A Q methodology study of women's experience of enduring postnatal perineal and pelvic floor morbidity

Objective: to explore women’s experiences of enduring postnatal perineal and pelvic floor morbidity. Design: a retrospective Q methodology study of postnatal women between 12 and 18 months postpartum. Setting: maternity services at the Heart of England NHS Foundation Trust, Birmingham. Participants: women were self-identified by expression of interest as part of their earlier involvement in a retrospective cross-sectional community survey of enduring postnatal perineal and pelvic floor morbidity. Twenty women responded to the invitation posted on the back of the initial survey questionnaire. All 20 women took part in stage one (interview) of the study (100% response rate). Fourteen women returned the completed response grids in stage four after 1 month of dissemination (response rate 70%). Methods: the project included five stages: (1) data were gathered using an individual face-to-face, semi-structured, community-based interview method (developing the concourse); (2) the concourse was analysed using MAXqda (2004) to produce ‘themes’; (3) the themes were reduced to ‘statements’ that reflected the overall content of the concourse using an unstructured evolving approach to Q set design (giving the Q set); (4) participants were asked to sort the statements (Q sorting) according to a pre-designed distribution grid (providing individual participant response grids); and (5) the response grids were factor analysed using PQMethod (V2.0), which generates clusters of participants rather than clusters of variables. Factor loadings were calculated using factor analysis by principal components with varimax rotation. This produced a list of factors, each of which represents a ‘story’ of women’s experience of enduring postnatal perineal and pelvic floor morbidity. Findings: five factors were identified: perineal morbidity of minor inconvenience, insufficient support and services, the ‘taboo’ subject of enduring perineal and pelvic floor morbidity, normalising morbidity and the isolation of perineal morbidity. Women varied in their experiences of enduring postnatal perineal and pelvic floor morbidity, with some having minor problems, with little affect on daily living, whereas others were significantly affected. The affect of the morbidity varied. Women highlighted the lack of service provision for these problems and stated that health-care practitioners, and society at large, were often dismissive of, or trivialised, their experiences of enduring postnatal perineal and pelvic floor morbidity. Conclusion: the findings from this study highlight that the postnatal recovery period is longer than the presumed 6 weeks. The effect of postnatal perineal and pelvic floor morbidity on women’s lives varies, and more long-term postnatal health support and research using women-centred outcomes is needed