How to decrease the frequency of sphincter tears:

1.     A clear definition of the problem together with an external analysis so that everybody can understand that there exists a     problem.
2.     Support from the leaders of the unit
3.     Every midwife has started their own process with a will to improve
4.     Consensus in the midwife and in the physician group on the importance of a common method.
5.     Choose one or two persons who are driven and have authority at the management level as well as with the midwives and the physicians. In Hudiksvall a midwife/care planner was chosen.
6.     Introduce a second midwife in the delivery room at the time of birth
7.     Dare to set tough goals – sphincter tears < 1 %
8.     Create supporting documents. Routine
9.     Continuous follow-up of results. Result boards
10.   Ensure that all new midwives and physicians are introduced to the method before they begin their clinical work at the unit.