title: Achieving sustainable quality in maternity services - using audit of incontinence and dyspareunia to identify shortfalls in meeting standards.
abstract: BACKGROUND: Some complications of childbirth (for example, faecal incontinence) are a source of social embarrassment for women, and are often under reported. Therefore, it was felt important to determine levels of complications (against established standards) and to consider obstetric measures aimed at reducing them. METHODS: Clinical information was collected on 1036 primiparous women delivering at North and South Staffordshire Acute and Community Trusts over a 5-month period in 1997. A questionnaire was sent to 970 women which included self-assessment of levels of incontinence and dyspareunia prior to pregnancy, at 6 weeks post delivery and 9 to 14 months post delivery. RESULTS: The response rate was 48%(470/970). Relatively high levels of obstetric interventions were found. In addition, the rates of instrumental deliveries differed between the two hospitals. The highest rates of postnatal symptoms had occurred at 6 weeks, but for many women problems were still present at the time of the survey. At 9-14 months high rates of dyspareunia (29%(102/347)) and urinary incontinence (35%(133/382)) were reported. Seventeen women (4%) complained of faecal incontinence at this time. Similar rates of urinary incontinence and dyspareunia were seen regardless of mode of delivery. CONCLUSION: Further work should be undertaken to reduce the obstetric interventions, especially instrumental deliveries. Improvements in a number of areas of care should be undertaken, including improved patient information, improved professional communication and improved professional recognition and management of third degree tears. It is likely that these measures would lead to a reduction in incontinence and dyspareunia after childbirth.
authors.affiliation: Obstetrics & Gynaecology, North Staffordshire Hospital NHS Trust, Stoke on Trent, United Kingdom. richard@kogs.freeserve.co.uk
authors.forename: James
authors.initials: J
authors.lastname: Clarkson
authors.forename: Cindy
authors.initials: C
authors.lastname: Newton
authors.forename: Debra
authors.initials: D
authors.lastname: Bick
authors.forename: Gill
authors.initials: G
authors.lastname: Gyte
authors.forename: Chris
authors.initials: C
authors.lastname: Kettle
authors.forename: Mary
authors.initials: M
authors.lastname: Newburn
authors.forename: Jane
authors.initials: J
authors.lastname: Radford
authors.forename: Richard
authors.initials: R
authors.lastname: Johanson