title: Do we know enough? A quality assessment of the Finnish intervention to prevent obstetric anal sphincter injuries.
abstract: OBJECTIVE
  Especially in the Nordic countries, increases in obstetric anal sphincter injuries (OASIS) have prompted standard use of the Finnish intervention for their prevention. We performed a quality assessment of the introduction of the intervention in a Danish hospital setting.
  
  
  METHODS
  All vaginal deliveries by primiparous women the year before (N = 343) and after (N = 334) the introduction were compared in a retrospective, observational design. Fisher's exact test, Student's t-test, and multiple logistic regression analysis were performed.
  
  
  RESULTS
  No significant difference in OASIS (OR: 0.5; 95% CI: 0.3-1.1) was found. The post-implementation group saw a significant increase in episiotomy (OR: 1.8; 95% CI: 1.1-2.9) and the length of second stage labor (p < 0.05) while intact perineum (OR: 0.5; 95% CI: 0.3-0.9), use of upright positions for birth (OR: 3.2; 95% CI: 1.8-5.5), and neonatal blood gas levels were significantly reduced (p < 0.05).
  
  
  CONCLUSIONS
  Introduction of the Finnish intervention was not followed by a significant reduction of OASIS, but a downward trend was seen. The study results raise questions about potential side effects of the Finnish intervention on neonatal outcomes, intact perineum, and women's free choice of birth positions. More knowledge on effect and side effects from high-evidence studies are needed.
authors.affiliation: a Department of Health Science and Technology , Faculty of Medicine, Aalborg University , Aalborg , Denmark.
authors.forename: Anne-Cathrine
authors.initials: AC
authors.lastname: Skriver-Møller
authors.affiliation: a Department of Health Science and Technology , Faculty of Medicine, Aalborg University , Aalborg , Denmark.
authors.forename: Mia Lund
authors.initials: ML
authors.lastname: Madsen
authors.affiliation: a Department of Health Science and Technology , Faculty of Medicine, Aalborg University , Aalborg , Denmark.
authors.forename: Mette Østergaard
authors.initials: MØ
authors.lastname: Poulsen
authors.affiliation: a Department of Health Science and Technology , Faculty of Medicine, Aalborg University , Aalborg , Denmark.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Overgaard
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000293:injuries*; D000704:Analysis of Variance; D036861:Delivery, Obstetric / Q000379:methods*; D004841:Episiotomy / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007748:Labor Stage, Second; D022125:Lacerations / Q000517:prevention & control*; D016015:Logistic Models; D007744:Obstetric Labor Complications / Q000517:prevention & control*; D010502:Perineum / Q000293:injuries*; D011247:Pregnancy; D012189:Retrospective Studies; D013997:Time Factors
keywords: Asphyxia neonatorum; Finnish intervention; OASIS; birth position; episiotomy; obstetric anal sphincter injuries; perineal injury; perineum