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NH AIM/ERASE Maternal Mortality Webinar Series - Beyond Kegels: Understanding the Mental Health Implications of Childbirth-Related Pelvic Floor Injuries and Conditions

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Date & Location
Thursday, October 16, 2025, 12:00 PM - Monday, October 16, 2028, 1:00 PM

Credits
AMA PRA Category 1 Credits™ (1.00 hours), ANCC Nursing Contact Hours (1.00 hours), CME-Designated Participation Credit (1.00 hours)

Overview

This session will provide a general introduction and overview of pelvic floor injuries and conditions, including rates of occurrence and risk and protective factors. Our AIM implementation team and the NHPQC will briefly share administrative updates and relevant elements from New Hampshire's active Patient Safety Bundles. We will then hear from Kimberley Johnson, PhD, Postdoctoral Fellow, Department of Community and Family Medicine and Department of Psychiatry at DHMC, who will discuss the mental health and quality of life implications of childbirth-related pelvic floor injuries (including presentation of her dissertation data) and provide practical tools including screening, treatment resources, and example scripts for use in patient settings. We will end the hour with an interactive Q&A session.

Presenter

Kimberley Johnson, PhD
Postdoctoral Fellow
Department of Community and Family Medicine and Department of Psychiatry
Dartmouth Hitchcock Medical Center


Learning Objectives
At the conclusion of this learning activity, participants will be able to:

  1. Describe the prevalence and scope of childbirth-related pelvic floor injuries, including related mental health implications for patients.
  2. Identify one or more pelvic floor injury screening tools, treatment resources, and/or patient-facing discussion scripts that can be incorporated into the perinatal care setting.

Accreditation

In support of improving patient care, Dartmouth Health is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. 

American Medical Association (AMA)
Dartmouth Health designates this Enduring Material for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

American Nurses Credentialing Center (ANCC)
Dartmouth Health designates this Enduring Material for a maximum of 1.00 ANCC contact hours.

All other learners may claim CME-designated participation credit. Consult your professional licensing board regarding the applicability and acceptance of CME-designated participation credit for programs certified for credit by organizations accredited by Joint Accreditation for Interprofessional Education.


Registration/Requirements for Successful Completion

You may claim credit for successful completion of this online course. In order to claim credit, you must follow these steps:

  1. Click the Register tab above. If you are not logged into your account, you will need to log in. Use the Forgot Your Password? button if you need to reset your password.

  2. Register for the activity.

  3. Click the Content/Tests tab and then View Content to view the recording. View the entire presentation.

  4. Complete the Post-Test (attestation - return to the Content/Tests tab to find it).

  5. Click the Complete Evaluation button, or click My Account in the menu bar; then click Evaluations.

  6. Complete and Submit the Evaluation.


Bibliographic Material

  • Abhyankar, P., Uny, I., Semple, K., Wane, S., Hagen, S., Wilkinson, J., Guerrero, K., Tincello, D., Duncan, E., Calveley, E., Elders, A., McClurg, D., & Maxwell, M. (2019). Women's experiences of receiving care for pelvic organ prolapse: a qualitative study. BMC women's health, 19, 45. https://doi.org/10.1186/s12905-019-0741-2

  • Banaei, M., Kariman, N., Ozgoli, G., Nasiri, M., Ghasemi, V., Khiabani, A., Dashti, S., & Mohamadkhani Shahri, L. (2021). Prevalence of postpartum dyspareunia: A systematic review and meta-analysis. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 153, 14–24. https://doi.org/10.1002/ijgo.13523

  • Barkin, J. L., Bloch, J. R., Hawkins, K. C., & Thomas, T. S. (2014). Barriers to optimal social support in the postpartum period. Journal of obstetric, gynecologic, and neonatal nursing : JOGNN, 43, 445–454. https://doi.org/10.1111/1552-6909.12463

