Skip to main content

Research Repository

Advanced Search

Antenatal preventative pelvic floor muscle exercise intervention led by midwives to reduce postnatal urinary incontinence (APPEAL): protocol for a feasibility and pilot cluster randomised controlled trial

Bick, D.; Bishop, J.; Coleman, T.; Dean, S.; Edwards, E.; Frawley, H.; Gkini, E.; Hay-Smith, J.; Hemming, K.; Jones, E.; Oborn, E.; Pearson, M.; Salmon, V.; Webb, S.; MacArthur, C.


D. Bick

J. Bishop

T. Coleman

S. Dean

E. Edwards

H. Frawley

E. Gkini

J. Hay-Smith

K. Hemming

E. Jones

E. Oborn

V. Salmon

S. Webb

C. MacArthur


Background: Antenatal pelvic floor muscle exercises (PFME) in women without prior urinary incontinence (UI) are effective in reducing postnatal UI; however, UK midwives often do not provide advice and information to women on undertaking PFME, with evidence that among women who do receive advice, many do not perform PFME. Methods: The primary aim of this feasibility and pilot cluster randomised controlled trial is to provide a potential assessment of the feasibility of undertaking a future definitive trial of a midwifery-led antenatal intervention to support women to perform PFME in pregnancy and reduce UI postnatally. Community midwifery teams in participating NHS sites comprise trial clusters (n = 17). Midwives in teams randomised to the intervention will be trained on how to teach PFME to women and how to support them in undertaking PFME in pregnancy. Women whose community midwifery teams are allocated to control will receive standard antenatal care only. All pregnant women who give birth over a pre-selected sample month who receive antenatal care from participating community midwifery teams (clusters) will be sent a questionnaire at 10–12 weeks postpartum (around 1400–1500 women). Process evaluation data will include interviews with midwives to assess if the intervention could be implemented as planned. Interviews with women in both trial arms will explore their experiences of support from midwives to perform PFME during pregnancy. Data will be stored securely at the Universities of Birmingham and Exeter. Results will be disseminated through publications aimed at maternity service users, clinicians, and academics and inform a potential definitive trial of effectiveness. The West Midlands–Edgbaston Research Ethics Committee approved the study protocol. Discussion: Trial outcomes will determine if criteria to progress to a definitive cluster trial are met. These include women’s questionnaire return rates, prevalence of UI, and other health outcomes as reported by women at 10–12 weeks postpartum. Progress to a definitive trial however is likely to be prevented in the UK context by new perinatal pelvic health service, although this may be possible elsewhere. Trial registration: Registered 09/03/2020


Bick, D., Bishop, J., Coleman, T., Dean, S., Edwards, E., Frawley, H., …MacArthur, C. (2022). Antenatal preventative pelvic floor muscle exercise intervention led by midwives to reduce postnatal urinary incontinence (APPEAL): protocol for a feasibility and pilot cluster randomised controlled trial. Pilot and Feasibility Studies, 8(1), Article 231.

Journal Article Type Article
Acceptance Date Oct 11, 2022
Online Publication Date Oct 22, 2022
Publication Date Dec 1, 2022
Deposit Date Nov 12, 2022
Publicly Available Date Nov 14, 2022
Journal Pilot and Feasibility Studies
Electronic ISSN 2055-5784
Publisher BioMed Central
Peer Reviewed Peer Reviewed
Volume 8
Issue 1
Article Number 231
Keywords Pelvic floor muscle exercises; Pregnancy; Postnatal; Urinary incontinence
Public URL


Published article (1.4 Mb)

Publisher Licence URL

Copyright Statement
© The Author(s) 2022..<br /> Open Access. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

You might also like

Downloadable Citations