(Poster 33) Rates of Postpartum Pelvic Floor Physical Therapy in a Multi-hospital System

Objectives: There is strong evidence for the efficacy of pelvic floor physical therapy (PFPT) in the postnatal period in reducing pelvic floor dysfunction including urinary incontinence. Up to 50% of parturients are at risk of developing pelvic floor dysfunction during and immediately after pregnancy. There is currently limited data on the rate of referrals to PFPT in the postpartum period. Understanding referral rates and associated patient and clinical characteristics is critical in guiding efforts to integrate PFPT in postpartum care. We hypothesize that in our setting, less than 30% of all term deliveries are referred to PFPT. This is less than the expected prevalence of pelvic floor dysfunctions and approximates the referral rate amongst other single institution studies.

Methods: This is a retrospective cohort study of patients with term singleton deliveries between 2020 and 2024 at a multi-hospital system. Those with a history of PFPT within a year prior to delivery were excluded. PFPT referrals were summarized by demographic (age, delivery location, ethnicity, race, language, insurance type), obstetric variables (gestational age, mode of delivery, parity, birth weight), and pelvic floor dysfunction diagnosis. Student’s t-tests, Wilcoxon rank-sum, Chi-square or Fisher’s exact tests, and logistic regression models were used, when appropriate. A P value of < 0.05 was considered statistically significant.

Results: Of the 39053 patients included, 984 were excluded from analysis for prior history of PFPT. Only 4% (n=1506) were referred to PFPT in the postpartum period, including 4.7% of all spontaneous vaginal deliveries. Urban hospitals were more likely to refer to PFPT compared to suburban and rural hospitals (11.3% vs 2.5% vs 3.3%, p< 0.001, Table 1). Of those with diagnosis of pelvic floor dysfunction, only 70% were referred. Of those with a diagnosis of 3rd or 4th degree OASIS tears and operative vaginal births, 13.3% and 5.5% were referred respectively (all p< 0.001, Table 1). Non-English speakers and Hispanic patients were less likely to be referred (aOR: 0.7, 95% CI: 0.56-0.85; aOR: 0.7, 95% CI: 0.53-0.91 respectively, Table 2). Furthermore, those on public insurance were less likely to be referred, compared to those on private insurance (aOR: 0.73, 95% CI: 0.64-0.82, Table 2).

Conclusions: Only 4% of postpartum patients in our population were referred to PFPT within one year of delivery. Of patients with documented indications for PFPT, only 33% were referred. Of referred patients, non-urban populations, non-English speakers, Hispanic patients, and those on public insurance were disproportionately less likely to have referrals placed, indicating potential disparities in access to PFPT. Our data demonstrates a severe underutilization of this resource for postpartum patients and a need to integrate access to PFPT as part of pregnancy and postnatal care.