  • Bonasia, K., Clancy, A., & Stairs, J. (2023). Prevalence and risk factors for urinary incontinence up to 2 years postpartum: a cross-sectional population-based study. International urogynecology journal, 34, 2467–2472. https://doi.org/10.1007/s00192-023-05571-9

  • Borello-France, D., Burgio, K. L., Richter, H. E., Zyczynski, H., Fitzgerald, M. P., Whitehead, W., Fine, P., Nygaard, I., Handa, V. L., Visco, A. G., Weber, A. M., Brown, M. B., & Pelvic Floor Disorders Network (2006). Fecal and urinary incontinence in primiparous women. Obstetrics and gynecology, 108, 863–872. https://doi.org/10.1097/01.AOG.0000232504.32589.3b

  • Brown, S., Gartland, D., Perlen, S., McDonald, E., & MacArthur, C. (2015). Consultation about urinary and faecal incontinence in the year after childbirth: A cohort study. BJOG, 122, 954-962. https://doi.org/10.1111/1471-0528.12963

  • Burkhart, R., Couchman, K., Crowell, K., Jeffries, S., Monvillers, S., & Vilensky, J. (2021). Pelvic floor dysfunction after childbirth: Occupational impact and awareness of available treatment. OTJR: Occupation, Participation and Health, 41, 108-115. https://doi.org/10.1177/15394492209708

  • Buurman, M. B., & Lagro-Janssen, A. L. (2013). Women's perception of postpartum pelvic floor dysfunction and their help-seeking behaviour: A qualitative interview study. Scandinavian Journal of Caring Sciences, 27, 406-413. https://doi.org/10.1111/j.1471-6712.2012.01044.x

  • Cárdenas, E. F., Kujawa, A., & Humphreys, K. L. (2020). Neurobiological changes during the peripartum period: implications for health and behavior. Social cognitive and affective neuroscience, 15, 1097-1110. https://doi.org/10.1093/scan/nsz091

  • Cooke, C. M., O’Sullivan, O. E., & O’Reilly, B. A. (2018). Urogynaecology providers’ attitudes towards postnatal pelvic floor dysfunction. International Urogynecology Journal, 29, 751-766. https://doi.org/10.1007/s00192-017-3419-z

  • DeLancey, J. O. L., Masteling, M., Pipitone, F., LaCross, J., Mastrovito, S., & Ashton-Miller, J. A. (2024). Pelvic floor injury during vaginal birth is life-altering and preventable: what can we do about it?. American journal of obstetrics and gynecology, 230, 279–294.e2. https://doi.org/10.1016/j.ajog.2023.11.1253

  • Dudding, T. C., Vaizey, C. J., & Kamm, M. A. (2008). Obstetric anal sphincter injury: incidence, risk factors, and management. Annals of surgery, 247, 224–237. https://doi.org/10.1097/SLA.0b013e318142cdf4

  • Engel G. L. (1980). The clinical application of the biopsychosocial model. The American journal of psychiatry, 137(5), 535–544. https://doi.org/10.1176/ajp.137.5.535

  • Fahey, J. O., & Shenassa, E. (2013). Understanding and meeting the needs of women in the postpartum period: The perinatal maternal health promotion model. Journal of midwifery & women's health, 58, 613-621. https://doi.org/10.1111/jmwh.12139

  • Geoffrion, R., Badowski, S., Gong, M., Mann, G., Tilak, M., Koenig, N., & Lee, T. (2023). Pelvic Floor Health Index: Initial validation of a practical postpartum tool for busy clinicians. Canadian family physician Medecin de famille canadien, 69, e229–e235. https://doi.org/10.46747/cfp.6911e229

  • Giugale, L. E., Moalli, P. A., Canavan, T. P., Meyn, L. A., & Oliphant, S. S. (2021). Prevalence and Predictors of Urinary Incontinence at 1 Year Postpartum. Female pelvic medicine & reconstructive surgery, 27, e436–e441. https://doi.org/10.1097/SPV.0000000000000955

