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Building Better Pathways: Our Roadmap to Enhancing Perinatal Pelvic Health in Kent and Medway

Caroline Potter-Edwards (Programme Manager)

Donna Meers (Physiotherapy Clinical Lead)

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Context

National policy focused on improving perinatal pelvic health services
A new national service specification
An opportunity to build better pathways and improve the experiences of women needing pelvic health support and treatment in the perinatal period
We began to gather the data and understand existing provision and experience across Kent and Medway

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Prevalence Data and Local Need

40-50% of women in their 2nd and 3rd trimesters of pregnancy and immediately after birth have urinary leakage
25% of pregnant women can also have anal incontinence
One in three women experience urinary incontinence three months after pregnancy
One in seven anal incontinence six months after birth
One in twelve women report symptoms of pelvic organ prolapse
Approx. 20–25% of all pregnant women suffer from Pelvic Girdle Pain (PGP) that is sufficiently serious to require medical help
64% experience sexual dysfunction postnatally

Outcome/intervention	Oct-Dec 2024
Third or fourth-degree tear (OASI)	82 (3.12%)
Assisted deliveries without an OASI	220 (8.38%)
Occiput posterior position births without an OASI or assisted delivery	97 (3.7%) Data only available from 3 Trusts

Local rates of intrapartum high-risk outcomes:

Those who encounter these risk factors should receive a standard pathway of care that meets NICE guidance that is not dependent on where they gave birth.

~3000 women per month
Local data demonstrated only 269 perinatal referrals per month across the county
OASI pathway is established but not equitable

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Current Pathways – identified gaps

Inequitable pathways in terms of the type of service provision and time it takes to be seen.

Inequitable access to streamlined services and support for symptom management as well as education around risk factors for pelvic floor dysfunction

Issue	Identified gap
Referrals	Unclear referral information and point of access to physiotherapy
Information	Information on Pelvic Floor Dysfunction (including prevention) and Pelvic Floor Exercises is not routinely given to women in the perinatal period
Intrapartum Care frameworks	There is no standard framework for intrapartum care and the mitigation of risk of Obstetric Anal Sphincter Injury (OASI) tears, or the identification of these.
Data and Outcome Monitoring	If a framework is in place e.g. PEACHES or the OASI Care Bundle, these are not auditable and so there is no understanding of their use or effectiveness at preventing injuries.
Access for OASIs	If an OASI tear is identified, women’s access to treatment depends on their hospital Trust’s provision and pathways. Some will see a pelvic health physiotherapist on the delivery ward, some will be referred to one prior to discharge by the midwife, while others will receive their first appointment by phone call within 3 months and then be referred to an online Education Session before having the opportunity to be seen 1:1 face-to-face.
High Risk Patients	If there are other perinatal risk factors, there is no routine access or follow up.

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Green light to begin building better pathways

We used the data we had gathered, alongside the financial impact of poor provision (using Jo’s story to demonstrate) and the need for adequate prevention.

We were successful in gaining the full support of the ICB and the Trusts to sustainably commission new perinatal pelvic health services across the county.

We set up a Steering Group with representatives from the Trusts including physios, midwives, and Obstetricians and began to design the enhancement of services against the national service specification

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Progress over the last year

Staff education and training

MDT training in Trusts (Pelvic Health and OASI care bundle)
Adaptations for wider staff groups including GP practice staff, Health Visitors, Infant Feeding Teams, sexual health clinics, mental health teams, psychosexual services, and practitioners working within the Women’s Health Hubs
Trauma Informed Care Training

Service Design

Tiered service treatment model accessed via self-assessment
Tier 2 content for antenatal, postnatal, and PGP
Integration with existing pathways

Workforce planning

Model for enhanced teams within acute Trusts
Pelvic Health Champion models for community midwifery teams and Health Visiting – practice nurses?

Co-production

2 x Service User Leads as core members of the Steering Group
Education videos
Surveys
Facebook group
OASI support group
PGP Task and Finish group co-chaired by SU Lead
Co-produced Trauma Informed Care Training (birth trauma)

Digital solutions and considerations

Single Point of Access
Self-assessment with Digital Triage
Purchase of WEPP video resources from Sussex LMNS
Digital information and awareness resources
Researching Apps

Tier 1

Universal
Online
Information / advice and guidance re PF
Digital resources, including videos with exercises and information
Prevention and identification of symptoms

Tier 2

Symptomatic but not severe
Intrapartum risk factors apart from OASI
Online group interventions offered co-facilitated with midwife and physiotherapist
Refer to 1:1 support if symptoms persist

Tier 3

Symptomatic moderate-severe
OASIs
1:1 treatment with perinatal pelvic health physiotherapist

“Your session was the highlight of the day!”

"pelvic health was an excellent addition giving that extra background and anatomy reminder as to the importance of practice"

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OASI Pathway of care

Repair

Acute Management

Acute Physio Input

Tier 3 / Perineal Clinic

Urogynae Team

Colorectal Team

Physio Team

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We’ve identified the gaps
We understand where we need to get to

Please feel free to get in touch to find out more…

Donna Meers – Physiotherapy Clinical Lead d.meers@nhs.net

Caroline Potter-Edwards - Programme Manager caroline.potter-edwards@nhs.net

Pathway development is ongoing