Routine pelvic health has been swept through maternity care through many generations, including everything from routine pelvimetry measurements to routine paps. Commonly the pelvis is now only discussed in terms of acute infections that may affect gestation or delivery. We’re missing an important aspect of care — discussion, education, counseling, and assessment of pelvic floor function.
It’s arguable that the American College of Obstetricians and Gynecologists include pelvic floor health as a component of their recommended initial health history and physical, but because it has not been called out as a separate, specific area of need few providers include pelvic floor health in routine care.
Research shows that >50% of maternity care providers rarely discuss the risk of pelvic floor dysfunction prenatally or screen for dysfunction in the postpartum period. Research shows that over one third of clients were never referred to pelvic floor physical therapy even if they were experiencing severe incontinence or other pelvic floor dysfunctions.
Research shows that over one third of clients were never referred to pelvic floor physical therapy even if they were experiencing severe incontinence or other pelvic floor dysfunctions.
Why Aren’t Providers Talking about
Pelvic Health?
- Lack of time in visits
- Lack of knowledge about the subject
- Assuming the client already understood the risk and connection between PFD and childbirth
- A mistaken belief in a low-incidence of PFD
- A concern that discussing PFD would encourage more patients to request cesarean sections
“Maternity care may be the only place a client will be
encouraged to discuss pelvic floor health with a medical provider in their lifetime.”
Community Midwifery
A different style of maternity care that may offer more
Midwives Model of Care™
The Midwives Model of Care™ is a fundamentally different approach to pregnancy and childbirth than contemporary obstetrics. Midwifery care is uniquely nurturing, hands-on care before, during, and after birth. Midwives are health care professionals specializing in pregnancy and childbirth who develop a trusting relationship with their clients, which results in confident, supported labor and birth. While there are different types of midwives practicing in various settings, all midwives are trained to provide comprehensive prenatal care and education, guide labor and birth, address complications, and care for newborns. The Midwives Model of Care™ is based on the fact that pregnancy and birth are normal life events. The Midwives Model of Care includes:
monitoring the physical, psychological and social well-being of the mother throughout the childbearing cycle
providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
minimizing technological interventions and
identifying and referring women who require obstetrical attention.
The application of this model has been proven to reduce to incidence of birth injury, trauma, and cesarean section.
(Midwives Model of Care definition is Copyrighted © by the Midwifery Task Force, all rights reserved)
Midwives are more equipped to address pelvic health because of longer visits, more focus on holistic health and well-being, and a model of care that addresses additional needs of clients and appropriately refers to other providers—such as pelvic floor physical therapists.
Speak and introduce the topic of pelvic floor health from a non-judgmental, trauma-informed perspective can help reduce the stigma associated with pelvic floor dysfunction, creating open communication between client and provider to discuss these sensitive topics throughout the course of care.
Do not hesitate to initiate a discussion about pelvic health; do not wait for the client to describe symptoms of PFD before recommending an assessment.
All discussion of pelvic health should be done in the client’s primary language or with a licensed medical interpreter.
There is also good evidence to show that midwives use screening tools effectively, which makes the Perinatal Pelvic Risk Assessment a great option for midwives who want to change the face of maternity care and start addressing the pelvic needs of their clients.