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K. Divine1, J. Boissionnault1, J. Fritts1, S. Sova1, V. Patel1
1Shenandoah University, Physical Therapy, Winchester, United States
Background: While pregnancy has 3 trimesters over 40 weeks, the American College of Obstetricians and Gynecologist (ACOG) have recommended there should be a 4th trimester that lasts 12 weeks after delivery. Full access to postpartum care requires governmental or private coverage of services with a commitment to refer and an educated workforce. There is a global knowledge gap as to what postpartum care is offered and what women are eligible through national health plans/services and private insurance plans.
Purpose: This study aimed to investigate postpartum medical and physical therapy (PT) care offered under national health and private insurance plans in International Organization of Physical Therapists in Pelvic and Women’s Health (IOPTPWH) member countries.
Methods: Survey development utilized evidence from a literature review of postpartum medical and PT-related services and postpartum pathology. The survey consists of a demographic section and a section regarding postpartum women’s eligibility for medical and PT services. The validated survey was fielded to 30 chief delegates of the IOPTPWH.
Results: Fifteen chief delegates responded to the survey yielding a 50% response rate. The study found that (1) the major barriers to postpartum women participating in medical and PT-related treatment include the cost of treatment (20%, 53.3% respectively), lack of transportation (20% medical), and lack of providers (20% PT); (2) several countries do not cover postpartum medical or PT treatments and care under their national health plan/service or private insurance; and (3), self-referral for postpartum medical and PT care is nearly as common as a physician or midwife referral. All three of these referral-types are options in almost half of the responding countries. Only 46.6% of countries reported that all women were eligible for medical and/or PT services in the postpartum period. The most common diagnoses resulting in referral to PT were urinary incontinence and/or pelvic organ prolapse (93.3%), low back pain and/or pelvic girdle pain (93.3%), sexual dysfunction (86.6%) and diastasis recti (80%). The least common referrals reported were general weakness/endurance issues (46.6%) and carpal tunnel syndrome (53.3%). Postpartum medical visits covered by national health service/insurance and and private insurance plans varied from 1-5 visits in the first year after delivery.
Conclusion(s): Postpartum impairments and functional limitations have been well documented in the literature. There are vast differences in medical and PT-related services covered by national health services/insurance to postpartum women globally. Not all women are eligible for postpartum care, which may have long-term implications. Access barriers include financial, workforce, and informational gaps.
Implications: Striving to standardize postpartum care could allow women to receive early, essential and adequate medical and rehabilitative care, leading to improved quality of life. Future research exploring the interventions and treatments prescribed in the postpartum population in IOPTPWH countries could result in evidence-based postpartum PT practice advancements.
Funding, acknowledgements: Work was unfunded.
Keywords: Postpartum, Physical Therapy, National Health Service/Insurance
Topic: Pelvic, sexual and reproductive health
Did this work require ethics approval? Yes
Institution: Shenandoah University
Committee: Shenandoah University IRB
Ethics number: Protocol #781
All authors, affiliations and abstracts have been published as submitted.
