Pelvic Floor Verbal Instructions in Early Postpartum

Does prior training in pelvic floor muscle exercises contribute to a woman’s ability to contract the pelvic floor shortly after childbirth? Researchers aimed to study this question and other variables in a prospective observational study involving 958 women. Within one week of childbirth, and in the hospital setting, participants were instructed by a physiotherapist (specializing in pelvic floor) to contract the pelvic floor in a supine position. Confirmation of a contraction was determined by visual observation of the perineum moving inward. The women were also asked by a physiotherapist if they had prior knowledge or experience with pelvic floor muscle training, and if not, the women were briefly instructed in the location and function of the pelvic floor muscles. The women who had some knowledge of the pelvic floor muscles including exercise experience “…were asked if they considered themselves able to perform correct…” pelvic muscle contractions.

All women was asked to complete three pelvic muscle contractions in a row and were assessed visually using a score of 0 (no movement of the perineum), 1 (weak movement), or 2 (strong inward displacement/lift of perineum). The physiotherapist gave feedback if the women completed a correct, insufficient, or incorrect contraction. Further verbal instruction was provided to those who could not adequately contract, and a re-assessment was completed with a quantification of any change in ability to contract. After providing feedback on pelvic muscle contractions, 73.6% of the women were able to perform a better contraction. In 500 of the 958 women, no inward displacement of the perineum was observed. Additionally, a significant number of the women (33%), believed that they were doing a contraction correctly but in fact were not. Another interesting point is that women with urinary incontinence before or during pregnancy had more knowledge about pelvic floor function and training.

Although in this study, 47.8% of the participants were able to perform a pelvic floor muscle contraction shortly after giving birth, “Knowing about the function and location of the pelvic floor was a positive predictor for being able to complete a pelvic floor muscle contraction.” Interestingly, having prior training in pelvic muscle exercises was not predictive of being able to complete a contraction. The value of assessing the ability to contract the pelvic floor is evident in this study, and with methods that are quick, easy, and non-invasive, women can be empowered with an improved ability to improve performance of a pelvic muscle contraction which is necessary for an effective pelvic muscle training program.