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We accept referrals for patients who are booked to give birth or are within one year after birth at St Mary’s Hospital or Queen Charlotte's & Chelsea Hospital.

Name Date of birth MRN / NHS number Ethnicity Postcode Due date / delivery date Which hospital are you delivering / delivered at? St Marys Queen Charlottes Home birth Delivery method if applicable Vaginal Instrumental forceps ventouse Caesarean section 6 weeks postnatal date Reason for referral Postnatal perineal wound breakdown infection after 28 days from birth Postnatal perineal wound poorly healed after 28 days from birth Perineal scar pain Postnatal Urinary incontinence Postnatal bowel incontinence Pelvic organ prolapse Previous or current 3rd 4th degree tears Postnatal sexual pain Persistent perineal pain Difficulties that may cause issues with intimate examinations

Any wound issues from birth until 28 days postpartum please attend MDAU/Maternity triage for urgent review. An onwards referral to PPHS will be made if appropriate by your health care provider.

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Last updated 25 Feb 2025

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