  • Greene, J., & Ramos, C. (2021). A Mixed Methods Examination of Health Care Provider Behaviors That Build Patients' Trust. Patient education and counseling, 104, 1222–1228. https://doi.org/10.1016/j.pec.2020.09.003

  • Hagen, S., Sellers, C., Elders, A., Glazener, C., MacArthur, C., Toozs-Hobson, P., Hemming, C., Herbison, P., & Wilson, D. (2024). Urinary incontinence, faecal incontinence and pelvic organ prolapse symptoms 20-26?years after childbirth: A longitudinal cohort study. BJOG : An international journal of obstetrics and gynaecology, 131, 1815–1823. https://doi.org/10.1111/1471-0528.17913

  • Handa, V. L., Blomquist, J. L., Knoepp, L. R., Hoskey, K. A., McDermott, K. C., & Muñoz, A. (2011). Pelvic floor disorders 5–10 years after vaginal or cesarean childbirth. Obstetrics & Gynecology, 118, 777-784. https://doi.org/10.1097/AOG.0b013e3182267f2f

  • Handa, V. L., Blomquist, J. L., Roem, J., & Mu?oz, A. (2018). Longitudinal study of quantitative changes in pelvic organ support among parous women. American journal of obstetrics and gynecology, 218, 320.e1–320.e7. https://doi.org/10.1016/j.ajog.2017.12.214

  • Helgeson, V. S., & Zajdel, M. (2017). Adjusting to chronic health conditions. Annual Review of Psychology, 68, 545-571. https://doi.org/10.1146/annurev-psych-010416-044014

  • Interrante, J. D., Admon, L. K., Carroll, C., Henning-Smith, C., Chastain, P., & Kozhimannil, K. B. (2022). Association of health insurance, geography, and race and ethnicity With disparities in receipt of recommended postpartum care in the US. JAMA health forum, 3, e223292. https://doi.org/10.1001/jamahealthforum.2022.3292

  • Johnson, K. T., Williams, P. G., & Hill, A. J. (2021). The importance of information: Prenatal education surrounding birth-related pelvic floor trauma mitigates symptom-related distress. Journal of Women's Health Physical Therapy, 36, 62-72. https://doi.org/10.1097/JWH.0000000000000229

  • Kaliush, P. R., Conradt, E., Kerig, P. K., Williams, P. G., & Crowell, S. E. (2024). A multilevel developmental psychopathology model of childbirth and the perinatal transition. Development and Psychopathology, 36, 533–544. https://doi.org/10.1017/S0954579422001389

  • Kim, P., Leckman, J. F., Mayes, L. C., Feldman, R., Wang, X., & Swain, J. E. (2010). The plasticity of human maternal brain: Longitudinal changes in brain anatomy during the early postpartum period. Behavioral neuroscience, 124, 695–700. https://doi.org/10.1037/a0020884

  • Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. Springer.

  • Li, B., Jin, N., Wang, Y., Hou, X., Meng, J., & Zhang, Y. (2025). Perinatal women’s perception of maternal health information quality on digital media: Scoping review. Journal of Medical Internet Research, 27, e67620. https://doi.org/10.2196/67620

  • Okun, M. L. (2016). Disturbed sleep and postpartum depression. Current psychiatry reports, 18, 1-7. https://doi.org/10.1007/s11920-016-0705-2

  • Pessoa, P., Carvalho, A., & Mota, P. (2024). Prevalence of levator ani muscle injuries in primiparous women after delivery and their influence on pelvic floor disorders-systematic review. Neurourology and urodynamics, 43, 1962–1969. https://doi.org/10.1002/nau.25529

  • Quin, N., Lee, J. J., Pinnington, D. M., Newman, L., Manber, R., & Bei, B. (2022). Differentiating perinatal Insomnia Disorder and sleep disruption: A longitudinal study from pregnancy to 2 years postpartum. Sleep, 45, zsab293. https://doi.org/10.1093/sleep/zsab293

