APPEAL: Antenatal preventative pelvic floor muscle exercise intervention led by midwives to reduce postnatal urinary incontinence

INTERVENTION: The intervention in this pilot and feasibility cluster randomized controlled trial comprises an antenatal midwife training package aimed at enhancing midwife ability and motivation to inform and support women in their practice of PFME. Midwives in the community midwifery teams randomly allocated to the intervention will be trained how to teach PFME Following training, midwives in intervention clusters will be asked to provide verbal information and a resource pack to all women in their care to assist them in performing PFME. The midwifery‐led intervention will be introduced to the women at their antenatal booking, with support and advice to undertake PFME included as part of each subsequent follow‐up appointment throughout the rest of the pregnancy. Midwives will also be given resource packs to give to each woman to assist them in performing PFME, which will include recommended ‘apps’, a specially prepared leaflet and other reminders. Women whose community midwifery teams are allocated to the control will receive standard antenatal care only. The current NICE antenatal care guideline (NICE 2010) recommends that midwives give women advice about exercise, including PFME, at the antenatal booking visit but research suggests that this either does not happen at all, or not in a manner likely to result in sufficient PFME practice. Fourteen community midwifery teams in two participating NHS trusts will comprise the trial clusters. Midwifery teams will be randomised in a 1:1 ratio to either standard care only or intervention using a dedicated computer programme supplied by BCTU. As randomisation will be by cluster, and the number of clusters allocated to trial arm will be small, it is important to balance t CONDITION: Postpartum urinary incontinence ; Urological and Genital Diseases PRIMARY OUTCOME: ; 1. Dichotomous feasibility measures, such as recruitment and questionnaire return rates, as well as data completeness, will be reported as numbers and percentages; 2. The feasibility and pilot cluster trial questionnaire will provide data to facilitate estimation of the sample size required for a future RCT; 3. Outcome data on urinary incontinence and PFME will be collected from women at 10‐12 weeks postnatally; INCLUSION CRITERIA: All women who receive antenatal care from a participating community midwifery team (cluster) during the trial period