Post pregnancy care is a subject very close to my heart and women should be a focal point for healthcare. A woman’s life course offers multiple opportunities to prevent predictable morbidity and mortality and to empower them and through them their children with information to take positive steps to health. Women’s health physiotherapy is a specialist area of physiotherapy which focuses on problems related to the pelvic floor and the pelvis. These problems may be either gynaecological or pregnancy related and include conditions such as incontinence, pelvic organ prolapse, pelvic pain, constipation and painful intercourse. For years, this speciality of physiotherapy has allowed physiotherapists the privilege of focussing just on the woman and the so called ‘taboo’ subjects mentioned. It is an incredibly successful area of physiotherapy but still one that women are not tapping into enough in order to improve their health.
The Chief Medical Officer’s annual report was released in November 2015 and dedicated to women. Professor Dame Sally Davies makes recommendations that will benefit women’s health and encourage a normalisation of the conditions which are very common amongst women but yet still do not get treated because women remain embarrassed about them. The statistics within the report make for a depressing read and the disparity and urgent need for care to be updated is evident. The report covers all things related to women’s health from female genital mutilation to incontinence, to the menopause.
A chapter in the report that stood out for me was one on post pregnancy care. 80% of women will have a baby in this country. During the pre and postnatal stage of a woman’s pregnancy she will come into contact a lot with various healthcare providers. In my opinion it is around this time that women are a captive audience and educating and treating them at this stage of their lives will result in successful treatment of many problems that may be developing or worsening. In my ideal world women would receive the postnatal care that the women in France have been receiving since 1985. In France, postpartum women are routinely prescribed “la re-education perineale,” 10–20 visits of physiotherapy designed to retrain the pelvic floor muscles, to be followed by “abdominal re-education” after the pelvic floor sessions are completed, if necessary La reeducation perineale” has been subsidized by French Social Security since 1985. The French state health system subsidizes 60–100 percent of the cost; private insurance typically covers the rest. France is one of the only countries to sponsor such a program for women postpartum. Read more about it here:
Postnatal care in the UK is usually concluded by 6-8 weeks post birth which marks the formal end of maternity care in England. The aim of care is to enhance birth recovery, promote maternal and infant physical and psychological health and support infant feeding. The current timing and content of postnatal care originated in the early 20tn century in response to the then high maternal mortality rate. Unfortunately this has been subject to minimal revision, despite a dramatic decline in maternal mortality, increasingly early postnatal discharge and evidence of widespread and persistent maternal morbidity. The health profile of women giving birth in 2015 is not reflected in postnatal care provision and the postnatal care is not fit for purpose, lacking any evidence or maternal need. C section has increased by 3% over the past 10 years. Maternal factors e.g. obesity, increased maternal age and conditions like diabetes are on the rise. Incontinence, perineal pain, anxiety and depression are common and can persist for years. Revisions to the GP contract in 2004 removed an item of service payment for maternity care which has led to a decline in GP involvement. An online survey of 4000 self-selected women found that a third reported that their 6 week routine GP appointment did not meet their emotional needs and almost half said that it was not thorough enough.
I strongly believe that every woman should be offered at least one session with a women’s health physiotherapist after having a baby. Most women, after giving birth will have a weakness in either the tummy or pelvic floor which then creates instability and poor core strength. The result can be back pain, pelvic pain, bladder and bowel weakness. Most Women Health Physiotherapists offer a postnatal check from any time after a woman is 6 weeks postnatal. They will check and test the muscles of the tummy and pelvic floor, provide advice on safe exercises, posture, personal goals. Such a check helps avoid any long term issues and if necessary treatment can be provided and an optimal postnatal recovery programme commenced.
When I was 8 weeks postnatal I was lucky enough to have a postnatal check (Mummy MOT) from two outstanding physiotherapists, Lisa Few, based at London Bridge Hospital and Maria Elliot based in Harley Street. During the sessions sensitive subjects like incontinence, prolapse and sexual intercourse were addressed. Both assessed my scar tissue (from my c sections), pelvic floor, tummy as well as my posture, musculoskeletal system, and general core stability. Without their input my recovery would have been hindered and my return to running much slower. I am one of the lucky ones, knowing such wonderful colleagues. I also have private health insurance. However this service is available without health insurance via self-funding or it is possible to request a referral via your GP in the NHS.
This Valentine’s day do something for yourself. Whether you had a baby 6 weeks ago or 6 years ago book to see a Women’s Health Physiotherapist. Show that body a little love, you deserve it!