A Collaborative Approach to Treating Women With Postpartum Pelvic Floor Issues

UPMC Magee-Womens Hospital Postpartum Pelvic Floor Healing Clinic Sees Rapid Growth 

Many first-time mothers will experience some form of trauma to the pelvic floor region as a result of vaginal childbirth. Approximately 80% to 90% of first-time mothers will have some degree of laceration — from minimal tearing to more severe third and fourth-degree anal sphincter lacerations. Women who experience third and fourth-degree wounds are the highest risk population for acute wound complications: infections, wound breakdown, and incomplete or prolonged healing. Additionally, less acute but equally problematic are pelvic floor issues such as persistent pain or pain with intercourse, urinary or bowel leakage, and in some cases pelvic organ prolapse, which may arise as a consequence of pregnancy and childbirth.

At UPMC Magee-Womens Hospital, the Postpartum Pelvic Floor Healing Clinic was created to better serve this vulnerable patient population. The initiative was led by Lauren Giugale, MD, assistant professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences Division of Urogynecology and Reconstructive Pelvic Surgery at the University of Pittsburgh School of Medicine, who spent nearly five years working to conceive, develop, and launch the clinic. To launch the clinic in November 2020, Dr. Giugale collaborated with Gabriella Gosman, MD, vice president of Medical Affairs at UPMC Magee, John Fisch, MD, vice-chair of clinical operations in the department, and Pamela Moalli, MD, PhD, director of the Division of Urogynecology and Reconstructive Pelvic Surgery.

“This is a specialized clinic run through our Division solely focused on maternal healing after childbirth. We know there is a significant amount of healing that happens after childbirth, and of course, this varies by the individual. Unfortunately, there are many instances where issues go either unnoticed or unrecognized in the early weeks after birth,” says Dr. Giugale.

Postpartum Pelvic Floor Healing Clinic Providers

Lauren Giugale, MD – Clinic Director
Pamela Moalli, MD, PhD – Chief, Division of Urogynecology and Reconstructive Pelvic Surgery
Amanda Artsen, MD, MSc
Jocelyn Fitzgerald, MD

Clinic Goals and Care Functions

The initial goal for the clinic was to identify those individuals with severe or high-grade lacerations (3rd or 4th degree) or those individuals with other complex obstetrical lacerations within two weeks after birth (or as soon as possible) in order to identify healing or other complications early and intervene appropriately.

However, since the clinic began operation, it has expanded its scope to take referrals for any peripartum pelvic floor symptom or pelvic floor disorder emerging within the first year after childbirth.

The Postpartum Pelvic Floor Healing Clinic operates as a collaboration with obstetricians, midwives, advance practice providers, and gynecologists. The goal is to evaluate the pelvic floor needs of each patient and provide therapies if necessary. However, if individual patients are doing well with no complications or symptoms of concern, they return for routine care with their existing OB/GYN. 

“We function as a collaborative consultation and evaluation service for women experiencing any pelvic floor issue during the first year postpartum. Collaboration is key because in order to be successful, we have to work in concert with the patient’s obstetrician and gynecologist to coordinate care,” says Dr. Giugale. 

Initial Patient Volumes and Successes

In the first full year of the Postpartum Pelvic Floor Healing Clinic accepting patients, the clinic saw more than 160 new patients — on average 14 new patients each month — as well as return visits for patients needing additional follow-up care beyond their initial visit.

“With UPMC Magee handling more than 9,000 vaginal childbirths every year, we fully expect our patient volumes to increase over time as more of our obstetric providers and patients learn about the clinic. With what we know about the prevalence of pelvic floor issues after childbirth, there are undoubtedly more women experiencing difficulties than are currently seeking help. Our goal is to reduce that number dramatically,” says Dr. Giugale.

Quality Improvement and Future Clinic Expansion

Currently, Dr. Giugale and her clinical team are working on two quality improvement initiatives: assessing patient satisfaction and patient outcomes. 

“Our goal is to continually evolve our practice to better meet the needs of the patients we serve. Satisfaction surveys will help us to identify and implement changes to improve patient care, and we are actively working to assess outcomes from our early and ongoing interventions up to 16 weeks after a patient’s initial visit,” says Dr. Giugale.

Within the next 12 months, Dr. Giugale expects to have the capability to perform on-site pelvic floor ultrasound imaging. The clinic has worked extensively with Noedahn Copley-Woods, MD, from the Division of Obstetrical & Gynecological Ultrasound, who has been performing many of the postpartum pelvic floor ultrasound scans. Dr. Giugale is currently finishing training with Dr. Copley-Woods and Timothy Canavan, MD, MSc, to become certified to perform point-of-care ultrasound imaging .

"We are excited that we will be able to offer this imaging directly in the clinic to save our patients time and reduce the number of follow-up appointments they need to make,” says Dr. Giugale. “This type of ultrasound imaging will allow us to better visualize an injury from childbirth, provide patients with education about the status of their pelvic floor, and monitor healing of patients who do have signs of pelvic floor damage.”

A long-term goal for the clinic will be to expand into a more multidisciplinary team by having a dedicated pelvic floor physical therapist to aid in patient assessments and provide direct patient care during their visit. 

“We know the benefits that can be achieved through specialized pelvic floor PT and providing that additional layer of assessment and care directly in the clinic will be of great value to our patients,” says Dr. Giugale. “So too would the addition of behavioral health, gastroenterology, nutrition, and other disciplines when required for more complex or challenging cases, which is another of our long-term goals.”

Learn more about the Postpartum Pelvic Floor Healing Clinic. For additional information or to make a patient referral, please call 412-641-MAMA (6262).