Bäckenbottenutbildning.se har sitt ursprung i Säker Förlossningsvård, ett projekt som startade 2007 som ett samarbete mellan Svensk Förening för Obstetrik och Gynekologi (SFOG), Svenska Barnmorskeförbundet (SBF), Svenska Neonatalföreningen (SNF) och Löf (regionernas ömsesidiga försäkringsbolag), och med syfte att få ner frekvensen undvikbara skador i svensk förlossningsvård. I projektets första del låg fokus på skador på barnet, medan i dess andra del även på mamman. Behovet av en samlad plats där bästa kända praxis för förebyggande, diagnostik och åtgärdande av bäckenbottenskador i samband med förlossning var stort, och därför fattades beslut om att ta fram en utbildning som mötte kraven enligt ovan.

Utbildningen har tagits fram av Eva Uustal, Marie Bolin, Monica Orrskog samt Gunilla Tegerstedt (SFOG) och Malin Edqvist, Ann Olsson och Marianne Weichselbraun (SBF). Sedan 2019 har Anna Bonnevier ersatt Monica Orrskog.

Innehållet har reviderats i maj 2018, september 2019 samt i september 2021.

Löf har täckt kostnader för utbildningens framtagande, och äger också utbildningen.

För att få veta mer om Löf, klicka på logotypen nedan:

 

Löf

 

 

Short description in English

History

Bäckenbottenutbildning.se ("pelvic floor education.se") originates from Safe Delivery Care, a collaborative project between Swedish obstetricians, midwives, pediatricians/neonatologists via their professional associations, and the Swedish National Patient Insurance Company, aimed at reducing avoidable injuries to the baby and the mother. The model used is based on non-normative self-evaluation, external review/peer-review, agreement on actions and follow-up.

For more information, see:www.lof.se/patientsakerhet/vara-projekt/saker-forlossningsvard/

Method

An expert group, appointed by the Swedish Association of Obstetricians and Gynaecologists (SFOG) and the Swedish Midwifery Association (SBF), developed audit questions regarding pelvic floor injuries which were submitted to all Swedish delivery units:

  1. How do you ensure that pelvic floor damage is prevented?
  2. How do you ensure that pelvic floor damage is diagnosed?
  3. How do you ensure that pelvic floor damage is treated properly?
  4. How do you ensure that the woman is informed of her pelvic floor injury?
  5. How do you ensure that pelvic floor damage is followed up in maternal health care?
  6. How do you ensure that long-term results after pelvic floor injury are followed up?

The questions were subdivided into: What routines/guidelines do you have? How do you create the conditions for their compliance? How do you measure/control the level of compliance? What ideas do you have about measures/improvements? 

The delivery units were audited by multiprofessional teams to clarify the written statements. Doctors and midwives were intervewed in a structured manner. Written answers and reports from the audits were compiled. These reports formed the base for the program content, and were considered of value both by exposing gaps in routines, knowledge and doumentation, but also in providing examples of good practice.

The authors´ common understanding of problems, as well as good examples from the audits, form the basis of the training program. All texts and recommendations has been written by, and discussed in, the group of authors.

In parallell, and partly within the project, two systematic literature reviews have been conducted. They were done under the direction of the Swedish agency for health technology assessment and assessment of social services, SBU. The program authors were part of the review process. The results are presented in two separate SBU reports [1, 2].

Evidence for practice is generally sparse, which has made it necessary to use consensus methods to create recommendations and instructions. The parts of this program based on specific scientific texts are marked with reference numbers, and the references are in each section. To build consensus, combined elements from the Nominal Group Technique, The RAND/UCLA Appropriateness Method, Delphi and the National Institute of Health's Consensus Development Conference were used [3]. A link to draft texts and recommendations were sent for review to key groups of doctors and midwives in Sweden. They evaluated the recommendations via an online survey under the auspices of SFOG. Changes were made until agreement was reasonable. The results of the survey shaped the recommendations, that thus reflect intended best standard of care in Sweden at this time.

All recommendations in the program are indicative. They do not form grounds for legal or professional action against caregivers.

References

  1. SBU-rapport 249. Analsfinkterskador vid förlossning. http://www.sbu.se/sv/publikationer/SBU-utvarderar/analsfinkterskador-vid-forlossning/
  2. SBU-rapport 250. Behandling av förlossningsskador som uppkommit vid vaginal förlossning – en kartläggning av systematiska översikter. http://www.sbu.se/sv/publikationer/sbu-kartlagger/behandling-av-forlossningsskador-som-uppkommit-vid-vaginal-forlossning--en-kartlaggning-av-systematiska-oversikter/
  3. Nair R, Aggarwal R, Khanna D. Methods of Formal Consensus in Classification/Diagnostic Criteria and Guideline Development. Semin Arthritis Rheum 2011; 41(2): 95–105