The OASIS Syndrome Professor MRB Keighley Discoveries from an MA Durham Case studies and interviews (81 + 14) Interviews – Health Professionals (12) Focus Group (14 + 16) MASIC IS BORN

Anal incontinence (AI: lack of control of wind and waste) occurs in over 1:10 mothers after having a baby through the birth canal Obstetric anal sphincter injuries (oasis) is the term to describe these mothers. The risk factors for AI in OASIS are:- 1st vaginal delivery Instrumental delivery; forceps > ventouse Big baby small pelvis Post maturity Long second stage pushing Poor control of perineum at childbirth

Results: 81 Case Studies of AI in OASIS 4/6/2019 11:22 PM Results: 81 Case Studies of AI in OASIS Risk: 68 First Baby (84%) 70 Assisted Births (70%) 11 ventouse alone 23 forceps alone 23 ventouse → forceps 79 Anatomical Injury 2 neuropathy alone (23 neuropathy and OASI) 41 Incorrect Assessment of Injury (54%) 25 missed third degree 16 missed fourth degree 24 Sustained a Fistula 10 Anoperineal 14 rectovaginal © 2007 Microsoft Corporation. All rights reserved. Microsoft, Windows, Windows Vista and other product names are or may be registered trademarks and/or trademarks in the U.S. and/or other countries. The information herein is for informational purposes only and represents the current view of Microsoft Corporation as of the date of this presentation. Because Microsoft must respond to changing market conditions, it should not be interpreted to be a commitment on the part of Microsoft, and Microsoft cannot guarantee the accuracy of any information provided after the date of this presentation. MICROSOFT MAKES NO WARRANTIES, EXPRESS, IMPLIED OR STATUTORY, AS TO THE INFORMATION IN THIS PRESENTATION. 3

Hiding My Condition ‘I keep hiding the dirty linen’ 4/6/2019 11:22 PM Hiding My Condition ‘I keep hiding the dirty linen’ ‘I did not want my children to know’ ‘I hope to keep it a secret’ ‘It is best not to talk about it’ © 2007 Microsoft Corporation. All rights reserved. Microsoft, Windows, Windows Vista and other product names are or may be registered trademarks and/or trademarks in the U.S. and/or other countries. The information herein is for informational purposes only and represents the current view of Microsoft Corporation as of the date of this presentation. Because Microsoft must respond to changing market conditions, it should not be interpreted to be a commitment on the part of Microsoft, and Microsoft cannot guarantee the accuracy of any information provided after the date of this presentation. MICROSOFT MAKES NO WARRANTIES, EXPRESS, IMPLIED OR STATUTORY, AS TO THE INFORMATION IN THIS PRESENTATION. 4

‘I feel constantly unclean’ ‘I'm obsessed with washing’ 4/6/2019 11:22 PM Unclean ‘I feel constantly unclean’ ‘I'm obsessed with washing’ ‘I feel dirty’ © 2007 Microsoft Corporation. All rights reserved. Microsoft, Windows, Windows Vista and other product names are or may be registered trademarks and/or trademarks in the U.S. and/or other countries. The information herein is for informational purposes only and represents the current view of Microsoft Corporation as of the date of this presentation. Because Microsoft must respond to changing market conditions, it should not be interpreted to be a commitment on the part of Microsoft, and Microsoft cannot guarantee the accuracy of any information provided after the date of this presentation. MICROSOFT MAKES NO WARRANTIES, EXPRESS, IMPLIED OR STATUTORY, AS TO THE INFORMATION IN THIS PRESENTATION. 5

4/6/2019 11:22 PM Sexual Horrors ‘We have had no sexual encounters since the birth (over 3 years)’ ‘It is never spontaneous’ ‘I am always worried I may leak’ ‘I have to shower beforehand’ ‘I go to bed early in order to avoid it’ ‘He is hardly a husband anymore…more like a carer’ © 2007 Microsoft Corporation. All rights reserved. Microsoft, Windows, Windows Vista and other product names are or may be registered trademarks and/or trademarks in the U.S. and/or other countries. The information herein is for informational purposes only and represents the current view of Microsoft Corporation as of the date of this presentation. Because Microsoft must respond to changing market conditions, it should not be interpreted to be a commitment on the part of Microsoft, and Microsoft cannot guarantee the accuracy of any information provided after the date of this presentation. MICROSOFT MAKES NO WARRANTIES, EXPRESS, IMPLIED OR STATUTORY, AS TO THE INFORMATION IN THIS PRESENTATION. 6

Isolation Embarrassed ‘I am afraid to go out of the house’ 4/6/2019 11:22 PM Isolation ‘I am afraid to go out of the house’ ‘I cannot talk to people and I feel isolated’ ‘I dare not socialise’ ‘I have no control over wind which is a great embarrassment’ Embarrassed © 2007 Microsoft Corporation. All rights reserved. Microsoft, Windows, Windows Vista and other product names are or may be registered trademarks and/or trademarks in the U.S. and/or other countries. The information herein is for informational purposes only and represents the current view of Microsoft Corporation as of the date of this presentation. Because Microsoft must respond to changing market conditions, it should not be interpreted to be a commitment on the part of Microsoft, and Microsoft cannot guarantee the accuracy of any information provided after the date of this presentation. MICROSOFT MAKES NO WARRANTIES, EXPRESS, IMPLIED OR STATUTORY, AS TO THE INFORMATION IN THIS PRESENTATION. 7

