title: The impact of an intervention programme employing a hands-on technique to reduce the incidence of anal sphincter tears: interrupted time-series reanalysis.
abstract: OBJECTIVE
  To re-evaluate previously published findings from an uncontrolled before-after evaluation of an intervention programme to reduce the incidence of anal sphincter tears. A key component of the programme was the use of a hands-on technique where the birth attendant presses the neonate's head during the final stage of delivery while simultaneously supporting the woman's perineum with the other hand.
  
  
  METHODS
  Interrupted time-series analysis using segmented regression modelling.
  
  
  METHODS
  Obstetric departments of five Norwegian hospitals.
  
  
  METHODS
  All women giving births vaginally in the study hospitals, 2002-2008.
  
  
  METHODS
  The main data source was the Medical Birth Registry of Norway. We estimated the change in incidence of anal sphincter tears before and after implementation of the intervention in the five intervention hospitals, taking into account the trends in incidence before and after implementation.
  
  
  METHODS
  Incidence of anal sphincter tears and episiotomies.
  
  
  RESULTS
  There were 75 543 registered births at the five included hospitals. We found a 2% absolute reduction in incidence of anal sphincter tears associated with the hospital intervention programme, representing almost a halving in the number of women experiencing serious anal sphincter tears. This is a substantially smaller estimate than previously reported. However, it does represent a highly significant decrease in anal sphincter injuries. The programme was also associated with a significant increase in episiotomies.
  
  
  CONCLUSIONS
  The intervention programme was associated with a significant reduction in the incidence of obstetric anal sphincter tears. Still, the findings should be interpreted with caution as they seem to contradict the findings from randomised controlled studies of similar interventions.
authors.affiliation: Global Health Unit, Norwegian Knowledge Centre for the Health Services, Oslo, Norway.
authors.forename: Atle
authors.initials: A
authors.lastname: Fretheim
authors.forename: Jan
authors.initials: J
authors.lastname: Odgaard-Jensen
authors.forename: John-Arne
authors.initials: JA
authors.lastname: Røttingen
authors.forename: Liv Merete
authors.initials: LM
authors.lastname: Reinar
authors.forename: Siri
authors.initials: S
authors.lastname: Vangen
authors.forename: Tom
authors.initials: T
authors.lastname: Tanbo
keywords: OBSTETRICS; STATISTICS & RESEARCH METHODS