Problem: Frequent obstetric perineal morbidity in a hospital setting with service providers inexperienced in getting evidence into practice.
Design: Clinical practice improvement methodology in a tertiary referral obstetric unit.
Strategies for change: 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.
Effects of change: Improved perineal outcomes with a 21.5% increase in intact perineum rate and a 100% reduction in fourth degree perineal tears.
Lessons learned: Clinical practice improvement methodology is a useful tool for getting evidence into practice, resulting in improved clinical outcomes.