Risk Factors for Pelvic Floor Dysfunction and Women’s Experience of Accessing Information, Diagnosis, and Treatment of Pelvic Floor Dysfunction in the Postnatal Period in New Zealand

Abstract

Introduction

Pelvic floor dysfunction is a debilitating set of symptoms, which predominantly impacts women. These symptoms often arise at a particularly vulnerable time for women after the birth of their child. However, there has been very little research into the prevalence of pelvic floor dysfunction in New Zealand or women’s experience of symptoms after the birth of their child. This research focuses on the underlying risk factors for the development of pelvic floor dysfunction and provides a greater understanding of women’s experience of pelvic floor dysfunction in the year after birth. The research has two research questions: how is the mode of delivery (childbirth) and associated pelvic floor trauma (perineal tears) changing in New Zealand; and what are the experiences of women with pelvic floor dysfunction within the postnatal period (one year after birth) in accessing information, diagnosis, and treatment for their symptoms?

Methodology

A convergent mixed method design underpinned by pragmatism was used to answer both research questions. First, a retrospective descriptive study using data from the National Maternity Collection within the National Minimum Dataset and the Sexual Reproductive Health Module of the New Zealand Health Survey 2014/15 was used to answer the first research question. Descriptive and regression analyses were used to analyse the results. Secondly, individual interviews with postnatal women and key informant health professionals were conducted to answer the second research question. Thematic analysis using qualitative description was used to analyse the interview transcripts.

Results

The results from the quantitative phase of the study showed that women are having more intervention in their births, with increasing numbers of caesarean sections and assisted deliveries over time. The rates of perineal tears are also increasing in number and severity. Prevalence of urinary incontinence is high in the female population, with 43.5% of women experiencing some form of symptoms. Women who have been pregnant are three times more likely to experience urinary incontinence in their lifetime.

The qualitative phase of the study concludes that women with symptoms of pelvic floor dysfunction have a very poor experience of accessing information, diagnosis, and treatment of their symptoms within the year after birth. Women's symptoms were normalised and dismissed with multiple other barriers in place to accessing appropriate treatment.

Discussion

The changing mode of delivery and the rising number and severity of perineal tears in New Zealand women, in addition to the growing aging population, is likely to result in an increasing prevalence of pelvic floor dysfunction symptoms amongst New Zealand women. There is a risk that if the New Zealand maternal health system does not adapt to better support postnatal women with pelvic floor dysfunction, more women will suffer poor quality of life and poorer health outcomes as they age. The current study highlights significant, avoidable gaps in perinatal health service provision, which is based on a specialised model of care, not suitable for a highly prevalent health issue for women. This research recommends better pelvic floor information resources for women, pelvic floor training for health professionals involved in perinatal care, improved public pelvic physiotherapy services, a six-week postnatal primary care check-up, and finally tackling the normalisation of pelvic floor dysfunction.