Hypothesis / aims of study
To assess the information given to women during pregnancy and in the postpartum period on perineal trauma and pelvic floor muscle training (PFMT). The study intended to explore provision of information on PFMT in general and specific information relating to perineal injury during childbirth, including symptoms experienced and the impact on quality of life.
Study design, materials and methods
A cross-sectional study with data collection between September 2021– November 2021. 33 patients attending perineal trauma clinic were asked to complete a questionnaire. This had been devised and validated by distributing the questionnaire to 5 patients prior to the data collection and their feedback was obtained. It contained questions covering patient demographics, birth injuries, education on PFMT and symptoms experienced post-trauma. Quantitative and qualitative data was collected. This was analysed using Microsoft Excel 365.
Results
A key finding was that 79% of the women were informed about PFMT with 49% carrying out PFMT at least daily, 33% weekly, and 15% not doing them despite being informed, leaving a 30% disparity between those being informed and those being compliant.
In response to the questionnaire, 44% of the cohort of women were aware they had a 3rd degree tear. 19% had episiotomies and 18% had 2nd degree tears. However, 19% were unaware of their birth injury type. Of the cohort, 58% were given information at the birth verbally and 37% written. Qualitative data further showed the need for providing written information.
Looking into the incidence of perineal trauma symptoms; 73% experienced urinary symptoms, ranging from mild to severe incontinence, 54% experienced flatus symptoms and 58% experienced bowel incontinence symptoms. Qualitative data collected highlighted the difficulties with the symptoms mentioned and the significant effect on quality of life.
Interpretation of results
A significant proportion of women were informed about PFMT, highlighting that the discussion is being had with most women. However, 30% were not compliant. It would be interesting to find out more information from this cohort as to what affected their compliance, for example: how often were they told about PFMT and were they encouraged to do them? What was the quality of the information given? Did they feel confident in doing the exercises? Were they aware of the potential consequences of not doing PFMT?
Concluding message
We recommend that PFMT is regularly discussed with women in both the antenatal and post-natal period, to emphasize the significant consequences these injuries can have on their future social, psychological, and sexual aspects of life, including impacting future pregnancies. As per Royal College of Obstetrics and Gynaecologists’ Green-top guidelines (1), giving verbal and written information to women that sustain 3rd and 4th degree tears at birth is also recommended.