Midwife-led models of care are associated with less risk factors for pelvic floor dysfunctions, beyond reduction in patient’s request of epidural analgesia, episiotomy, operative delivery, and OASIS. This may be due to the one-to-one delivery assistance and the increased time that midwives and patients spend together. Nevertheless, effective communication requires a shared understanding of what is being expressed both verbally and non-verbally. Therefore, since we suppose a difference between Italian and non-Italian speakers with a language barrier, the aim of our study was to evaluate whether adverse obstetric pelvic floor outcomes were increased in non-Italian speaking women.

All women who underwent vaginal delivery in our center between 01/01/2022 and 31/12/2023 where included. For most of them, delivery was midwife-led. The “Italian Society of Urodynamics (SIUD) delivery and pelvic dysfunction card” (Perineal Card, PC) was completed for all patients as a screening tool to detect patients at increased risk of pelvic floor dysfunctions. The PC spans three domains: I) the anamnestic domain, evaluating pre-birth risk factors; II) the delivery domain, evaluating intrapartum risk factors (such as operative delivery, episiotomy, fetal weight >4kg, epidural, prolonged second stage, shoulder dystocia, OASIS); III) the postpartum domain, which includes suture complications or postpartum voiding dysfunctions. Each risk factor is evaluated with a score between 1 and 4 and women can be placed in three different groups: R1 (0-3), R2 (4-7), R3 (>8). PC card is considered at high risk of adverse pelvic floor outcomes in R2 and R3 groups. Women in those groups are referred to early pelvic floor rehabilitation and/or urogynecologist evaluation. Non-Italian speaking patients where the study group, while Italian speaking ones served as controls. PC scores were compared between groups to investigate whether cultural and language barrier (therefore less effective communication), are related to increased risk of pelvic floor dysfunctions. Data are reported as means, and percentages. The statistical analysis was obtained by calculating chi-squared test.

995 patients were included. Among them, 368 (37%) are Italian speakers and 627 (63%) are foreigners (non-Italian speakers). The mean age is 31 years old for Italian speakers and 29 for foreigners. The mean parity is 0.74 for Italian speaking women and 1.09 for foreigners. 51% of Italian speaking women are multiparous versus 62% of foreigners. We had 292 (30.6%) high risk PC (R2 and R3). In Italian women the average PC score was 2.53, in foreign women 2.30. Among positive PC, 117 (34.6%) were Italian women and 175 (26.3%) foreign women. There were no statistically significant differences between the two groups (p>0.05).
We therefore performed a sub-analysis limited only to the delivery domain of the PC: 32 (8.6%) Italian women had a positive delivery domain, 58 (9.2%) foreign women had a positive delivery domain. No statistically significant differences emerged between these two groups either (p>0.05).

In our sample, the prevalence of patients at increased risk for pelvic floor dysfunctions was 30.6%, consistent with literature. Counterintuitively, there was no significant differences in high-risk PC between Italian and non-Italian speakers patients. Even when limited at the delivery domain no significant differences was found between groups. This can be explained by fact that in our center there is high prevalence of patients with a language barrier. This might be an indicator of greater attention to non-verbal communication and inclusion of the patients' companions in the delivery room to encourage a more effective communication.  The strength of this study are: the large sample size and the originality of the topic. 
In literature all the studies investigating the importance of communication in the delivery room focus on midwife-led assistance. In our center, the assistance is mostly midwife-led, except for cases of high obstetrical risk, where assistance is shared between the midwife and the obstetrician. We actually included both midwife-led delivery patients and mixed-led delivery patients. The limitation could be the difference between an exclusively midwife-led delivery routine as reported in literature and a mixed one as it is managed in our center. Even though, to date, there are no studies focusing on communication and perineal outcomes in mixed delivery care.

Although effective communication remains a cornerstone of our profession, there is no evidence that patients with a language barrier are at increased risk for postpartum pelvic floor dysfunction. It would be interesting to further investigate whether there are differences between mixed and purely midwife-led delivery care centers.

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Continence 12S (2024) 101391
DOI: 10.1016/j.cont.2024.101391