Making PFME a priority would help
(The impact of midwives' lack of prioritisation acting as a barrier) | ‘I think if the midwife would have mentioned it probably every appointment, like have you been doing your, your pelvic floor, I think, if she would have mentioned it, then I probably would have done it more regularly’. (30) | ‘I started off enthusiastically and then I just kind of gave up because I just, you know, it hadn’t been stressed as being important and I had many other things on my mind’. (128) |
PFME knowledge and awareness matters
(Lack of knowledge hinders or negatively impacts on doing PFME) | ‘ … and then as soon as I knew more about, about it, like, I would do it more often as well, because before I knew information about it, I would just do it like once a week or once every couple of months, to just, whenever I would remember or read about it or see about it, or whatever. But yeah, and now I do it more often now that I know more information about it’. (117) | ‘I’d say I didn’t find them easy because I wasn’t overly sure about what I’m supposed to be doing. So it kind of left me feeling a bit silly I guess because I was just a bit like “well I don’t really know what I’m doing right now”, so it became a thing that in the end I just didn’t bother to do because of that reason’. (128)
But knowledge is not always enough:
‘I think hearing the midwife say to me that as I get older, my pelvic floor muscles won’t be as strong, therefore the risk of me leaking as I’m older gets higher, so you should do them. That was enough for me to go, “OK, yeah, I should really do them”. But for me, that’s the reason why I want to do them because when I get older, I don’t want to leak … I don’t ever want to be incontinent so I know I should do it but I don’t’. (017) |
Knowing how to do PFME (mastery)
(Lack of mastery reduces motivation to do the exercises) | ‘I think, knowing about how important it is to relax those muscles and understanding how to relax them, would have been useful, but I don’t know how easy that is to do through a leaflet, because it wasn’t really until someone examined me and saying, now those muscles are relaxing, that I understood how to do it. I think, you know, sometimes you’re holding on and you don’t realise’. (026) | ‘ … if there were like diagrams, maybe, or, you know, just if there was, like, some kind of like leaflet with diagrams on there or information telling you exactly how to perform them and, you know, how to get the best, you know, the most effectiveness out of them as well, even like if they, you know, gave us some links to videos that we could watch, demonstrating it, you know, even, yeah, leaflets, even…’ (019) |
Knowing how and why matters
(The need to understand ‘why’ reinforces the doing) | ‘Probably how to do the pelvic floors and why they were important … like it’s a pretty standard thing to do. But you see it’s only easy if you know how to do it. I think people, women would probably benefit to learn how to do it in the first place, which then would enable them to just sort of bring it into their daily routine I guess’. (032)
‘I think if you speak to any pregnant woman they know that you need to do pelvic floor, but I don’t think they understand the reasons why you have to do it during pregnancy and why it’s important. I think it becomes more apparent once you’ve given birth what kind of the main function and things is of it…’ (355)
‘I don’t think you want to scare women but I think it might be valuable to sort of warn the, sort of warn what the risks are if you don’t do enough exercise … I’m not sure, and, you know, and then the midwives who delivered my baby were, you know, were very, they were sure to tell me how important it would be to do my pelvic floor after that. But I can’t, I perhaps hadn’t realised prior to having my second baby that, you know, that was something that might happen…’ (544) | ‘Honestly, I would have loved to receive more information like how to do it. Because it’s good, at least when they explain it to you it’s good, rather than having to go on YouTube and look at it yourself. So I prefer like the, just like physical exercise they can show it to you or if they can tell you there’s like antenatal classes you can go do and they can show you what exercises you can do, that would really help’. (50) |
Importance of resources to support women to do PFME
(Examples: leaflets, apps or other physical resources) | ‘Yes, definitely, I think my midwife said from the get-go that I should be doing my pelvic floor exercises, sent me a video to watch and, yeah, sent me links that were really useful, so I think that was quite clear’. (314)
‘ … then gave me a little bag and some leaflets in that about kind of different things you could get to help train with the pelvic floor and told me the kind of repetitions that I needed to do, so when I was cleaning my teeth in the morning, those kind of things. That was about it, that I got’. (355)
