Impact of verbal instructions on pelvic floor contraction in the immediate postpartum

Abstract

Introduction: Pregnancy predisposes the emergence of pelvic floor dysfunctions (PFD), postpartum being the opportune moment to assess these muscles. Objective: To investigate the effect of instructions and verbal feedback on the contraction capacity of pelvic floor muscles (PFM) in postpartum women. Methods: Quasi-experimental study with 109 women in the immediate vaginal postpartum at a reference maternity hospital in Fortaleza, Ceará state, Brazil. PFM were visually inspected using the visual contraction scale (0 = no visible contraction; 1 = weak visible contraction; 2 = visible contraction with perineal elevation), in addition to observing the use of accessory muscles and movements. Assessments occurred in consecutive moments: 1 – PFM contraction at a verbal command; 2 – contraction after instructions on structure, function and correct contraction; and 3 – contraction after feedback on the use of accessory muscles and reinforcement of correct contraction. Cochran’s Q test and a 5% significance level were used to compare the outcomes between different moments. Results: At the first assessment, 15.6% of the postpartum women did not exhibit visible PFM contraction (grade 0). Of these, 70.5% changed their contraction grade after instructions and feedback. At the end, 45.9% of women correctly contracted their PFM with perineal elevation (grade 2) (p < 000.1). The use of accessory muscles (abductors, abdominals and gluteal) declined after instructions and feedback (p < 000.1). Perineal trauma, forceps delivery, previous information and fear of feeling pain were not associated with contraction grade. Conclusion: Instructions and verbal feedback are useful tools for correct PMF contraction in the immediate postpartum.