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Prevention and treatment of peripartum urinary incontinence—a survey of hospital-based maternity services in Ireland

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Abstract

Introduction and hypothesis

Considerable proportions of pregnant and postpartum women experience urinary incontinence, but to our knowledge, there are no national data on the preventative and treatment services available in Ireland’s 19 maternity hospitals.

Methods

Ethical approval was granted. A national benchmarking survey on the range and type of services on prevention and treatment of urinary incontinence during pregnancy and postpartum was developed. Directors of Midwifery and Nursing in each hospital identified midwives and women’s health physiotherapists to complete the survey. Data were analysed descriptively, and results presented as proportions.

Results

Responses were received from 17 hospitals. Women were asked about urinary incontinence during their first booking visit in 6 hospitals, during all antenatal visits in 2 and the onus was on women self-reporting symptoms in 9. Pelvic floor muscle exercises were taught in antenatal classes in 14 hospitals and management of urinary incontinence in 9. In hospital postpartum, midwives in 13 hospitals asked women about urinary incontinence. All women were seen by a physiotherapist in 7 hospitals and only those who were referred in 6. Women could access the hospital’s physiotherapy services up to 6 weeks postpartum in 3 hospitals, up to 6 months or 1 year in 5 and beyond 1 year in 6.

Conclusions

Geographical inequity exists in the services offered to pregnant and postpartum women nationally. This indicates that many pregnant and postpartum women, both continent and incontinent, cannot avail themselves of preventative and treatment services within the maternity hospital system and points to the need to review, reconfigure and resource services.

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References

  1. Woodley SJ, Lawrenson P, Boyle R, Cody JD, Mørkved S, Kernohan A, et al. Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev. 2020;5:CD007471. https://doi.org/10.1002/14651858.CD007471.pub3.

    Article  PubMed  Google Scholar 

  2. NICE. Antenatal care. NICE guideline NG201. 2021. Available at: https://www.nice.org.uk/guidance/ng201/resources/antenatal-care-pdf-66143709695941. Accessed 12 Jun 2022

  3. Haylen B, de Ridder D, Freeman R, Swift S, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010;21(1):5–26. https://doi.org/10.1007/s00192-009-0976-9.

    Article  PubMed  Google Scholar 

  4. Daly D, Clarke M, Begley C. Urinary incontinence in nulliparous women before and during pregnancy: prevalence, incidence, type, and risk factors. Int Urogynecol J. 2018;29(3):353–62. https://doi.org/10.1007/s00192-018-3554-1.

    Article  PubMed  Google Scholar 

  5. Brown SJ, Donath S, MacArthur C, McDonald EA, Krastev AH. Urinary incontinence in nulliparous women before and during pregnancy: prevalence, incidence, and associated risk factors. Int Urogynecol J. 2010;21(2):193–202. https://doi.org/10.1007/s00192-009-1011-x.

    Article  PubMed  Google Scholar 

  6. Wesnes SL, Rortveit G, Bø K, Hunskaar S. Urinary incontinence during pregnancy. Obstet Gynecol. 2007;109(4):922–8. https://doi.org/10.1097/01.Aog.0000257120.23260.00.

    Article  PubMed  Google Scholar 

  7. Eliasson K, Nordlander I, Larson B, Hammarström M, Mattsson E. Influence of physical activity on urinary leakage in primiparous women. Scand J Med Sci Sports. 2005;15(2):87–94.

    Article  PubMed  CAS  Google Scholar 

  8. Solans-Domenech M, Sanchez E, Espuna-Pons M. Urinary and anal incontinence during pregnancy and postpartum: incidence, severity, and risk factors. Obstet Gynecol. 2010;115(3):618–28. https://doi.org/10.1097/AOG.0b013e3181d04dff.

    Article  PubMed  Google Scholar 

  9. Gartland D, MacArthur C, Woolhouse H, McDonald E, Brown SJ. Frequency, severity and risk factors for urinary and faecal incontinence at 4 years postpartum: a prospective cohort. BJOG. 2016;123(7):1203–11. https://doi.org/10.1111/1471-0528.14251.

    Article  PubMed  CAS  Google Scholar 

  10. Viktrup L, Lose G. Lower urinary tract symptoms 5 years after the first delivery. Int Urogynecol J Pelvic Floor Dysfunct. 2000;11(6):336–40. https://doi.org/10.1007/s001920070002.

