The utility of teaching women pelvic floor muscle training with vaginal palpation: Evaluation by postpartum women

Abstract

Purpose

The purpose of this study was to evaluate the utility of pelvic floor muscle training using vaginal palpation in postpartum period from the change of pelvic floor muscle contraction before and after teaching and the postpartum women's reactions.

Methods

14 postpartum women who had vaginal deliveries in a maternity home and had a good postpartum progress participated in the study. Midwives implemented pelvic floor muscle training using vaginal palpation on women's fourth postpartum day. In order to evaluate the utility of teaching muscle contractions using vaginal palpation, the change of pelvic floor muscle contraction before and after teaching and the postpartum women's reactions were used as indices. Pelvic floor muscle contraction force was measured using the Oxford scale to quantify changes before and after teaching of pelvic floor muscle contraction. In addition, three observation indices evaluated: (1) movement of the vaginal and anal muscles; (2) presence or absence of substitute muscle contraction and (3) sensation of muscle contraction. Interview data from participants' reactions were analyzed qualitatively after practice as well as an anonymous questionnaire one month later.

Results

After the training, the majority of participants' weak pelvic floor muscle contractility disappeared, their use of substitute muscle contractions decreased and participants increased their understanding of the muscle contraction sensation. Five participants who did not understand how to contract the pelvic floor muscles before the training showed improvement on the Oxford scale after training. This change seemed to be due to increased awareness of contraction site and contraction sensation particularly through the midwives' use of vaginal palpation with pelvic floor muscle training.

Pearson's correlation analysis indicated a strong significant correlation between Oxford scale score and the “movement of the vaginal and anal muscles”, “substitute contraction”, and “sensation of contraction”; these three variables proved to be a valid evaluation index of pelvic floor muscle contraction.

Based on the interviews and an anonymous questionnaire, participants had no negative opinions on the pelvic floor muscle training using vaginal palpation. Two categories were extracted as evaluation from the postpartum women: Comprehension of pelvic floor muscle contraction, and Requirements for vaginal palpation. Comprehension of pelvic floor muscle contraction were supported by three subcategories: (1) understanding of the contraction site, (2) direct sensation of contraction, and (3) confirmation of correct muscle group contraction. Requirements for vaginal palpation were supported by three subcategories: (1) trust in providers of practice, (2) painless implementation and (3) consideration for shame.

Conclusion

Vaginal palpation was used as a teaching method for pelvic floor muscle training in the early postpartum period because it helped to confirm the contraction site, the direct sensation and the correct contraction. We suggest that vaginal palpation may have good utility for teaching postpartum women pelvic floor muscle training who have difficulty in understanding and feeling proper pelvic floor muscle contraction.