



In the early 1990s it was claimed that an experienced colleague helps to decrease the number of OASIS. Surely true, but if one thinks that the older colleague has learned an incorrect technique, this helps very little. Gårebergfound, already in 1993 [23], that abnormal delivery positions were associated with increased risk for OASIS. For example, a delivery in an upright position included seven times higher risk for a sphincter tear. Later, the Swedish scientist has not found the same difference. This is not very surprising because the perineal support and the use of correct episiotomy technique has been totally forgotten. Therefore, when not using a perineal support technique neither in a treatment norin a control group, the result in the OASIS rate will be the same in both groups. However, we have to keep inmind that the purpose of these early attempts was just to describe the different risk factors, and the existing situation in different delivery units, and not to decrease the OASIS rate.
Parnell., et al. published their material in 2001 [19]. The study included 1072 primiparous women at term. In non-instrumental vaginal deliveries easing of the perineum over the caput as it advanced helped prevent a rupture of the anal sphincter. Vacuum extraction performed with the woman in a semi-recumbent position was associated with an increased risk of rupture of the anal sphincter, whereas attention to the perineum during extraction decreased the risk. They concluded that fewer vacuum extractions and improved delivery technique will cause a decrease in the OASIS rate. This interesting finding was, however, forgotten, and the rise of the tears continued.
Since 1998, when our study comparing OASIS statistic between Finland and Sweden came out, there was a silent period. Suddenly in 2004 something started to happen in Norway. The national Health Control Agency (Helsetilsynet) reviewed all the Norwegian delivery ward data in 2004. The agency felt the level of tears was unacceptable, and after consultation with the Department of Health and Social Affairs, a National Advisory Committee for Childbirth (Nasjonaltråd for födselsomsorg) was set up to develop a national plan to reduce the number of anal sphincter ruptures. At first, a national meeting was arranged in Bergen, Norway in January 2005 where I was invited to speak. After the meeting the officials together with us decided to start a nationwide project in aim to reduce these tears. National Advisory Committee for Childbirth prepared national guidelines which were published in January 2006. The hospital in Fredrikstad was the first one to take part in this intervention which had its start in September 2005.
It has been almost two decades since the first warning signals of increasing number of perineal tears were published [24]. Since then, an intervention was started in Norway with a dramatic improvement in the OASIS statistic [15,28]. Later, even in Denmark, a similar intervention caused a significant decrease in these serious tears [32]. A similar effect using a better technique has been described also in Sweden (article in progress).
- Frankman EA., et al. “Episiotomy in theUnited States: has anything changed?” American Journal of Obstetrics & Gynecology 200.5 (2009): 573-577.
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- Altman D., et al. “Anal sphincter lacerations and upright delivery postures-a risk analysis from a randomized controlled trial”. International Urogynecology Journal - and Pelvic Floor 18.2 (2007): 141-146.
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- OECD (2013), Health at a Glance 2013: OECD Indicators. OECD Publishing.
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- Escuriet R., et al. “Cross-sectional study comparing public and private hospitals in Catalonia: Is the practice of routine episiotomy changing?” BMC Health Service Research 15 (2015): 95.
- Sagi-Dain L and Sagi S. “The correct episiotomy: does it exist? A cross-sectional survey of four public Israeli hospitals and review of the literature”. International Urogynecology Journal 26.8 (2015) 1213-1219.
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