National pelvic health service for women going through pregnancy and childbirth

• Maternity and neonatal services nationwide will be required to support and inform women who experience trauma during childbirth
• Distressing issues like pelvic organ prolapse, perineal tears, pelvic pain and incontinence due to childbirth are too common so government and NHS taking action
• Boosting women’s health and wellbeing remains a top priority and government continues working and investing in world-class healthcare

Women who have gone through the often devastating pain and distress of a traumatic birth will receive better aftercare and support, and pregnant women will be better equipped with the information they need as part of their routine antenatal care, as plans are unveiled for the implementation of a nationwide pelvic health service.

Roughly one in three women experience urinary incontinence three months after pregnancy, and around one in seven experience anal incontinence six months after birth. One in twelve women report symptoms of pelvic organ prolapse – which is when one or more of the organs in the pelvis slip down from their normal position and bulge into the vagina. These distressing issues can affect women’s ability to work, their sexual and social relationships, and their mental health.

But action is being taken on a national level. Backed by over £11 million of government funding from April 2024, plans published by NHS England for the implementation of a new national service will:

• ensure all women are offered a self-assessment of their pelvic health as early as possible in pregnancy – and by 18 weeks at the latest
• educate all women on the risk of pelvic floor dysfunction and birth injuries and preventative action they can take to reduce this risk
• provide additional support to those at higher risk of pelvic health problems
• reduce NHS waiting times – one of the Prime Minister’s five pledges – and minimise administrative barriers to treatment
• allow affected women to access appropriate physiotherapy assessment and personalised treatment

Women’s Health Minister Maria Caulfield said:

“For too many women, the joy of pregnancy and birth is tarnished by trauma, and pelvic health problems can have devastating ramifications for women’s lives. 

“It’s vital women receive appropriate support, treatment and information. From initial antenatal appointments, right through to mental health care after birth, we are determined to support women throughout their pregnancy and birth journey.”

Kate Brintworth, NHS England’s Chief Midwifery Officer, said:

“For any women that have experienced a traumatic birth, timely access to support is crucial to help address any issues like incontinence that can occur.  

“To increase the support available, the NHS is rolling out dedicated pelvic health clinics nationally, bringing together expert clinicians under one roof, so women can seek help quickly and easily – and already thousands of women have been supported through our pilot sites. 

“As part of these plans, women will be supported by maternity teams to recognise pelvic health problems and offered a self-assessment of their pelvic health as early as possible in pregnancy, and the NHS is here for women if they need support.”

Perinatal Pelvic Health Services (PPHS) – run by specialist midwives and pelvic health physiotherapists – are already being implemented as pilots right across England. All areas in England are on track to implement these services by March 2024 – helping women everywhere.

These services work alongside maternity and physiotherapy services to support the prevention, identification and timely treatment of pelvic health problems around birth, and include a clear pathway for referral into mental health services.

They also reduce the risk of these injuries happening in the first place through close work with midwives and obstetricians and through support for the implementation of the OASI care bundle.

Developed by a team of UK experts and supported by national professional organisations and women’s groups, the care bundle which is a set of interventions likely to improve outcomes for women. Analysis of the effectiveness of this care bundle based on over 50,000 vaginal births found that women’s risk of obstetric anal sphincter injuries decreased by 20%. 

Dr Ranee Thakar, President of the Royal College of Obstetricians and Gynaecologists, said:

“Too many women currently suffer pelvic injuries during childbirth, which can mean long-term complications including difficulty controlling the bladder and bowel, chronic pain and painful intercourse. This guidance represents an important milestone in the development of vital Perinatal Pelvic Health Services, created to improve access to early intervention and support for women and people experiencing symptoms of pelvic floor dysfunction.

“We are delighted that this service specification sets out how PPHS will work with maternity units to implement the joint RCOG and Royal College of Midwives’ Obstetric Anal Sphincter Injury (OASI) Care Bundle. As a College we look forward to supporting the implementation of this important guidance, working with our membership and our NHS partners to help ensure all women have access to high-quality pelvic floor health information, education and care.”

It’s vital women are educated properly about pelvic health problems before and after giving birth. NHS England’s new service specification highlights how every woman using maternity services should receive routine information at every contact antenatally and postnatally about perinatal pelvic health.

At all routine perinatal appointments, clinicians should discuss with patients preventative measures that can be taken, including pelvic floor exercises, when to get help, where to go for help, and potential management options.

Women who have gone through such physical trauma can also experience devastating mental illness, and it’s vital the proper mental health support is in place.

The service specification requires maternity and neonatal services to establish strong working links with mental health services – particularly maternity mental health services, perinatal mental health services, and psychosexual counselling services. This will ensure women are signposted in an appropriate and timely way, and that they can be referred between pelvic and mental health care as seamlessly as possible.

Progress is already being seen in this area and by May 2023, an additional 16,000 women per year accessed specialist community perinatal mental health services and maternity mental health services compared to two years previously.

This follows unprecedented levels of funding to grow the maternity workforce and boost neonatal services, including £165 million of additional investment a year to improve maternity and neonatal care, and this will rise to an additional £186 million a year from 2024/25. The NHS recently published the first ever Long Term Workforce Plan, backed by over £2.4billion in government funding to deliver the biggest training expansion in NHS history to help meet the challenges of a growing and ageing population by recruiting and retaining hundreds of thousands more staff over the next 15 years.

The government also continues to build on the Maternity Transformation Programme, and continues to work closely with NHS England to implement the 3 year delivery plan for maternity and neonatal services that was published in March 2023. This plan looks to guide services towards safer and more personalised care for women, babies and families.