The impact of the nine-item list intervention on the rate of obstetric anal sphincter injury in women with spontaneous and operative vaginal births.

I Sir, i We would like to thank Dr Rasmussen for his interest in our article and for raising some important points regarding the rate of obstetric anal sphincter injury (OASI).1 The overall purpose of the nine-item list intervention of organizational and cultural changes was to increase the number of spontaneous vaginal births without increasing adverse neonatal outcomes.2 In the present paper we evaluated long-term effects on outcomes in Robson group 1, with the emphasis on neonatal variables.3 We agree that vaginal birth is the correct denominator when comparing OASI rates, although all births are widely used. As suggested by Dr Rasmussen, we hereby present the rate of OASI overall and in spontaneous vaginal births and operative vaginal births according to study period (Table 1). [Extracted from the article]