Improve the rehabilitation care for New Zealand Women post Birth
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New Zealand Women lack rehabilitative education, pelvic health maternity checks and funding for birthing rehabilitation. Our system does not nurture and support the mother and her body is not supported when it comes to recovering from childbirth.
- Pelvic Floor - It is estimated that 1 in 3 women who have carried a baby will leak, 50% of women live with some degree of prolapse and 1 in 4 New Zealanders live with bladder and/or bowel incontinence. 1 in 5 women report pain during sex, and the prevalence of urinary incontinence is even higher in adult Maori women at 47% (Continence.org.nz).
- Current Clearance and Care - There is a discrepancy in the clearance from medical practitioners such as GP's and Midwives in clearing Women for exercise. Often it is determined by babies age (6 weeks) and then their return to exercise begins, without internally checking pelvic floor function or asking key pelvic health questions. Our Midwives are not at fault; they are underfunded, it may not be part of their formal processes, and services differ between General Practitioners and midwives.
- What’s available - Women who have grade 3-4 perineal tears will be referred to DHB Physio's for rehabilitation. However, other injuries attained in childbirth, such as during long pushing stages, or intervention (use of forceps/ventouse), tailbone injuries, pelvic floor avulsion, are unlikely covered with a claim from ACC for rehab for those sustained injuries. These are injuries that affect women for the rest of their lives, both physically, financially and mentally. Specialist womens health/pelvic floor physio's , urologists and gynecologists can be expensive over a period of time if self funding, and for many unaffordable.
- Prolapse - The risk of prolapse increases as we age. If we were taught correctly at the earliest opportunity (first midwife visits/antenatal classes) then we lessen the chance of prolapse or incontinence related issues and surgery. It is estimated that over the next 10 years, $1.6 billion will be spent for mesh surgeries for prolapse, stress urinary innocence and abdominal hernias surgeries in New Zealand (Surgical Mesh Registry: Cost Benefit Analysis, Ministry of Health). Surgeries are a bottom of the cliff action. We need to have better systems in place so that our women are not only educated and empowered.
- Cost of Treatment - Seeing a private Womens Health Physiotherapist is unaffordable and unattainable for many (cost, transport, work commitments, time, location) and is something that women aren't even aware exists. A referral from your GP is needed to seek free physiotherapy services. In some cases, you are not seen by a pelvic floor physiotherapist or physically internally checked, but instead instructed on how to perform exercises from a video or pamphlet. It is estimated up to 50% of women perform this initial rehab incorrectly (Zugaib M, Et al 2007).
- How we compare - In other countries such as France, all women recovering from childbirth are entitled to 10-20 sessions with a Pelvic Health Physiotherapist to rehabilitate their pelvic floor. ACC or A maternity care funding needs to consider this.
- Continence NZ - Continence NZ is severely underfunded. They cover many populations and postnatal care is a small part in that. If they had education provided for them from early pregnancy, potentially the risk of birth related trauma and ongoing care would be minimised. For example, there could be education/intervention early on in pregnancy to assess the health and determine what type of pelvic floor they have. This health can influence how she carries baby and how she approaches pregnancy exercise. A weak pelvic floor will require a different type of exercise program to an overactive or hypertonic pelvic floor.
The goals for this petition are:
- ALL New Zealand Women should have the right to access free checks by a qualified Pelvic Health/Women's Health Physiotherapist during pregnancy for pregnancy related issues and pelvic floor dysfunction.
- ALL New Zealand Women should have the right to access a free post natal check of their pelvic health by a qualified Pelvic Health/Women's Health Physiotherapist, for up to the first 2 years after giving birth/carrying baby.
- Education from early pregnancy and during birthing education classes on pelvic floor dysfunction, wound care management plans for birth related surgical procedures, and how to correctly perform pelvic floor exercises.
- Substantially better funding for Continence NZ, to employ more continence nurses.
- DHB’s to increase funding to employ more Pelvic Health Physiotherapists or a referral system so that the cost is covered if utilising private practice Pelvic Floor Physiotherapy.
- Physical and Mental Health Birth Trauma treatment to be funded by ACC.
Incontinence, pelvic health and prolapse affects us physically, sexually, mentally and emotionally. Our relationships and overall ability to lead a healthy, active lifestyle is lessened when these issues are present. It shouldn't be this way for our NZ Wahine. Positive pelvic health should not be a privilege, it should be a right that ALL women have equal access to education, funding, resources and rehabilitation.
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