Title: Optimising the care of women following childbirth related perineal trauma
Funder: Department of Health and Social Care

Abstract: Research question How can we optimise the care of women following childbirth related perineal trauma (CRPT)? Background There is a lack of evidence regarding the care of women following the common problem of CRPT and a lack of tools to support provision of high-quality care. Specifically, there is a lack of high quality evidence relating to prevalence of subsequent health problems, care pathways and tools. We believe the existing evidence underestimates the prevalence, complications, health consequences and cost burden. Aims and objectives Our primary aim is to work with women and stakeholders to optimise the care of women following CRPT in the NHS. Our secondary aims are to summarise the published evidence in this area for global settings and to work with collaborators representing global stakeholders to consider the relevance of outputs for global settings, and to develop a network for dissemination and future research. Objectives 1. To describe the current prevalence, management and outcomes of CRPT. 2. To determine risk factors for developing complications of CRPT, risk factors or predictors of health problems following complications of CRPT. 3. To summarise the evidence from a prospective cohort study, data linkage study, published literature, women s and Healthcare Professionals (HCPs) views related to prediction, assessment, diagnosis and management of CRPT and complications of CRPT. 4. To explore with key stakeholders (women, clinicians and primary and secondary health care services) their views on CRPT wound management and healing, what they would want from an assessment tool and outcomes that are important to them. 5. To develop and test a reliable, valid wound assessment tool and care pathway for assessment and treatment guidance of CRPT wounds. 6. To determine the important outcomes following CRPT for women, clinicians and the NHS and design a tool to capture these outcomes (CRPT management, outcomes and women s experience) and co-develop a core outcome set for CRPT. 7. To integrate, synthesize, disseminate the programme outputs, to optimise outcomes for women and the NHS. To develop future directions for research and clinical practice. Methods This is a mixed-methods programme of four interlinked work packages (WP) with PPI throughout culminating in an integrated synthesis. The WPs involve a cohort study, primary and secondary care routine data linkage, qualitative research with women and HCPs to capture their experiences and views, working with women and HCPs to develop tools to assess CRPT, capture important outcomes and an optimised care pathway. Timelines for delivery The programme runs for 4 years with outputs delivered in months in months 21, 30 and 45. Anticipated impact and dissemination The final 3 months are for integration and dissemination via a series of workshops and stakeholder events. By standardising and optimising the care of women with CRPT after giving birth, we hope to improve their recovery, ability to care, bond and breastfeed their baby, reduce inappropriate antibiotic use, ensure high-quality care if complications arise and improve long-term outcomes. This will positively affect the lives of over half a million women per year in the UK.

Lay abstract: The problem Each year in the UK, 80% of women who give birth vaginally (450,000 women), experience damage to the surrounding area. This may result from tears or cuts to tissues, muscles and skin around the bladder, vagina and perineum (the skin between the vagina and back passage). This is called Childbirth Related Perineal Trauma (CRPT). CRPT needs to be dealt with quickly and effectively. If not treated, women can be left with pelvic floor problems (e.g. incontinence) or psychological problems (e.g. bonding with baby). We currently do not collect information to tell us how frequent or serious these complications are, but we know that 15% of re-admissions to hospital after childbirth come from perineal wound problems (costing the NHS &pound;2.4 million each year). GPs and midwives say they lack confidence, knowledge and training on how to assess and treat CRPT, as there is little research or guidelines in this area. In national surveys, women say they are dissatisfied with their care after giving birth. Our Aims and Approach Our research team brings together women, the public, midwives, doctors and academics to improve care for women with CRPT by: Summarising existing research and good practice worldwide. Carrying out research using existing information to understand how frequent and serious any complications are. Develop and testing a tool to assess CRPT and help direct care more effectively. Working with mothers and healthcare professionals to understand their views on what is important to them, how an assessment tool might be used and how any treatment should be delivered. Involving the public Women have told us that they support our research. We will set up a Programme Advisory Group of at least 8 women and 4 partners who will be involved throughout, advising us how best to recruit women, guide us on the use of the tool, advise how best to share the results and help shape the future direction of research into CRPT. Sharing our findings We will share our findings with women and policy makers via key organisations such as National Childbirth Trust, Royal Colleges of Midwives, Obstetricians and Gynaecologists, GPs and target publications such as British Medical Journal and Midwifery. We will also target wider networks such as Health Visitors, physiotherapists etc. We will work with stakeholders to promote further areas for research and develop future guidelines and policies. Our impact By standardising and optimising the care of women with CRPT after giving birth, we hope to improve their recovery, ability to care, bond and breastfeed their baby, reduce inappropriate antibiotic use, ensure high-quality care if complications arise and improve long-term outcomes. This will positively affect the lives of over half a million women per year in the UK.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;2.1 BIOLOGICAL AND ENDOGENOUS FACTORS;7.3 MANAGEMENT AND DECISION MAKING;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH