title: Getting evidence into obstetric and midwifery practice: reducing perineal trauma.
abstract: OBJECTIVE
  Frequent obstetric perineal morbidity in a hospital setting with service providers inexperienced in getting evidence into practice.
  
  
  METHODS
  Clinical practice improvement methodology in a tertiary referral obstetric unit.
  
  
  METHODS
  To cease active instruction to push in the second stage of labour; encourage the adoption of the left lateral position when delivering on a bed; use of the vacuum extractor rather than forceps where instrumental delivery indicated.
  
  
  RESULTS
  Improved perineal outcomes with a 21.5% increase in intact perineum rate and a 100% reduction in fourth degree perineal tears.
  
  
  CONCLUSIONS
  Clinical practice improvement methodology is a useful tool for getting evidence into practice, resulting in improved clinical outcomes.
authors.affiliation: Division Women's Children's and Family Health, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia. mnicholl@nsccahs.health.nsw.gov.au
authors.forename: Michael C
authors.initials: MC
authors.lastname: Nicholl
authors.forename: Miriam A
authors.initials: MA
authors.lastname: Cattell
mesh_terms: D036861:Delivery, Obstetric; D019317:Evidence-Based Medicine; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008880:Midwifery; D009517:New South Wales; D010502:Perineum / Q000293:injuries*; D011247:Pregnancy; D014947:Wounds and Injuries / Q000517:prevention & control*