Pelvic Health Physiotherapists to Support Birthing Women
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Australian women are falling through the cracks when it comes to the diagnosis and treatment of physical injuries from birth, such as pelvic organ prolapse and anal/urinary incontinence, which are often debilitating conditions that hugely effect a woman’s quality of life. Pelvic floor dysfunction can limit a woman’s ability to care for her children, exercise, work, socialise, and be intimate with her partner; and it can affect her emotionally and psychologically as she struggles to come to terms with her impairment.
15,000 to 30,000 women per year may suffer major irreversible physical birth trauma in the form of pelvic floor muscle and/or anal sphincter tears.
50 per cent of women who have had more than one vaginal delivery have some degree of pelvic organ prolapse – this equates to millions of women who would have benefited greatly from early access to physiotherapy in the period post-birth.
Up to 20% of all women who deliver a baby vaginally will end up with surgery for pelvic organ prolapse, anal or urinary incontinence.
In 2013 it was estimated that the annual cost of incontinence in Australia is AUD$6.7 billion.
Urinary incontinence affects 1/3 Australian women - Despite the fact that many cases of incontinence can be prevented or treated, 70% of those with symptoms do not seek treatment
In 2010, there were about 4.2 million Australians living with urinary incontinence, and 1.3 million with faecal incontinence. It is projected that in 2030 this number will rise to 5.6million with urinary incontinence and 1.8 million with faecal incontinence.
The impacts of urinary incontinence extend well beyond leaking. 91% of women who present for urinary incontinence testing report that the incontinence affects at least three of the following: physical health, mental health, domestic chores, social life, relationships, career, clothes, restriction of activities. (Norton 1982)
Anal sphincter injury – recent Australian data reveals that at 4 years post birth 54% of women who had an anal sphincter injury will have significant ongoing impacts in three of the following areas: faecal or flatal incontinence, impact sexual dysfunction, return to exercise or work.
The Current Position
- Women report receiving a diagnosis without being given an adequate explanation of the condition or a care pathway to services that can assist.
- Access to post-natal care is especially difficult for those in remote and rural areas and those from culturally diverse backgrounds.
- Women report spending thousands of dollars on out-of-pocket expenses for treatment of physical and psychological injuries.
- Women who can’t afford these services live their lives with chronic conditions which impact on their identity, relationships, health and ability to generate an income.
- Women commonly ask “Why wasn’t I told?” as they reflect on their birth and injuries, developing feelings of guilt and anger over information on birthing complications that was not disclosed during pregnancy.
The Goal of This Petition
The Australasian Birth Trauma Association (ABTA) has identified the inclusion of pelvic health physiotherapists in pregnancy and postnatal care as a key strategy for providing:
1. more accurate physical assessment in preparation for birth,
2. improving the quality of information on birthing and the procedures that may be involved, and
3.improving the postnatal assessment and support for physical birth trauma.
Include pelvic health physiotherapists in pregnancy and postnatal care for all women
“Physiotherapy has an important role to play at all stages of pregnancy, labour and post birth, and as has been recently recognised in the UK, should be part of routine care for all pregnant and postnatal women here in Australia regardless of the number of babies they’ve had or mode of delivery,” Cath Willis, chair of the APA Women’s, Men’s and Pelvic Health group.
“All women should also have access to a physiotherapist consultation after birth as part of routine care to screen for and help manage a wide range of conditions including urinary incontinence, faecal incontinence, pelvic girdle pain, abdominal muscle separation and symptoms of prolapse.”
Delays in diagnosis and inaccurate diagnoses lead to extended suffering and the compounding of health implications for affected women, their partners and families.
As the ABTA member Sarah says; ‘‘Given the significant impact on my quality of life why had no one discussed the risks with me before the procedure? Why were there no checks on the damage after it? Why was I sent home unprepared for the fear and confusion that plagued me as my expectations of a full recovery failed to materialise?”.
We are therefore calling for the Government to:
Provide Medicare subsidised access to quality physiotherapy assessment and management via GP’s to specialist for women during pregnancy and up to one year postpartum
Why 1 x antenatal session is needed:
Preventive + education session
· We know that supervised PF ex in pregnancy that is taught correctly 1:1 reduces rates of post-natal urinary incontinence
· Help to pick up those at higher risk of pelvic floor muscle dysfunction
· Assists with birth preparation, by teaching how to relax pelvic floor, how to push in labour with appropriate direction, and practice labour positions specifically when a woman has pelvic girdle pain. This all leads to increased self -confidence, reduction in birth related anxiety, which contribute to better birth outcomes.
· Helps to start a relationship with a women’s health physiotherapist, which will assist in ensuring the woman attends her postnatal appointment at 6 weeks.
Why 5 x post-natal sessions are needed:
First visit at 6 weeks post-natal to assess for pelvic floor and musculoskeletal impacts of birth that are not looked at in the routine 6 week check from OBGYN or GP A physiotherapy based 6- week appointment assesses in much greater detail the physical impact and healing of the women.
A further 5 sessions should be made available if required.
We invite the Government to recognise the prevalence of birth-related trauma, acknowledge the fact the Australia has some of the highest rates of 3/4th degree tears in the world and encourage conversations around the prevention of these adverse outcomes because we can no longer assume that women (and families) don’t want to know the risks. And we must make pelvic health a key performance indicator when assessing childbirth outcomes, because, while all women naturally state a desire for a healthy baby above all else, they don’t expect this to come at the expense of their own long-term quality of life.
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