Antenatal Preventative Pelvic floor Exercises And Localisation programme (APPEAL)
Training midwives to teach pelvic floor muscle exercises during pregnancy to reduce urinary incontinence after giving birth
Programme
overview
- Evidence-based programme of training for midwives to improve antenatal advice and education about pelvic floor muscle exercises
- Supporting implementation in local perinatal pelvic health services
- Developing a sustainable business model to continue national spread
Partners involved
- 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.
- NIHR PenARC
- University of Exeter
Programme
detail
Leaking urine, known as urinary incontinence, affects one in three women after having a baby. It has a big impact on a woman’s physical, mental and social quality of life, with huge costs for individuals, health and care services, and the environment.
Research shows that doing pelvic floor muscle exercises during pregnancy can stop leaking urine before and after birth. However, when it comes to pelvic floor muscle exercises, many women say they are not sure what to do. What’s more, there is evidence that self-help resources are more likely to be accessed by people with higher levels of education.
Midwives in the UK are well placed to give women advice and support for such exercises. APPEAL (Antenatal Preventative Pelvic floor Exercises and Localisation) is an evidence-based programme of training and resources to help midwives to know when and how to teach pelvic floor exercises so they are less likely to leak after giving birth. The programme also focuses on community midwifery care with potential to reduce the need for specialist hospital-based treatment for women who leak.
APPEAL is funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research, and led by researchers at the University of Birmingham and University of Exeter with support from NIHR Applied Research Collaboration South West Peninsula (PenARC).
Health Innovation South West and the University of Exeter’s APPEAL research team secured funding from the Medical Research Council’s ‘Impact Accelerator Impact Co-Creation’ programme, to help roll out and embed APPEAL training in the South West Peninsula and across England.
Health Innovation South West has played a key role in engaging the system, facilitating local adoption of the APPEAL programme, running monthly peer support sessions for service leads, and promoting the programme’s benefits.
Impact to date
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- 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
- Over 200 perinatal pelvic health service and maternity service leads have attended ‘train the trainer’ sessions across England and Northern Ireland
- 9 maternity services are actively implementing APPEAL within their organisations
- 50 primary care staff have participated in a pilot of Pflexi – our training for primary care
- Staff training has increased confidence to talk about urinary confidence, teach pelvic floor exercises and refer to specialist services when needed, in data from 350 staff
- New video resources for midwives and pregnant women have provided women with a greater awareness and understanding of pelvic floor muscle exercises, and confidence in managing their pelvic health
- 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
Extending the reach of APPEAL resources
In 2023 Health Innovation South West partnered with researchers at the University of Exeter and with young parents from WILD Young Parent Project in Cornwall to design new videos on pelvic floor muscle exercises to support women from under-served populations in rural and coastal communities.
Partnering with WILD ensured we included voices of women who often experience challenges accessing health and care in rural and coastal communities in the South West.
The videos feature midwife Leann covering how to find, squeeze and lift your pelvic floor muscles and invites pregnant mother Emma to practice pelvic floor muscles with Leann. It’s an easy guide for women to follow along at home and with their midwife during antenatal appointments.
You can watch one of the videos below and explore the full series here.
“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, who experienced leaking during her first pregnancy