    Article  PubMed  CAS  Google Scholar 

  11. MacArthur C, Wilson D, Herbison P, Lancashire RJ, Hagen S, Toozs-Hobson P, et al. Urinary incontinence persisting after childbirth: extent, delivery history, and effects in a 12-year longitudinal cohort study. BJOG. 2016;123(6):1022–9. https://doi.org/10.1111/1471-0528.13395.

    Article  PubMed  CAS  Google Scholar 

  12. Durnea CM, Khashan AS, Kenny LC, Durnea UA, Dornan JC, O'Sullivan SM, et al. What is to blame for postnatal pelvic floor dysfunction in primiparous women—pre-pregnancy or intrapartum risk factors? Eur J Obstet Gynecol Reprod Biol. 2017;214:6–43. https://doi.org/10.1016/j.ejogrb.2017.04.036.

    Article  Google Scholar 

  13. Hill AM, McPhail SM, Wilson JM, Berlach RG. Pregnant women's awareness, knowledge and beliefs about pelvic floor muscles: a cross-sectional survey. Int Urogynecol J. 2017;28(10):1557–65. https://doi.org/10.1007/s00192-017-3309-4.

    Article  PubMed  Google Scholar 

  14. Hermansen IL, O'Connell BO, Gaskin CJ. Women's explanations for urinary incontinence, their management strategies, and their quality of life during the postpartum period. J Wound Ostomy Continence Nurs. 2010;37(2):187–92. https://doi.org/10.1097/WON.0b013e3181cf7946.

    Article  PubMed  Google Scholar 

  15. Whitford HM, Jones M. An exploration of the motivation of pregnant women to perform pelvic floor exercises using the revised theory of planned behaviour. Br J Health Psychol. 2011;16(4):761–78. https://doi.org/10.1111/j.2044-8287.2010.02013.x.

    Article  PubMed  Google Scholar 

  16. Murphy M, McHugh S, O’Keeffe LM, Greene RA, Corcoran P, Kearney PM. Preventive health counselling during antenatal care using the pregnancy risk assessment monitoring system (PRAMS) in Ireland. BMC Pregnancy Childbirth. 2020;20(1):98. https://doi.org/10.1186/s12884-020-2756-y.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Terry R, Jarvie R, Hay-Smith J, Salmon V, Pearson M, Boddy K, MacArthur C, Dean S. "Are you doing your pelvic floor?" An ethnographic exploration of the interaction between women and midwives about pelvic floor muscle exercises (PFME) during pregnancy. Midwifery. 2020;83:102647. https://doi.org/10.1016/j.midw.2020.102647.

    Article  PubMed  Google Scholar 

  18. Daly D, Cusack C, Begley C. Learning about pelvic floor muscle exercises before and during pregnancy: a cross-sectional study. Int Urogynecol J. 2019;6:965–75. https://doi.org/10.1007/s00192-018-3848-3.

    Article  Google Scholar 

  19. Government of Ireland. Slaintecare: Dublin, Ireland. 2017. Available at: https://assets.gov.ie/22609/e68786c13e1b4d7daca89b495c506bb8.pdf. Accessed 14 Jun 2022

  20. Government of Ireland. Healthy Ireland Outcomes Framework 2013-2025. 2013: Dublin, Ireland. Available at: https://assets.gov.ie/7555/62842eef4b13413494b13340fff9077d.pdf. Accessed 14 Jun 2022

  21. Government of Ireland. Healthy Ireland Strategic Action Plan 2021–2025. 2021: Dublin, Ireland. Available at: https://www.gov.ie/en/publication/441c8-healthy-ireland-strategic-action-plan-2021-2025/. Accessed 14 Jun 2022

  22. Department of Health. Creating a better future together. National Maternity Strategy 2016–2026. Department of Health: Dublin, Ireland. 2016. Available at: http://hdl.handle.net/10147/608326. Accessed 9 Jun 2022

  23. National Women's Council of Ireland and Department of Health. Women’s Health in Ireland. Evidence Base for the Development of the Women's Health Action Plan. Dublin, Ireland. 2019. Available at: https://s3-eu-west-1.amazonaws.com/govieassets/34221/1896ea11479242e09073d5c78098dff4.pdf. Accessed 14 Jun 2022

