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Physiotherapy is an instrumental part of postnatal healing

Physiotherapy is an instrumental part of postnatal
Photo: Physiotherapy is an instrumental part of postnatal healing
Physiotherapy is an instrumental part of physical and mental recovery for new mothers, yet most women wouldn’t know it, with many failing to understand exactly what ‘normal’ looks like post-birth.

“Women’s bodies change quite significantly during the childbearing year and during childbirth, which is why we advocate for women to work actively from the moment they become pregnant to the end of the ‘forth trimester’ (3 months after delivery),” says Director of Viva Physiotherapy, Kathryn Anderson.

“As a woman carries her baby, we see the tissues around the abs and pelvis become stretched and her posture adapting as the pregnancy progresses.

“We know that the pelvic floor progressively affected as the woman carries the baby during pregnancy and so even those who have a caesarean (rather than natural birth) are vulnerable to a compromised pelvic floor.
“A woman can also experience prolapse which may require surgical intervention.”

Unfortunately though, Ms Anderson says many women are simply not informed or empowered to understand what ‘normal’ looks like, or how to access broader care to help get their bodies back to a healthy state.

While most privately insured women do have access to physiotherapy to manage and treat the effects of vaginal birth trauma, women birthing in the public health system often have minimal to no access, creating a significant health and economic burden.

Australian Physiotherapy Association National Chair of the Women’s and Pelvic Health Group, Cath Willis, says this results in women living with the indignity of incontinence, prolapse and pain, often for many years.

“If left untreated, conditions like perineal tears, pelvic floor muscle damage, incontinence and prolapse will cause lifelong harm, affecting a woman’s relationships, quality of life, likelihood to have more children and
ability to re-enter the workforce.”

According to Ms Anderson, there are both short and long term effects for women who fail to seek help following childbirth.

“In the short term, we can see women suffer from back pain, neck pain and pelvic joint pain,” she says.

“In addition to that, women can suffer from pain due to the delivery, such as joint pain in the back and pelvis, plus pain from scar healing such as episiotomy, or caesarean.”

While physiotherapy has been proven to effectively assist with these conditions, costs can be prohibitive for some new mothers, already struggling to cope with the impact of lost income and increased expenses.

Long term, this can have devastating consequences – not just physically.

“In the industry, we have a definition of ‘chronic pain’, which is defined by being in pain for more than three months,” says Ms Anderson.

“It is very easy for this amount of time to go by, where a new mother has not sought help, and so the condition weaves more deeply into broader issues, such as identity and confidence and even mental health.

“And of course, an injury left untreated always takes longer to heal.

“There is also an enormous amount of research about the relationship of getting new mums back into exercise and the implications on their long term health.

“This affects bigger markers such as cardiovascular health and even cancer, so we really advocate for women to take an active role in their recoveries from the start.”

Making matters worse, is that the more pregnancies you experience, the worse these problems can become, particularly if left untreated.

“The risk and severity of conditions such as incontinence and DRAM (separation of the stomach muscles) will increase from pregnancy to pregnancy,” says Ms Anderson.

“Conditions such as back pain and pelvic joint pain often will get worse in subsequent pregnancies, but we can often improve outcomes and pain levels with physiotherapy in between pregnancies, and during the subsequent ones through specific exercise and education.”

According to the APA, rates of difficult deliveries are increasing in Australia as the average age and health conditions of expectant mothers increases.

“It’s imperative that the federal government removes the cost barrier for physiotherapy treatment for all women so they can be appropriately diagnosed and treated during and after pregnancy,” says Ms Willis.

“Up to twenty per cent of vaginal births can result in muscle detachment from the pelvic wall, which is often undiagnosed, and this figure increases to almost 65 per cent if forceps are used in delivery.”

But aside from the physical and mental repercussions for women, there’s also a significant  economic cost.

For example, the cost of incontinence as a result of traumatic birth injuries costs $271 million per year, predicted to grow to $450 million this year.

“Economic productivity losses are estimated at more than $34 billion due to lower than average return to employment for women suffering incontinence.

Additional data commissioned by the APA from Nous Group also highlights that physiotherapy treatment of stress urinary incontinence can save the health system $16,000 per person in ongoing medical costs.

Ms Willis says the evidence is irrefutable.

“We know that a preventive health approach is so important for women during pregnancy, and engaging them in the process so they understand the importance of pelvic floor muscle training and other health impacts will bring about a better outcome for them.

“Women should have access to the treatment that is best for them, so they can make informed birth decisions that will support their post-partum mental and physical health, social engagement and return to the workforce.”

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Nicole Madigan

Nicole Madigan is a widely published journalist with more than 15 years experience in the media and communications industries.

Specialising in health, business, property and finance, Nicole writes regularly for numerous high-profile newspapers, magazines and online publications.

Before moving into freelance writing almost a decade ago, Nicole was an on-air reporter with Channel Nine and a newspaper journalist with News Limited.

Nicole is also the Director of content and communications agency Stella Communications (www.stellacomms.com) and a children's author.