University of Exeter College of Medicine and Health, College House, St Luke's Campus, Heavitree Road, Exeter EX1 2LU, United Kingdom.
University of Exeter College of Medicine and Health, College House, St Luke's Campus, Heavitree Road, Exeter EX1 2LU, United Kingdom.
Midwifery. 2020 Apr;83:102647. doi: 10.1016/j.midw.2020.102647. Epub 2020 Jan 22.
Many women experience urinary incontinence (UI) during and after pregnancy. Pelvic floor muscle exercises (PFME) can prevent and reduce the symptoms of UI. The objective of the study was to explore challenges, opportunities and concerns for women and health care professionals (HCPs), related to the implementation of PFME training for women in current antenatal care.
An ethnographic study design was used. Researchers also formed and collaborated with a public advisory group, consisting of seven women with recent experiences of pregnancy, throughout the study.
Seventeen midwife-woman interactions were observed in antenatal clinics. In addition, 23 midwives and 15 pregnant women were interviewed. Repeat interviews were carried out with 12 of the women postnatally. Interviews were also carried out with other HCPs; four physiotherapists, a linkworker/translator and two consultant obstetricians. Additional data sources included field notes, photographs, leaflets, policy and other relevant documents.
Data were collected in three geographical areas of the UK spanning rural, urban and suburban areas. Data collection took place in antenatal clinics, in primary and secondary care settings, and the majority of women were interviewed in their homes.
Three broad and inter-related themes of "ideological commitment", "confidence" and "assumptions, stigma and normalisation" were identified. The challenges, opportunities and concerns regarding PFME implementation were explored within these themes.
Although HCPs and some women knew that PFME were important, they were not prioritised and the significant benefits of doing PFME may not have been communicated by midwives or recognised by women. There was a lack of confidence amongst midwives to teach PFME and manage UI within the antenatal care pathway and amongst women to ask about PFME or UI. A perceived lack of consistent guidelines and policy at local and national levels may have impeded clear communication and prioritisation of PFME. Furthermore, assumptions made by both women and midwives, for example, women regarding UI as a normal outcome of pregnancy, or midwives' perception that certain women were more likely to do PFME, may have exacerbated this situation. Training for midwives to help women in the antenatal period to engage in PFME could address challenges and concerns and to help prevent opportunities for women to learn about PFME from being missed.
许多女性在怀孕期间和产后会经历尿失禁（UI）。盆底肌锻炼（PFME）可以预防和减轻 UI 的症状。本研究的目的是探讨女性和医疗保健专业人员（HCPs）在当前产前保健中实施 PFME 培训时面临的挑战、机遇和关注点。
采用人种学研究设计。研究人员还与一个由七名有近期妊娠经历的女性组成的公众咨询小组一起形成并合作，整个研究过程中。
在产前诊所观察了 17 次助产士-女性互动。此外，还对 23 名助产士和 15 名孕妇进行了访谈。对 12 名女性进行了产后重复访谈。还对其他 HCP 进行了访谈；四名物理治疗师、一名联络/翻译员和两名顾问产科医生。其他数据来源包括实地笔记、照片、传单、政策和其他相关文件。
数据收集在英国的三个地理区域进行，涵盖农村、城市和郊区。数据收集在产前诊所、初级和二级保健机构进行，大多数女性在家中接受采访。
确定了三个广泛且相互关联的主题，即“意识形态承诺”、“信心”和“假设、污名化和正常化”。在这些主题中探讨了实施 PFME 的挑战、机遇和关注点。
尽管 HCPs 和一些女性知道 PFME 很重要，但它们没有被优先考虑，并且做 PFME 的显著好处可能没有被助产士传达或被女性认识到。助产士缺乏教授 PFME 和在产前保健途径中管理 UI 的信心，女性也缺乏询问 PFME 或 UI 的信心。当地和国家各级缺乏一致的指南和政策可能阻碍了 PFME 的明确沟通和优先化。此外，女性和助产士之间存在假设，例如，女性认为 UI 是怀孕的正常结果，或者助产士认为某些女性更有可能进行 PFME，这可能加剧了这种情况。为助产士提供培训，帮助女性在产前期间参与 PFME，可以解决挑战和关注点，并帮助防止女性错过学习 PFME 的机会。