‘I got given like a pack of, I don’t really remember exactly what was in there, but there was also like a QR code for an app to download. Yeah it was like near the end of the pregnancy … I liked the resources that I was given…’ (117) | ‘I think that the leaflet that I received the first time was very, very helpful so I think everyone should have that, like, no matter whether it’s their first or ninth pregnancy, I think that should always be provided’. (347)
‘I should have just had stickers in places where I sit down, reminding me to do them. And I had every intention of doing that, I just never got round to it’. (017)
‘I think maybe if, if we were given like some kind of, like a checklist or something that, you know, this many times a day, try to complete them, that would have been good’. (019)
‘ … if there was like some kind of like leaflet with diagrams on there or information telling you exactly how to perform them and, you know, how to get the best, you know, the most effectiveness out of them as well’. (019) |
Importance of additional support from services and clinicians
(Examples: classes, physical checks) | ‘ … like antenatal appointments and, you know, where you all get together and you talk about pain relief, things like that, it would be, it would’ve been quite useful to have, you know, maybe a session on pelvic floors and, because then I think we’d see it as more important, because, you know, just being given a leaflet in passing just doesn’t show how severe it is and it was only when people tell you “oh, you need to do it because it will affect you later in life”, so I think maybe like a bit of a little group session talking about it, you know, opportunities to, if it was, you know, … sessions to talk about things and actually just time with somebody to ask questions because I feel sometimes the midwives, particularly when it’s antenatal appointments, they’re so rushed and by the time you see them they’re already late with their appointments so you feel like you don’t want to keep up any more of their time, so I think dedicated sessions would be really good and would show how important they are to do’. (006)
‘ … so the information was fine. I felt like it would have been, yeah, it might have been nice to sit with your midwives, perhaps, and just gone through a few exercises together’. (413)
‘I would say to be perhaps given some material and then a conversation had, so it’s in your mind so that then you, you don’t then just put it, the leaflet, you know, down and never look at it again, that it’s, the conversation would, the discussion would, with your midwife would then prompt you to actually read the leaflet and, you know, keep it at the forefront of your mind because I think you do tend to get quite a lot of material around pregnancy and birth, so I think it’s easy to sort of just sort of stash it all away in a folder and not really pay that much attention to it, but if you have a conversation with your midwife I think that, about it, that would encourage you to pay more attention to it’. (544) | ‘ … even if there were like online Zoom classes, because I remember I joined them for breastfeeding support and like baby massage classes, I joined them on Zoom. So, even if there were classes like that, that would have been really useful’. (019)
‘But in some ways it’s kind of physical demonstration, of kind of sitting with women and talking them through it and making them aware of the feeling of it being correct etc., because I think something like a leaflet for that is very difficult and hands-off and doesn’t necessarily do the job’. (128)
‘But then I think without someone examining so that you know that you’re doing them correctly it’s difficult to reassure yourself that you’re doing them right. But then you know, you can’t really examine women during pregnancy, you know, because of the risk of infection and things so it’s difficult’. (52)
‘I went to this private physio which obviously is not available to everybody … a quick procedure for her to check internally the strength of your pelvic floor muscles and also any gaps in your abdominal muscles, … and it’s really quick to check and I feel like it would be really helpful it that was offered by the GP at the six-week check-up, you know to start women on that path to recovery again, really early on, would be really helpful’. (098) |
Women’s request for ongoing support to maintain PFME
(Support and reminders to continue and go beyond pregnancy) | ‘I think keep reminding and come back to us when we’ve got the breastfeeding sorted and we’re not as, you know, completely absorbed in our babies’. (026) | ‘I feel that you need until you get into a good habit, so anything that can be continually exposing women to the idea of it and the benefits I suppose, and I guess also the risks, not to scare people, but the risks of not doing it, or of having weak pelvic floor muscles, you know, what that means after pregnancy, incontinence and whatever, I think, yeah, just constant exposure to the whole thing, probably in different ways because I think if you constantly see the same something, that it’s the same, you just become sort of immune to it don’t you’. (098) |