  • Saxbe, D., Rossin-Slater, M., & Goldenberg, D. (2018). The transition to parenthood as a critical window for adult health. American Psychologist, 73, 1190-1200. https://doi.org/10.1037/amp0000376

  • Skinner, E. M., Barnett, B., & Dietz, H. P. (2018). Psychological consequences of pelvic floor trauma following vaginal birth: A qualitative study from two Australian tertiary maternity units. Archives of Women's Mental Health, 21, 341-351. https://doi.org/10.1007/s00737-017-0802-1

  • Snyder, K., Mollard, E., Bargstadt-Wilson, K., & Peterson, J. (2022). "We don't talk about it enough": Perceptions of pelvic health among postpartum women in rural communities. Women's health, 18, 17455057221122584. https://doi.org/10.1177/17455057221122584

  • Suls, J., & Rothman, A. (2004). Evolution of the Biopsychosocial Model: Prospects and Challenges for Health Psychology. Health Psychology, 23, 119–125. https://doi.org/10.1037/0278-6133.23.2.119

  • Swenson, C. W., DePorre, J. A., Haefner, J. K., Berger, M. B., & Fenner, D. E. (2018). Postpartum depression screening and pelvic floor symptoms among women referred to a specialty postpartum perineal clinic. American Journal of Obstetrics and Gynecology, 218, 335.e331-335.e336. https://doi.org/10.1016/j.ajog.2017.11.604

  • Walker, L. O., & Nichols, F. (2015). The broken thread of health promotion and disease prevention for women during the postpartum period. The Journal of Perinatal Education, 24, 81. https://doi.org/10.1891/1058-1243.24.2.81

  • Wu, Z., Zhu, Y., Wang, Y., Zhou, R., Ye, X., Chen, Z., Li, C., Li, J., Ye, Z., Wang, Z., Liu, W., & Xu, X. (2022). The effects of patient education on psychological status and clinical outcomes in rheumatoid arthritis: A systematic review and meta-analysis. Frontiers in Psychiatry, 13, 848427. https://doi.org/10.3389/fpsyt.2022.848427

Provider Contact Information
Provider contact information for questions regarding accreditation of the activity:

Center for Learning and Professional Development
ACE Office
Dartmouth Health
[email protected]

Mitigation of Relevant Financial Relationships

Dartmouth Health adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Education.  Any individuals in a position to control the content of a CE activity, including planners, faculty, authors, or others are required to disclose all financial relationships with ineligible companies^.  All relevant financial relationships have been mitigated prior to the commencement of the activity.

^Ineligible Company is any entity whose primary business purpose is producing, marketing, selling, re-selling or distributing healthcare products used by or on patients.

Member Information
Role in activity
Nature of Relationship(s) / Name of Ineligible Company(s)
Madalynne M Bridge, BS
Population Health Coord Sr
Dartmouth Health
Activity Coordinator
Nothing to disclose
Margaret Coleman, MPH
Population Health Coord Sr
Dartmouth Health
Activity Coordinator
Nothing to disclose
Emily Baker, MD
MFM Physician
Dartmouth Hitchcock Medical Center
Course Director
Nothing to disclose
Kimberley Johnson, PhD
Postdoctoral Fellow
Dartmouth Hitchcock Medical Center
Faculty
Nothing to disclose
Julie S Bosak, DrPH, APRN, CNM
Executive Director NNEPQIN and NHPQC
Dartmouth Health
Other Planning Committee Member
Nothing to disclose
Emily C Brayton, RN
Perinatal Outreach Nurse
Dartmouth Hitchcock Medical Center
Other Planning Committee Member
Nothing to disclose

NH AIM/ERASE Maternal Mortality Webinar Series - Beyond Kegels: Understanding the Mental Health Implications of Childbirth-Related Pelvic Floor Injuries and Conditions
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