ABC News: Women speak out about birth trauma and poor pelvic health care in public system
18 Oct 2023
Yet hundreds of thousands of Australian women come away from childbirth with damage to their pelvic floor — the group of muscles that hold up organs and control the bladder and bowel.
Currently there is no clear national data on how many women experience these symptoms, but fresh research offers rare insight into the possible scale of the problem.
A two-year study that asked 2,800 women on the Gold Coast about their symptoms following childbirth is about to be published — and the results are alarming.
It found that three months after giving birth:
- one in three women struggle to control their bladder
- one in 10 suffer faecal incontinence and
- one in two experience pain with sex
Valerie Slavin, a midwifery researcher at Griffith University who led the project, says pelvic injury isn’t being addressed because the health system doesn’t ask women about their symptoms.
“It’s just a really neglected area,” she says.
And she says until we start systematically collecting national data about the problem, women will continue to suffer.
‘No-one mentioned prolapse’
The first time Samantha Coughlan became aware of prolapse was when she did an internet search about what she was feeling.
She was out walking with her husband a few weeks after the birth of her first child when she says she felt like her insides were falling out.
Previous studies have estimated half of all women who have given birth experience some degree of prolapse — a condition in which one or more of the pelvic organs drop into the vagina — but there is no clear national data.
“No-one mentioned prolapse. I’d never heard the word,” she says.
That’s despite her daughter being delivered using forceps to pull her through the birth canal, which led to a severe vaginal tear. Both are linked with a higher risk of pelvic floor dysfunction.
The Melbourne mum had given birth in a public hospital, where she was told if she had any problems she could go on a waitlist to see a physiotherapist.
Unwilling to wait, she found a private women’s pelvic physio.
Four years later, Samantha still struggles with activities that strain her pelvic floor, including lifting her kids.
“I want to be that fun mum who jumps on the trampoline … and goes down the slide, but I can’t physically do it,” she says.
The former schoolteacher also experiences urinary incontinence when she coughs or laughs.
“That’s actually stopped me going to work.
“It’s not worth the embarrassment.”
Samantha Coughlan still struggles with activities that strain her pelvic floor, including lifting her kids. ()
Women’s health physiotherapist Lyz Evans runs a clinic in Sydney and says physical birth injuries can be catastrophic.
Women might avoid exercise, leaving the house because they’re not sure where the next bathroom is and intimacy with their partner, she says.
“On a daily basis, I’m sitting … with women in tears. And the impact of that emotion isn’t just to that woman. It affects her partner. It affects her children,” she says.
A ‘hidden epidemic’
The ABC has heard from nearly 4,000 women as part of the Birth Project.
Hundreds of women described devastating pelvic injuries and expressed dismay with the standard of care in the public system.
Many said they resorted to spending thousands of dollars seeing specialist physios in the private sector.
Access to publicly available pelvic physiotherapists across Australia varies from state to state and between urban, rural and remote areas.
Ms Evans believes the rate of pelvic floor trauma is higher than acknowledged and can be dramatically reduced if women were given access to pelvic floor physio before and after giving birth.
“It is a true hidden epidemic in our society that needs to be addressed.”
Physios can help prevent birth trauma by working with women during pregnancy to assess their risk of pelvic injury and help prepare their pelvic floors for labour.
They also help women recover from birth using pelvic floor muscle training and guidance on how to safely return to activities such as exercise.
The Australian Physiotherapy Association (APA) is calling on the federal government to provide all women with five Medicare-funded sessions with a pelvic physiotherapist during their child-bearing year.
Catherine Willis, chair of the APA’s advisory council, says this will help women prevent and recover from birth trauma.
“The cost of five physiotherapy appointments for women birthing in Australia has a much better economic value than the future interventions that they might need, including surgery, and also the inability to return to work due to their pelvic floor symptoms.”
Ms Willis says she’s seen women in their 60s and 70s who have endured pelvic floor problems since the first time they gave birth.
“That’s really sad to think that possibly for 30 or 40 years they’ve been putting up with these symptoms.”
‘Holding women back’
Emma Elder’s second pregnancy put twice as much strain on her body, but sessions with a physio made it a much better experience than her first.
After delivering twins it took her only a few months to return to running and jumping.
Following her first pregnancy, it took two years.
“I found [pelvic physio] extremely beneficial, not just for my recovery, but also for the preparation for birth,” she says.
Several months after giving birth to her first baby, which caused a severe vaginal tear, she was dismayed she couldn’t skip, jump or lift weights at the gym without wetting herself.
“I had to make sure that I was always carrying a spare change of clothes,” she says.
Unwilling to accept a weak pelvic floor as an inevitable and irreversible consequence of childbirth, she spent thousands of dollars on private physios and now wants that available to more women.
“I think this issue really holds women back,” says Emma.
‘What we don’t measure, we can’t improve’
Dr Slavin says one of the reasons women aren’t getting access to better pelvic care is that the scale of the problem is not known.
Australia has a clinical care standard for the 3 per cent of women who deliver vaginally and experience a tear that extends into the muscle of the anus.
Many more women than that experience life-altering pelvic injuries, but there is currently no way to evaluate how many women are affected and no national standard for the care they should receive.
Dr Slavin wants to see the public health system routinely collect data from women about their experience of pelvic floor disorders, as well as the model of care and procedures used during their delivery.
She believes that will drive improvement in maternity care.
“What we don’t measure, we can’t improve on,” says Dr Slavin.
Assistant Minister for Health Ged Kearney says she would be interested in discussing better data collection with her state counterparts.
“Collecting data is an incredibly important part of improving our health system,” she says.
Ms Kearney says many women have told her they don’t feel their experience has been heard and want birth trauma to be taken seriously.
Both Samantha Coughlan and Emma Elder think the first step towards this is rejecting the stigma of talking about pelvic disorders.
“I would love other women to know that there’s nothing to be ashamed of,” Samantha says.
“We need to talk about it so we can make things change.”
