The Chapter Study

Aims

Primary aim: to work with women and stakeholders to optimise the care of women following CRPT in the NHS

Secondary aims: to summarise the published evidence in this area for global settings and to work with collaborators representing global stakeholders to consider the relevance of outputs for global settings, and to develop a network for dissemination and future research.

Objectives

1. To describe the current prevalence, management and outcomes of CRPT.
2. To determine risk factors for developing complications of CRPT, risk factors or predictors of health problems following complications of CRPT.
3. To summarise the evidence from a prospective cohort study, data linkage study, published literature, women’s and Healthcare Professionals (HCPs) views related to prediction, assessment, diagnosis and management of CRPT and complications of CRPT.
4. To explore with key stakeholders (women, clinicians and primary and secondary health care services) their views on CRPT wound management and healing, what they would want from an assessment tool and outcomes that are important to them.
5. To develop and test a reliable, valid wound assessment tool and care pathway for assessment and treatment guidance of CRPT wounds.
6. To determine the important outcomes following CRPT for women, clinicians and the NHS and design a tool to capture these outcomes (CRPT management, outcomes and women’s experience) and co-develop a core outcome set for CRPT.
7. To integrate, synthesize, disseminate the programme outputs, to optimise outcomes for women and the NHS. To develop future directions for research and clinical practice.

Research Plan and Methods

The Chapter Study will include a mixed-methods programme of four interlinked work packages with PPI throughout culminating in an integrated synthesis. The work packages are:

Work Package 1 – Awareness of CRPT

• Prospective observational cohort study
• Data linkage between Primary and Secondary Care to determine long-term outcomes in a nationally representative sample

Work Package 2 – Data Synthesis

• Systematic reviews of relevant literature to inform prediction, assessment, diagnosis, management and outcomes of CRPT and complications
• Qualitative research with women and HCPs

Work Package 3 – Resource Development

• CRPT wound assessment tool development
• Development and testing of PROM
• Development of care pathways (including utilisation of tools)
• Core Outcome set for CRPT

Work Package 4 – Synthesis, dissemination, impact and future development

• Synthesis
• Dissemination
• Impact
• Future development

1. Hodgetts Morton V, Man R, Perry R, et al, Childbirth Acquired Perineal Trauma Study (CHAPTER): a UK prospective cohort study protocol - BMJ Open;14:e086724
2. Jones L, Delicate A, Waigwa S, et al, Exploring views and experiences of childbirth‑related perineal trauma: a qualitative study protocol for developing a wound management tool and care pathway - BMJ Open; 15:e088248. 
3. Blackburn A, Jones L, Morton VH, Morris RK, Yates D, Delicate A. Exploring women’s, birth partners’ and healthcare professionals’ views and experiences of childbirth‑related perineal trauma care provision in high‑income countries: a qualitative systematic review and thematic synthesis - Women and Birth . 2025 May;38(3):101907.
4. Armstrong H, Whitehurst J, Morris RK, Hodgetts Morton V, Man R, on behalf of the CHAPTER group (2025) Antibiotic prophylaxis for childbirth‑related perineal trauma: a systematic review and meta‑analysis - PLOS One20(5) : e0323267.
5. Man R, Le Vance J, Popa Y, et al. Healing‑assessment tools for perineal and caesarean section wounds in postpartum women: a scoping review - Acta Obstetricia et Gynecologica Scandinavica (AOGS) 2026; 105: 18-29.
6. Man R, Bhatia T, Sitch A, Morris RK, Morton VH,. Prognostic factors for wound complications after childbirth‑related perineal trauma: a systematic review and meta‑analysisActa Obstetricia et Gynecologica Scandinavica (AOGS) 2025; 00: 1-18. 
7. Man, R., Morris, R.K., Magill, L., Hughes, T., Perry, R., Tohill, S., Henry, N., Kadir, B., Macarthur, C., Hodgetts Morton, V. and the CHAPTER group (2026), Complications after childbirth‑related perineal trauma up to six‑weeks postpartum: a prospective cohort study - BJOG: An International Journal of Obstetrics and Gynaecology, 133: 274-282.
8. Man, R., Grumitt, G., Vance, J.L., Turner, A., Morris, R.K., Hodgetts Morton, V., Jones, L., Magill, L., Macarthur, C., Webb, S., Hillman, S., Adderley, N.J., Sitch, A., Aiyegbusi, O.L., Knight, M., Nirantharakumar, K., Whitehurst, J. and the CHAPTER group (2025), Outcomes of suture material, suture technique and tissue adhesives for repair of childbirth‑related perineal trauma: a systematic review and meta‑analysis - European Journal of Obstetrics & Gynecology and Reproductive Biology 2025; 312
9. Delicate, A., Hillman, S., et al. (2025), Postnatal care and pathways for childbirth‑related perineal trauma in England: a qualitative study of healthcare professionals’ experiences and perspectives on future development - PubMed, 38(6), pp. 102106–102106.
10. Delicate, A., Hillman, S., et al. (2026) ‘Women’s experiences of postnatal care in England following childbirth-related perineal trauma and considerations for developing an optimal care pathway: a qualitative study’, Midwifery, p. 104795.

Study Lead

Professor Katie Morris

Co-Investigators

• Professor Laura Jones
• Dr Victoria Hodgetts-Morton
• Dr Sara Webb
• Professor John Maltby
• Dr Sarah Hillman
• Dr Nicola Adderley
• Dr Alice Sitch
• Dr Olalekan Lee Aiyegbusi
• Professor Christine MacArthur
• Professor Marian Knight
• Professor Krishnarajah Nirantharakumar
• Ms Jane Whitehurst
• Dr Amie Wilson
• Dr Elizabeth Magill

Research Fellows

• Dr Amy Delicate
• Dr Rebecca Man

Programme Management

• Tarek Hussain

Have you suffered from any kind of Perineum Injury after birth?

Would you like to support our work to improve Women's care by joining our CHAPTER Public Advisory Group (PAG)?

What is the CHAPTER project?

CHAPTER is a 5-year Childbirth Acquired Perineal Trauma Study, funded by the National Health institute for Health and Care Research. It aims to improve care for women who experience perineal trauma during childbirth. The study brings together women, healthcare professionals, and researchers to develop better assessment tools, understand complications, and improve recovery journeys and care pathways. The project has entered its final year and will end in January 2027.

Why do we need your help?

The CHAPTER research team works closely with its Public Advisory Group (PAG), which consists of 9 members. We would like to expand our group to people with recent experience in this area and hear your lived experience. Other work may include: reviewing study findings and materials, provide feedback, and help shape how care and assessment can be improved for others.

Lived experience required

We welcome individuals with lived experience of childbirth-related perineal trauma (CRPT). No other experience is needed; just a willingness to contribute. Training and support will be provided. If you are interested please complete this short online application (CHAPTER Public Advisory Group: Application to Participate – Collaboration).

Time commitment

• 2 to 3 meetings per year, held virtually, hybrid, or face-to-face in Birmingham
• Some reading or preparation before meetings
• Optional involvement in smaller Study Working Groups at different stages
• Training and support will be given to all PAG members, and expenses will be covered

Payment rates

PAG members will receive £27.50 per hour for meetings and pre-meeting preparation. Travel expenses will be covered for in-person meetings, or £5 will be provided per virtual meeting. Childcare costs can also be reimbursed when needed.

Further information

For more information, contact the CHAPTER Email: Chapter@contacts.bham.ac.uk

Email: chapter@contacts.bham.ac.uk