Motherhood Loss of Confidence Employment No one to talk to 4/6/2019 11:22 PM Motherhood Loss of Confidence ‘I need a lot of support and reassurance’ ‘I feel bad I cannot join in school activities’ ‘I feel a failure as a mother’ ‘I have lost my job’ ‘I feel unable to talk to anyone’ ‘I cannot hide my condition at work’ Employment No one to talk to © 2007 Microsoft Corporation. All rights reserved. Microsoft, Windows, Windows Vista and other product names are or may be registered trademarks and/or trademarks in the U.S. and/or other countries. The information herein is for informational purposes only and represents the current view of Microsoft Corporation as of the date of this presentation. Because Microsoft must respond to changing market conditions, it should not be interpreted to be a commitment on the part of Microsoft, and Microsoft cannot guarantee the accuracy of any information provided after the date of this presentation. MICROSOFT MAKES NO WARRANTIES, EXPRESS, IMPLIED OR STATUTORY, AS TO THE INFORMATION IN THIS PRESENTATION. 8

Coping; Washing Planning the day Sharing 4/6/2019 11:22 PM Coping; Washing I feel better once I have washed I shower many times a day We have a tap with a hose as in most Asian homes Planning the day I must plan my day carefully Radar key availability is a life saver If I starve I cope better Sharing Silence is not helpful I have found a soul mate © 2007 Microsoft Corporation. All rights reserved. Microsoft, Windows, Windows Vista and other product names are or may be registered trademarks and/or trademarks in the U.S. and/or other countries. The information herein is for informational purposes only and represents the current view of Microsoft Corporation as of the date of this presentation. Because Microsoft must respond to changing market conditions, it should not be interpreted to be a commitment on the part of Microsoft, and Microsoft cannot guarantee the accuracy of any information provided after the date of this presentation. MICROSOFT MAKES NO WARRANTIES, EXPRESS, IMPLIED OR STATUTORY, AS TO THE INFORMATION IN THIS PRESENTATION. 9

Recovery and Healing; Hope My Baby Not alone Love Blessings 4/6/2019 11:22 PM Recovery and Healing; Hope I have not given up hope I believe in something beyond myself which I find helpful My Baby Although my problem was the result of the birth having him has helped me, my baby makes it all worthwhile Not alone I am encouraged by knowing that there are many other mothers… Love My loving family have been my rock Blessings I keep reminding myself about the gift of my child © 2007 Microsoft Corporation. All rights reserved. Microsoft, Windows, Windows Vista and other product names are or may be registered trademarks and/or trademarks in the U.S. and/or other countries. The information herein is for informational purposes only and represents the current view of Microsoft Corporation as of the date of this presentation. Because Microsoft must respond to changing market conditions, it should not be interpreted to be a commitment on the part of Microsoft, and Microsoft cannot guarantee the accuracy of any information provided after the date of this presentation. MICROSOFT MAKES NO WARRANTIES, EXPRESS, IMPLIED OR STATUTORY, AS TO THE INFORMATION IN THIS PRESENTATION. 10

4/6/2019 11:22 PM Word Picture; © 2007 Microsoft Corporation. All rights reserved. Microsoft, Windows, Windows Vista and other product names are or may be registered trademarks and/or trademarks in the U.S. and/or other countries. The information herein is for informational purposes only and represents the current view of Microsoft Corporation as of the date of this presentation. Because Microsoft must respond to changing market conditions, it should not be interpreted to be a commitment on the part of Microsoft, and Microsoft cannot guarantee the accuracy of any information provided after the date of this presentation. MICROSOFT MAKES NO WARRANTIES, EXPRESS, IMPLIED OR STATUTORY, AS TO THE INFORMATION IN THIS PRESENTATION. 11

4/6/2019 11:22 PM Conclusions Bowel incontinence as a result of an injury sustained during childbirth is common and unknown by the medical profession or the lay public This is an unspoken taboo This is a specific ‘syndrome’ © 2007 Microsoft Corporation. All rights reserved. Microsoft, Windows, Windows Vista and other product names are or may be registered trademarks and/or trademarks in the U.S. and/or other countries. The information herein is for informational purposes only and represents the current view of Microsoft Corporation as of the date of this presentation. Because Microsoft must respond to changing market conditions, it should not be interpreted to be a commitment on the part of Microsoft, and Microsoft cannot guarantee the accuracy of any information provided after the date of this presentation. MICROSOFT MAKES NO WARRANTIES, EXPRESS, IMPLIED OR STATUTORY, AS TO THE INFORMATION IN THIS PRESENTATION. 12