies, 83, 11-17. DOI: 10.1016/j.ijnurstu.2018.04.002 

More on the Perineal Tear Bundle and midwifery practice here: Bundles for perineal care: the impact on midwifery practice - Transforming Maternity Care Collaborative