Regional and national adoption of pelvic floor education – APPEAL
APPEAL is a midwifery led approach to improving pelvic floor health, it aims to prevent urinary incontinence related to pregnancy and childbirth.
Impact
- 200+ perinatal pelvic health and maternity service leads trained through ‘Train the Trainer’ sessions across England and Northern Ireland.
- Nine maternity services implementing APPEAL within their organisations by March 2025.
- 50 primary care staff participated in pilot of Pflexi, a similar training programme adapted for primary care.
- Survey data from 350 healthcare professionals show that training increased confidence to discuss urinary incontinence and teach pelvic floor exercises.
- Awarded the International Continence Society ‘Best in Category Health Services Research’ abstract prize 2024 for the real-world evaluation of APPEAL, led by University of Exeter in collaboration with Health Innovation South West.
Project summary
The Antenatal Preventative Pelvic Floor Exercises And Localisation Programme (APPEAL) provides training and resources for maternity staff and pregnant women to understand the importance of pelvic floor health in pregnancy, and to teach and practice pelvic floor muscle exercises that are effective for preventing urinary incontinence.
The University of Exeter APPEAL research team and Health Innovation South West were successful in securing Medical Research Council Impact Accelerator Impact Co-Creation funding to support uptake and implementation of APPEAL training in the South West Peninsula region and across England.
By March 2025, nine maternity services were implementing APPEAL within their organisations, and 200+ perinatal pelvic health and maternity service leads had been trained in ‘Train the Trainer’ sessions across England and Northern Ireland.
If adopted across the UK, pelvic floor education could transform outcomes for tens of thousands of pregnant women every year.
Rationale
Between 3 and 5 million women in the UK experience urinary incontinence. This condition severely impacts their quality of life – physically, psychologically and socially – with huge costs for the NHS and the environment.
Preventative pelvic floor education is not routinely provided in antenatal care or primary care in the UK. Many midwives and health professionals who do not specialise in women’s health report lacking the confidence and skills to address pelvic floor health effectively. Women often say they do not know how to do pelvic floor exercises.
APPEAL’s preventative approach and delivery via community midwifery care addresses this problem and has the potential to reduce the need for specialist treatment.
Key stakeholders
- Health Innovation South West played a critical role in the implementation of APPEAL in the South West, facilitating system-wide adoption, delivering monthly peer support sessions for service leads, and championing the programme through maternity networks.
- Other stakeholders include Local Maternity and Neonatal Systems, Maternity and Neonatal Voice Partnership, National Service User Representative for Perinatal Pelvic Health Services, Perinatal Pelvic Health Service Training leads, Lead Midwifery Educators, and Practice Development Midwives.
Next steps
The Medical Research Council collaborative project runs until July 2025, with a sustainable national business model in development.
The target is to train 95% of maternity staff within adopting organisations by March 2027.
Urinary leakage is one of those things you don't hear about until it happens to you. It completely changed my whole life.
Emma - mum of two, experienced leaking during her first pregnancy
