What are the key deliverables of the service?
- Routine antenatal education for all women about pelvic floor dysfunction
- Ensuring adoption and adherence by women to pelvic floor muscle training throughout pregnancy
- To offer a baseline self-assessment of pelvic health in early pregnancy
- Additional support provided for those at higher risk
- Provision of quality information and training to all staff about pelvic health common issues, symptoms and how to access support
- Provision of a single point of access or standardised multiple points of access across the system for women to self-refer or health professsionals to refer for common pelvic floor problems
- Reducing referral to treatment times by streamlining referral processes
- Increasing establishment of specialist women’s health physiotherapists to better meet demand
- Leadership in the local planning and provision of services aimed to improve perinatal pelvic health care
What have been the key successes of the project so far?
The Squeezy app
The Squeezy app is an NHS endorsed App which has been shown to improve the adherence to daily pelvic floor exercises. Since August 2022 all pregnant and postnatal patients (up to 12months after birth) can access the Squeezy app for free. Every patient is invited after their dating scan to download their free Squeezy app.
To date an average of 35% of patients are downloading the app. It is also being supported by the specialist Physiotherapy teams across Norfolk & Waveney to further support their patients who require specialist pelvic floor physiotherapy care.
Self-assessment of pelvic health programme
ePAQ Pelvic Floor is an electronic personal assessment questionnaire asking questions about bladder, bowel, vaginal and sexual health. The ePAQ- Pelvic Floor is a psychometrically validated tool and has a large evidence base with regards to efficiency, quality, acceptability and utility in clinical practice.
Over the course of the project each trust has successfully launched an antenatal and postnatal ePAQ screening programme, which remains live at the Norfolk & Norwich university Hospitals trust, and will be relaunched at Queen Elizabeth Hospital King’s Lynn and James Paget University Hospital in 2024.
Since the launch there have been over 2000 questionnaires completed, averaging 20% of women andbirthing people completing it across the system.
Improved access to specialist care
24% of these women completing the questionnaire were experiencing mild PFD symptoms during pregnancy, and 30% experiencing mild symptoms postnatally. These women were offered the support of a therapy assistant practitioner trained to deliver pelvic health advice & information such as pelvic floor muscle exercise training and bladder and bowel advice .
ePAQ helped to identify that 11% of women were experiencing severe symptoms during pregnancy and 14% during the postnatal period. These women were contacted and referred directly into to specialist support, including pelvic health physiotherapy, or in some cases urogynaecoogy clinic.
These has assisted in improving referral time to treatment across the system.
Campaign material to raise awareness of pelvic floor dysfunction issues related to pregnancy and childbirth
The PPHS team have worked closely with service users from the Maternity & Neonatal Voice’s Partnerhsip to identify the barriers to women accessing treatment.
A baseline service user survey titled ‘Perinatal Pelvic Health Service’ was shared on Maternity Voices Partnership websites between January-June 2022.
When asked if they had experienced pelvic floor symptoms, 72% described leakage of urine, 13% leakage of wind, 23% vaginal prolapse symptoms, with only 8% not describing any pelvic floor dysfunction symptoms.
When asked if they sought help for their symptoms, 43% said no. When asked why this was 48% thought it was normal to have these problems after pregnancy and birth, 35% felt embarrassed, 24% didn’t think it was possible to make the symptoms better, and 24% stated it wasn’t discussed at any of my appointments. 21% also stated they didn’t know who to ask.
The campaign material has since focused on addressing these barriers, to try and support women coming forward with issues to receive care. Both leaflets and online resources have been developed with translatable resources available. See the link to the online pages that sit within the ‘Just one Norfolk’ website:
Therapy assistant pracititioners in pelvic health
Each of the acute trusts has been provided a therapy asssiant pracitioner role, to support both the midwifery teams and physiotherapy teams in supporting women with PFD issues. They have worked closely with the antenatal and community midwifery teams to support women with preventative advice and information including the benefits of pelvic floor muscle exercises and perineal massage to reduce the risk of PFD sypmptoms & perineal trauma.
They have also established links with Action for children, providing pelvic health advice & information sessions within the early Family & Childrens centres. These sessions are also available online to suit all. All women across Norfolk & Waveney are encouraged to book onto these sessions (part 1 during pregnancy, aprt 2 after pregnancy). Click here to book onto a pelvic health advice session during and after pregnancy: Pelvic Health Advice Sessions (justonenorfolk.nhs.uk)