Referral Patterns and Attendance to a Peripartum Pelvic Floor Disorder Clinic

Objectives: Recovery of pelvic floor function after delivery may be critical to prevention of future pelvic floor disorders (PFDs). Postpartum pelvic health clinics provide information and access to pelvic floor physical therapy which may facilitate physical recovery from birth injury. Referral patterns and visit attendance at postpartum pelvic health clinics may vary based on race and ethnicity potentially predisposing certain populations to future pelvic floor disorders. This study examines the baseline demographics and referral patterns of patients seen in a specialized peripartum PFD clinic, Pelvic Health After Birth Program (P-HAB), initiated in January 2023.

Methods: A retrospective chart review was conducted for patients referred to P-HAB clinic following operative delivery and/or obstetric anal sphincter injury (OASI). Demographic data, delivery mode, laceration type, clinic referrals, and appointment attendance were analyzed.

Results: Between January and December 2023, 262 patients meeting criteria for referral to P-HAB clinic by OASI and/or operative delivery were identified. Mean patient age was 31.38 ± 5.6 years. 35% (93/262) of patients identified had OASI lacerations and delivered spontaneously, and 65% (169/262) underwent operative delivery (22% had concurrent OASI). Of these patients, 52% (135/262) were referred to P-HAB clinic, with 56% (75/135) of referred patients attending an appointment. Referral and attendance rates varied among racial groups: 17.6% (46/262) of total eligible patients were Asian, with 57% (26/46) being referred to P-HAB clinic, and 77% (20/26) of these patients attending an appointment. 5.7% (15/262) self-identified as Black, with 40% (6/15) referred to P-HAB clinic, and only 33% (2/6) attending an appointment. 22.5% (59/262) self-identified as Hispanic, with 41% (24/59) referred to P-HAB clinic, and 50% (12/24) attending an appointment. 8.4% (22/262) self-identified as Multiracial, 64% (14/22) were referred to P-HAB clinic, 50% (7/14) attended an appointment. 45.8% (120/262) self-identified as White, with 54% (65/120) referred to P-HAB clinic, and 52% (34/65) attended an appointment. Logistic regression analysis showed Asian patients were 95% more likely to attend appointments than White patients (OR 1.95, 95% CI [.961-3.93]), and Hispanic patients were 42% less likely to be referred to clinic than White patients (OR 0.58, 95% CI [.309-1.09]), while Black patients were 44% less likely (OR 0.56, 95% CI [.189-1.68]) though not statistically significant.

Conclusions: This 12-month experience underscores the necessity of specialized peripartum PFD clinics, with over half of referred patients attending appointments. While Asian patients demonstrated higher attendance rates, disparities exist, particularly for Hispanic and Black patients, indicating areas for improvement in referral practices to ensure equitable access to care.