Peripartum Evaluation and Assessment of the Pelvic Floor around Delivery (PEAPOD) Clinic
The birth of a child can be a hectic and an overwhelming time for new moms, and pelvic floor complications are not always addressed. At Prentice Women’s Hospital, over 12,000 women each year give birth. With this incredibly high delivery volume, Northwestern Medicine’s urogynecology faculty are uniquely positioned to offer comprehensive specialty care for women’s pelvic floor needs before, during and after pregnancy.
About the Clinic
Designed to help pregnant women and new moms receive specialized care sooner than a standard six-week postpartum appointment, Northwestern Medicine's PEAPOD clinic is a unique program in Chicago and its suburbs with its focus on the peripartum care of women who experience pelvic floor symptoms. Within this innovative, transdisciplinary care program for new mothers, the urogynecologists work cooperatively with obstetrician-gynecologists to provide comprehensive care plans for these women.
Why do some women develop pelvic floor issues after childbirth?
There are many risk factors for development of pelvic floor disorders after childbirth. One of the most significant risk factors for developing anal incontinence after having a baby is a severe tear. These tears are known as third or fourth degree tears and damage the anal sphincter. At the time of delivery, the sphincter is repaired with stitches; however, close follow-up to ensure proper healing is necessary.
Risk factors for developing a severe obstetric anal sphincter laceration include the following:
- Use of forceps to help deliver the baby vaginally
- Long "pushing" phase of labor
- Large baby
- Delivery position of baby ("sunny side up")
- Older maternal age
When should women seek care in the PEAPOD Clinic?
Many women begin experiencing pelvic floor symptoms during their pregnancy. While some of these symptoms will resolve after delivery, many women have bothersome symptoms that can be addressed during pregnancy and should be discussed with a primary obstetrician-gynecologist. Obstetrician-gynecologists may recommend that women consult with one of the urogynecologists in the PEAPOD Clinic during pregnancy or after delivery.
We offer appointments within one week to all pregnant or recently delivered women. We recommend that women with severe obstetric lacerations or tears are seen within one week of delivery. Our multidisciplinary providers are in clinic together every Friday afternoon to care for new mothers. Often, we find that patients only need one visit to reassure them that they are healing correctly. However, if a patient has a more complicated recovery, she may be seen multiple times. Once a patient has recovered properly, she will resume care with her primary obstetrician-gynecologist.
One of the urogynecologists in the PEAPOD Clinic may conduct additional tests of your pelvic floor and anal sphincter muscles, including:
- Pelvic floor and endoanal ultrasound: Some patients may benefit from visualizing the pelvic floor muscles and anal sphincter muscles after delivery on ultrasound. Ultrasound is a painless and quick procedure. It is done right in the clinic. Using this imaging modality, we can assess proper healing and determine if a patient’s anal sphincter needs to be repaired again.
- Anorectal manometry (ARM): ARM is used to assess the strength and integrity of the anal sphincters after a severe tear. This testing modality is also painless and can be done in the clinic. Some women may benefit from this testing to ensure that proper healing of the anal sphincter occurs.
Women who have suffered perineal trauma after delivery can typically have their symptoms managed with a variety of surgical and nonsurgical options. We have developed a multidisciplinary program to accomplish the best care possible for new mothers.