The cultural context of postpartum pelvic floor support following vaginal delivery: a comparative ethnographic analysis of Mexican-American and Euro-American women

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Project Summary/Abstract – Project 3 The goal of this ethnographic study is to understand the cultural context of postpartum pelvic floor support following vaginal delivery, as experienced by Mexican-American and Euro-American women. Major risk factors for pelvic organ prolapse (POP), experienced primarily by parous women, include vaginal childbirth, family history, and age; some studies find an association with Hispanic heritage. Preventive measures have been understudied, in part because it is infrequent for women to visit a physician regarding symptoms of a vaginal bulge until the vaginal wall descends to or below the level of the hymen. Future advances in preventing pelvic floor disorders will only be achieved if research efforts are directed toward understanding the impact of early changes as well as the implementation context for preventive strategies. Currently, little is known about how women become aware of early changes in vaginal support and its meaning for them. Specifically, we are interested in the early occurrence of pelvic floor changes, how they are perceived, and how women come to understand these changes and respond to them. We will explore the experience inter- generationally by interviewing primiparous women and their intimate others (mothers, partners, sisters, confidants) regarding the transmission of cultural knowledge, including onset, prevention, management, and self-care, especially related to 1) inklings and understandings of early changes in vaginal support, 2) their interplay with physical activity, and 3) how to translate this knowledge into early detection, improved care, and quality of life. In Aim 1 we use techniques of focused ethnography to describe Mexican-American and Euro-American women's experiences and cultural knowledge of postpartum pelvic floor support changes, including how early changes interplay with physical activity. In Aim 2, the collective knowledge gained from the entire parent P01 and novel findings from this project will be compiled into a nationally-disseminated, web-based resource toolkit for women, their families, and clinicians. The toolkit will include a checklist of early pelvic floor changes that we will develop in English and Spanish and preliminarily validate in this study.