Intervention Bundle

Planning and development

To provide advice on issues relating to the successful development and delivery of a Collaborative an expert panel was formed with representation from around Australia including midwives, obstetricians, urogynaecologists and consumer representatives.  The varied perspectives allow for a diverse cross section of stakeholder issues to then be taken into account.  In doing so, we aim to deliver long lasting and effective change for women’s perineal health and wellbeing.

The expert panel met on two occasions to evaluate evidence to determine the interventions that could reliably reduce rates of harm from third and fourth degree tears. 

In addition to the quality of evidence, other factors were taken into account in the selection process including:  

  • Acceptability of interventions by women
  • Research evidence from current systematic reviews, source articles, best practice guidelines  
  • Feasibility of implementation within Australian maternity services

Testing the Bundle

The bundle was tested across six sites in Australia.  This helped inform both the design and content of the Bundle, to make it fit for purpose and to reflect best practice.   The interventions that were included are all currently in practice within maternity units in Australia.  The collaborative aims only to improve the reliability with which the practices occur.

Support and education for participating services to deliver the different elements of the is being provided.  Refer to the Collaborative Methodology page.

 It is important to note that the bundle;

  • is dependent on the informed consent of the women
  • is being delivered with considerable education and expert support from trained Improvement Advisors  and a Director of Collaboratives out with the participating hospitals. This is critical as the bundle cannot be implemented reliably without due regard to education on how to design the processes in which the clinical teams work. The reliability of the outcome  for the women is wholly dependent on these key learnings.
  • Is compatible with clinician discretion
  • does not replace reasonable clinical judgement





    Supporting use of the Bundle in participating services

    This Intervention Bundle is supported by an accompanying booklet which provides information on how to perform all components.  Included in the booklet are recommendations on communicating with the woman about the elements of the bundle and suggested wording for documentation related to the interventions bundle. The bundle will be supported by an educational resources package and facilitated coaching by experts in improvement science that aims to achieve reliable sustained improvements in patient care.



    This booklet is intended for use by all midwives and obstetricians at participating hospitals and health services. The term ‘clinician’ is used which refers to both midwives and obstetricians irrespective of the level of experience. Local training in improvement science implementation on how to design the local processes and system to use the care bundle is critical to its success. The accompanying educational resource package is designed to support participating teams to understand basic concepts.  Those championing change within each service are responsible for ensuring that staff are provided with sufficient  quality improvement science training to enable them to carry out all elements safely and effectively.

    Intervention Bundle

    Accompanying bundle booklet