Postnatal Prolapse Care in the UK: A Qualitative Study.

Abstract

BackgroundProlapse following birth is common. Between 33-79% of postnatal women will have a prolapse on examination, and 43% of these women report severe symptoms. Postnatal women with a prolapse struggle to fulfil parental caring responsibilities and are five times more likely to have postnatal depression. This study aims to investigate the barriers and facilitators for postnatal women accessing services for postnatal prolapse in the UK.MethodsWe undertook semi-structured qualitative interviews with postnatal women with pelvic organ prolapse symptoms, pelvic health physiotherapists, primary and secondary care nurses and general practitioners. Participants were purposefully sampled. Reflective thematic analysis was used to analyse the data.ResultsFrom eight interviews, five themes were generated in relation to the barriers and facilitators for postnatal women accessing services for postnatal prolapse. These were: the screening process after birth; cultural approach to symptoms; the ideal care pathway, clinical pathways and health literacy for women. Suggested improvements included standardising screening appointments with routine vaginal examinations, improved clinician training to improve treatment choices and approach to symptoms, educating women about normal vaginal anatomy after birth, alongside the implementation of dedicated services for postnatal women with prolapse.ConclusionThis research suggests a need for a dedicated service and a review of existing clinical pathways for postnatal women with prolapse. The optimal service model should take screening and health literacy into consideration. Future research in this area should evaluate effective treatments for postnatal prolapse and the changes needed to standardise approaches to care for postnatal prolapse symptoms.