Aveyard H, Sharp P, Wooliams M A Beginners Guide to Critical Thinking and Writing in Health and Social Care, 2nd edn. Milton Keynes: Bell and Bain; 2015

Bladder and Bowel Foundation. Pelvic Floor Exercises. 2017. (accessed 25 January 2017)

Bo K, Haakstad L Is pelvic floor muscle training effective when taught in a general fitness class in pregnancy? A randomised controlled trial. Physiotherapy. 2011; 97:(3)190-5

Borello-France D, Burglo K, Goode P Adherence to behavioural interventions for stress incontinence: rates, barriers and predictors. Phys Ther. 2013; 93:(6)757-73

Bowling A Research Methods in Health: Investigating Health and Health Services, 4 edn. Berkshire: Open University Press; 2014

Boyle R, Hay-smith EJC, Cody JD, Morkved S Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in pregnant women and women who have recently given birth. Cochrane Database Syst Rev. 2012; 10

Burns N, Grove S, Gray J The Practice of Nursing Research: Appraisal, Synthesis, and Generation of Evidence, 7th edn. Maryland Heights, MO: Elsevier; 2013

Butterfield Y, O'Connell B, Phillips D Peripartum urinary incontinence: a study of midwives' knowledge and practices. Women Birth. 2007; 20:(2)65-9

Dinc A, Bebi N, Yalcin O Effect of pelvic floor muscle exercises in the treatment of urinary incontinence during pregnancy and the postpartum period. Int Urogynecol J Pelvic Floor Dysfunct. 2009; 20:(10)1223-31

Dumoulin C, Hay-Smith EJC, Mac Habée-Séguin G Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2014; 5

Domene PA, Moir HJ, Pummell E, Easton C Salsa dance and Zumba fitness: Acute responses during community-based classes. Journal of Sport and Health Science. 2016; 5:190-6

Faculty of Public Health. What is public health. 2010. (accessed 13 June 2017)

Fine P, Burglo K, Borello-France D Teaching and practicing of pelvic floor muscle exercises in primiparous women during pregnancy and the postpartum period. Am J Obstet Gynecol. 2007; 197:(1)107.e1-5

Joint statement on Pelvic Floor Muscle Exercise Improving health outcomes for women following pregnancy and birth and Chartered Society of Physiotherapy. 2013. (accessed 13 June 2017)

Guerrero K, Owen L, Hirst G, Emery S Antenatal pelvic floor exercises: A survey of both patients' and health professionals' beliefs and practice. J Obstet Gynaecol. 2007; 27:(7)684-7

Hay-Smith J, Morkved S, Fairbrother KA, Herbison GP Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev. 2008; 4

Exploring the Public Health Role of Midwives and Maternity Support Workers: Final Report. 2015. (accessed 13 June 2017)

Ko P, Liang C, Chang S, Lee J, Chao A, Cheng P A randomised controlled trial of antenatal pelvic floor exercises to prevent and treat urinary incontinence. Int Urogynecol J. 2011; 22:(1)17-22

Saving Lives, Improving Mothers' Care—Surveillance of maternal deaths in the UK 2012-14 and lessons learned to inform maternity care from the UK and Ireland: Confidential Enquiries into Maternal Deaths and Morbidity 2009-14. In: Knight M, Nair M, Tuffnell D (eds). Oxford: National Perinatal Epidemiology Unit, University of Oxford; 2016

Kumar R Research Methodology: a step-by-step guide for beginners, 3 edn. London: Sage Publications; 2011

Langeland-Wesnes S, Lose G Preventing Urinary Incontinence during Pregnancy and Postpartum: a review. Int Urogynecol J. 2013; 24:(6)889-99

Lueddeke GR Global population health and well-being in the 21st century: toward new paradigms, policy, and practice.New York City, NY: Springer Publishing Company; 2016

Mason L, Roe B, Wong H, Davies J, Bamber J The role of antenatal pelvic floor muscle exercises in prevention of postpartum stress incontinence: a randomised controlled trial. J Clin Nurs. 2010; 19:(19-20)2777-86

Melville J, Wagner L, Fan M, Katon W, Newton K Women's perceptions about the etiology of urinary incontinence. J Womens Health (Larchmt). 2008; 17:(7)1093-8

National Institute for Health and Care Excellence. Antenatal care for uncomplicated pregnancies [Clinical guideline 62]. 2008. (accessed 6 January 2016)

Panhale V, Mundra N Relationship between frequency of performing pelvic floor muscle exercises and stress incontinence in antenatal and postnatal period. International Journal of Physiotherapy and Occupational Therapy. 2012; 6:(4)7-11

Parahoo K Nursing Research: Principles, Processes and Issues, 3rd edn. Hampshire: Palgrave Macmillan; 2014

Rees C Introduction to Research for Midwives, 3 edn. Croydon: Elsevier; 2011

Sanders J, Hunter B, Warren L A wall of information? Exploring the public health component of maternity care in England. Midwifery. 2016; 34:253-60

Whitford H, Alder B, Jones M A cross sectional study of knowledge and practice of pelvic floor exercises during pregnancy and associated symptoms of stress urinary incontinence in north east Scotland. Midwifery. 2007a; 23:(2)204-17

Whitford H, Alder B, Jones M A longitudinal follow up of women in their practice of perinatal pelvic floor exercises and stress urinary incontinence in north east Scotland. Midwifery. 2007b; 23:(3)298-308

Whitford H, Jones M An exploration of the motivation of pregnant women to perform pelvic floor exercises using the revised theory of planned behaviour. Br J Health Psychol. 2011; 16:(4)761-78

Why is education for pelvic floor muscle exercises a neglected public health issue?

02 November 2017
Volume 25 · Issue 11



Pelvic floor muscle exercises positively impact on urinary stress incontinence and quality of life for women.


To try and understand more about pelvic floor exercises.


A search was performed on Cochrane, CINAHL and Discover More. Delimiting the search provided 28 papers, which then informed this literature review. Differing methodology and small sample size of individual studies, variation in trainer and the design of pelvic floor muscle exercises education limited the evidence base.


Many barriers existed and women were found to be disinterested with pelvic floor exercises or unaware of the reasons for performing them. Those who were young, in their first pregnancy and from deprived areas were less likely to perform pelvic floor muscle exercises, as they had no access to information or believed they were not necessary. Midwives lacked confidence in their knowledge and suggested that other health professionals could perform promotion better.


It is important to investigate how midwives can influence education about pelvic floor muscle exercises and women's perceptions. New and creative methods of health promotion are needed to engage women with pelvic floor muscle exercises more effectively.

Pelvic floor muscle exercises are suggested as a method to improve pelvic muscle control in the antenatal and postnatal period (Dinc et al, 2009; Bo and Haakstad, 2011; Langeland-Wesnes and Lose, 2013), and are defined as the repetitive contraction of the pelvic muscles performed with an intent to strengthen, increase endurance and coordinate muscle activity, in order to prevent urinary incontinence (Hay-Smith et al, 2008). During pregnancy, pelvic floor exercises may help to counteract the pressure caused by the fetus, and the increased laxity of ligaments in the pelvic area (Hay-Smith et al, 2008). It is recognised that this information is provided by midwives at booking as part of their role in public health. The National Institute for Health and Care Excellence (NICE) (2008) recommends that pregnant women are advised about pelvic floor exercises at their first booking appointment; however, there is no data collected that would indicate if this advice takes place in a standardised way locally, nationally or internationally.

Register now to continue reading

Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month