Empowering midwives to teach pelvic floor exercises to prevent urinary leakage in women during and after pregnancy

Pregnancy and childbirth are transformative experiences in a woman’s life. However, amidst the excitement, many women also find themselves facing unexpected health concerns that may feel embarrassing or taboo. One of these common issues is leaking urine, known as urinary incontinence, which is often overlooked and can significantly impact women’s physical, emotional and social wellbeing for many years after childbirth.

The APPEAL (Antenatal Preventative Pelvic Floor Exercises and Localisation) programme empowers midwives and antenatal care staff to teach pelvic floor muscle exercises to women during pregnancy and after childbirth to prevent and treat urinary incontinence. The programme also provides access to a series of videos for women to know why and how to do pelvic floor muscle exercises. You can view the full video series available here.

In this blog, Devon-based midwife, Nicky Collard, shares the impact APPEAL training has had on her practice and how it can help improve women’s pelvic health.

I’ve been a midwife since 1996, but I’d never been taught to teach women pelvic floor muscle exercises. Before the APPEAL training, I didn’t really understand how much women are negatively affected by their incontinence. Seeing women feel slightly lessened by their inability to control their bladder as well as they want has had a big impact on me. [Now] I can have that conversation in two minutes, and it can change somebody’s life.

The APPEAL programme is easy to learn and gives midwives [and other healthcare professionals] the tools to quickly talk to women about their pelvic health, which can be weaved into day-to-day clinical activities without adding to workload. 

For example, a referral came into the Devon Perinatal Pelvic Health Service for a lady following baby number four whose first language wasn’t English. During a video appointment, she told me she had had urinary leakage since the birth of her second child 12 years ago. She hadn’t mentioned it to anybody. She just thought it was normal. But it was causing a quite a lot of distress as she couldn’t go swimming with her children.

We talked about the pelvic floor and whether she had heard about it. She said she had but didn’t really understand what she needed to do with her muscles. If her midwife hadn’t been taught to ask: ‘Have you got any leakage?’ I don’t think she would have brought it up.

Having done the APPEAL training in spring 2023, I was able to talk her through cues and prompts until we found the right one to help her contract her pelvic floor muscles. I talked to her about how to make pelvic floor exercises a habit: when she was going to do them and what she was going to associate them with. This is really important as lots of people can’t see how they’re going to fit them into their already busy lives.

I referred her to our Women’s Health service for specialist physiotherapy. By the time she saw the physiotherapist she wasn’t leaking anymore, as she had already been regularly practising the exercises, and managed to reach her goal of going swimming.

About APPEAL training 

Funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research, and led by researchers at the Universities of Birmingham, Exeter and Warwick with support from NIHR Applied Research Collaboration (ARC) South West Peninsula and ARC West Midlands, APPEAL helps midwives and antenatal care staff know when and how to teach the exercises, and how to support women to perform the exercises so they are less likely to leak urine after giving birth. 

Health Innovation South West partnered with the University of Exeter and NIHR PenARC in 2023/24 to support local maternity and neonatal teams in Somerset, Devon and Cornwall to implement the APPEAL training programme – including a new set of videos – as part of their new perinatal pelvic health services.

Further information

More details about the APPEAL programme can be found here.

Contact us

If you would like to get in touch about the role of Health Innovation South West in supporting APPEAL implementation in the South West, please email Dr Victoria Salmon, Health Innovation South West Programme Manager.