  24. Healthcare Pricing Office (HPO). Perinatal Statistics Report 2017. 2020. Available at: https://www.hpo.ie/latest_hipe_nprs_reports/NPRS_2017/Perinatal_Statistics_Report_2017.pdf. Accessed 8 Aug 2022

  25. Daly D, Carroll M, Barros M, Begley C. Stop, think, reflect, realize—first-time mothers' views on taking part in longitudinal maternal health research. Health Expect. 2019;22(3):415–25. https://doi.org/10.1111/hex.12861.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Salmon VE, Hay-Smith EJ, Jarvie R, Dean S, Oborn E, Bayliss SE, et al. Opportunities, challenges and concerns for the implementation and uptake of pelvic floor muscle assessment and exercises during the childbearing years: protocol for a critical interpretive synthesis. Syst Rev. 2017;6(1):18. https://doi.org/10.1186/s13643-017-0420-z.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Salmon VE, Hay-Smith EJC, Jarvie R, Dean S, Terry R, Frawley H, et al. Implementing pelvic floor muscle training in women's childbearing years: a critical interpretive synthesis of individual, professional, and service issues. Neurourol Urodyn. 2020;39(2):863–70. https://doi.org/10.1002/nau.24256.

    Article  PubMed  Google Scholar 

  28. Health Service Executive (HSE). National standards for antenatal education in Ireland. 2020: Dublin, Ireland. Available at: https://www.hse.ie/eng/about/who/healthwellbeing/our-priority-programmes/child-health-and-wellbeing/antenatal-ed.pdf. Accessed 15 Jun 2022

  29. Wuytack F, Curtis E, Begley C. The health-seeking behaviours of first-time mothers with persistent pelvic girdle pain after childbirth in Ireland: a descriptive qualitative study. Midwifery. 2015;31(11):1104–9. https://doi.org/10.1016/j.midw.2015.07.009.

    Article  PubMed  Google Scholar 

  30. Wilson J, Berlach R, Hill A. An audit of antenatal education facilitated by physiotherapists in Western Australian public hospitals. ANZCJ. 2014;20(2):44–51.

    Google Scholar 

  31. Reed P, Mann K, Osborne J. Pelvic floor muscle training services across the UK: a benchmarking survey of POGP members. J Pelvic Obstet Gynaecol Physiother. 2020;126:9–57. Available from: https://thepogp.co.uk/journal/1/pogp_journal_issue_126_spring_2020/27/.

    Google Scholar 

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Acknowledgements

Sincere thanks to the Directors of Midwifery and Nursing in all participating hospitals and to all the midwives and physiotherapists who completed the survey. Thanks also to Sabrina Zarin, Research Assistant, who contributed to the design of the survey.

Funding

This study was funded by Trinity College Dublin’s Dean of the Faculty of Health Sciences, Research Initiative Awards 2018.

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Authors and Affiliations

  1. School of Nursing and Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin, D02T283, Ireland

    Deirdre Daly, Patrick Moran, Francesca Wuytack, Kathleen Hannon & Cecily Begley

  2. Trinity Centre for Maternity Care Research (TCMCR), Trinity College Dublin, 24 D’Olier Street, Dublin, D02T283, Ireland

    Deirdre Daly, Kathleen Hannon & Cecily Begley

  3. Physiotherapy Department, Rotunda Hospital, Parnell Square East, Dublin, D01 P5W9, Ireland

    Cinny Cusack

Authors
  1. Deirdre Daly
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  2. Patrick Moran
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  3. Francesca Wuytack
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  4. Cinny Cusack
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  5. Kathleen Hannon
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  6. Cecily Begley
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Contributions

D. Daly: study design, survey development, data collection, data analysis, manuscript writing; P. Moran: study design, survey development, data collection, manuscript writing; F. Wuytack: study design, manuscript writing; C. Cusack: study design, survey development, manuscript writing; K. Hannon: study design, survey development, data collection, data analysis, manuscript writing; C. Begley: study design, manuscript writing.

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Correspondence to Deirdre Daly.

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Appendix 1

Survey on urinary incontinence prevention and treatment services (PDF 386 kb)

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Daly, D., Moran, P., Wuytack, F. et al. Prevention and treatment of peripartum urinary incontinence—a survey of hospital-based maternity services in Ireland. Int Urogynecol J 33, 3481–3489 (2022). https://doi.org/10.1007/s00192-022-05361-9

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  • DOI: https://doi.org/10.1007/s00192-022-05361-9

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