Postpartum Pelvic Floor Physical Therapy Referral Rates in a Multihospital System

Up to 50% of parturients are at risk of developing pelvic floor dysfunction (PFD) during and immediately after pregnancy. There is strong evidence for the efficacy of pelvic floor physical therapy (PFPT) in the postpartum period in reducing PFD.

Currently, there are limited data on referral practices to PFPT in the postpartum period. Understanding referral rates and associated patient and clinical characteristics is critical in guiding efforts to integrate PFPT in postpartum care.

This was a retrospective cohort study of individuals with term singleton births between 2020 and 2024 at a multihospital system. Those with a history of PFPT within a year before birth were excluded. PFPT referrals were summarized and compared by demographics, obstetric variables, and PFD diagnosis.

Of the 37,329 individuals included, 3.9% were referred to PFPT postpartum, including 4.5% of spontaneous vaginal births. Of those with obstetric anal sphincter injuries and operative vaginal births, 13.1% and 5.3% were referred, respectively (P<0.001). Of those with a PFD diagnosis, 70.1% were referred. Urban hospitals were more likely to refer to PFPT compared with suburban and rural hospitals (11.1% vs 2.4% vs 3.2%, P<0.001). Non-English speakers (adjusted odds ratio [aOR], 0.67; 95% CI, 0.54-0.83), Hispanic individuals (aOR, 0.66; 95% CI, 0.50-0.86), and individuals with public insurance (aOR, 0.70; 95% CI, 0.62-0.80) had lower odds of referral.

There were significant differences in the patterns of referrals made, suggesting socioeconomic disparities in access to PFPT. Our data demonstrate underutilization of PFPT for individuals in the postpartum period and a need to better integrate access to PFPT in pregnancy and postpartum care.