Implementing pelvic floor muscle training in women's childbearing years: A critical interpretive synthesis of individual, professional, and service issues.

Mark Pearson,Eivor Oborn,Rachel Jarvie,Susan E. Bayliss,Debra Bick,E. J. C Hay‐Smith,Helena Frawley,Christine MacArthur,Sarah Dean,Rohini Terry,Victoria E. Salmon,Clare Davenport

doi:10.1002/nau.24256

Abstract

AimsAntenatal pelvic floor muscle training (PFMT) may be effective for the prevention and treatment of urinary and fecal incontinence both in pregnancy and postnatally, but it is not routinely implemented in practice despite guideline recommendations. This review synthesizes evidence that exposes challenges, opportunities, and concerns regarding the implementation of PFMT during the childbearing years, from the perspective of individuals, healthcare professionals (HCPs), and organizations.MethodsCritical interpretive synthesis of systematically identified primary quantitative or qualitative studies or research syntheses of women's and HCPs attitudes, beliefs, or experiences of implementing PFMT.ResultsFifty sources were included. These focused on experiences of postnatal urinary incontinence (UI) and perspectives of individual postnatal women, with limited evidence exploring the views of antenatal women and HCP or wider organizational and environmental issues. The concept of agency (people's ability to effect change through their interaction with other people, processes, and systems) provides an over‐arching explanation of how PFMT can be implemented during childbearing years. This requires both individual and collective action of women, HCPs, maternity services and organizations, funders and policymakers.ConclusionNumerous factors constrain women's and HCPs capacity to implement PFMT. It is unrealistic to expect women and HCPs to implement PFMT without reforming policy and service delivery. The implementation of PFMT during pregnancy, as recommended by antenatal care and UI management guidelines, requires policymakers, organizations, HCPs, and women to value the prevention of incontinence throughout women's lives by using low‐risk, low‐cost, and proven strategies as part of women's reproductive health.

Highlights

Pregnancy and childbirth are important risk factors for urinary incontinence (UI).[1]
This review addresses the gap in knowledge about the challenges and opportunities for population‐level implementation of pelvic floor muscle training (PFMT) in routine maternity services so that research and services can proactively address implementation issues
Existing research focuses on PFMT as the responsibility of individual women and healthcare professionals (HCPs), and on UI as a postnatal issue

Summary

Introduction

Pregnancy and childbirth are important risk factors for urinary incontinence (UI).[1] Prevalence rates of UI at 30 weeks gestation have been reported as 31% in nulliparous women and 42% in parous women.[2] Postpartum prevalence rates range from 30% in the first 3 months to 47% in the first 12 months.[3] Three quarters of women reporting UI at 3 months after giving birth may still experience symptoms at least 12 years later.[4] Incontinence places a large burden on womens physical, mental and social quality of life,[5] with associated pressure on healthcare resources and wider societal costs.[6] In the UK, the importance of preventative strategies has been recently highlighted in relation to safety,[7] the attainment of reproductive health,[8] and as a key component of the maternity service model envisaged in Better Births.[9]

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Results

Discussion

Conclusion