Improving Provider Ability to Prevent Pelvic Floor Dysfunction in Pregnancy and Postpartum

Background: Pelvic floor dysfunction (PFD) is primarily responsible for urinary incontinence, fecal incontinence, pelvic organ prolapse, and some sexual dysfunction and pelvic pain. PFD affects one third of women in the United States, and pregnancy/childbirth are major risk factors in its development. Pelvic floor muscle training is considered safe, effective, and low-cost for preventing and treating PFD. However, the majority of antenatal providers do not provide PFD education in pregnancy, leading to low patient knowledge and lack of primary, secondary, and tertiary prevention. Providers cite lack of time, lack of sufficient information, skepticism, and lack of standardized protocols as common reasons for not performing prenatal PFD teaching.Methods: A quality improvement study was conducted to address major barriers that antenatal providers face in educating patients. Providers were asked to report their baseline education practices and confidence regarding PFD patient education and prevention on Likert scales. Providers were trained in effective prevention strategies and provided with resources to aid patient education and appropriate referrals (patient handouts, referral guidelines, etc.). The training was delivered in person by a pelvic floor physical therapist and was followed up with an email to the providers containing the educational materials and patient resources. Providers were assessed four weeks after training for change in confidence and education practices.Results: Of the 12 antenatal providers who completed the pretest, only 4 completed the posttest completely and 2 completed it partially. We were unable to complete the planned statistical analyses due to low response rates.Conclusions: Due to the low response rates to the survey and our inability to perform statistical analyses, we are unable to determine whether our intervention was effective in improving provider confidence and ability to prevent PFD in pregnancy and postpartum. Response rates may have been impacted by the fact that data were collected in March 2020 while the healthcare system was being impacted by the COVID-19 outbreak. We feel that this project should be repeated under more optimal conditions and after conducting a formal needs assessment to guide the focus of our education efforts.