My talk at the Birth Trauma Conference earlier this month focused on the link between maternal mental health and pelvic floor dysfunction.
I explored three main questions:
Is there a link between birth injuries/pelvic floor health and maternal mental health issues/postnatal depression?
What is currently going awry with the system of postnatal care and how society views pelvic floor dysfunction?
How can we positively shape the future for postnatal women in terms of their physical–mental health?
Photo by Bryan Schneider on Pexels.com
Pelvic floor issues: incontinence and prolapse are not just a question of the physical impact on a woman’s quality of life: one study found that women who experience urinary incontinence following childbirth are nearly twice as likely to develop postnatal depression. (Sword et al, 2011)
• 50% of postnatal women experience pelvic organ prolapse with symptoms of bladder and bowel dysfunction. (Hagen et al 2004)
• 50% of women who have had children have some degree of symptomatic or asymptomatic pelvic organ prolapse. (Hagen & Stark 2011)
• In women with vaginal prolapse, 63% will experience urinary stress incontinence. (Baiet al 2002)
• Urinary incontinence during pregnancy nearly doubles the likelihood of urinary incontinence at three months post baby (regardless of delivery method– C-section or vaginal) (Eason et al 2004)
52% of women with lower back pain during pregnancy were found to have pelvic floor dysfunction (Study by Pool-Goudzwaardet al 2005
52% of women with a pelvic floor dysfunction (stress urinary incontinence or pelvic organ prolapse) also have a Diastasis Recti. (Spitznagleet al 2007)
66% of women with a diastasis recti have a pelvic floor support dysfunction (stress urinary incontinence or pelvic organ prolapse) (Spitznagle et al 2007)
45% of women have urinary incontinence 7 years postnatally. (Wilson et al 2002)
38% have rectus diastasis abdominis 8 weeks after delivery. (Boissonnault 1988)
Prevalence of stress or urge incontinence and intravaginalprolapse was 42% in women with one or more vaginal deliveries as opposed to 35% in women who had a C-section delivery. (Sakala 2006)
41.9% of mothers delivering last year experienced tearing.
Over a quarter of labours (26%) ended in caesarean sections and 12.9% forceps/ventouse.
Inductions have risen from 20% of births a decade ago to 32% last year. Induction is associated with stronger contractions and more rapid labours– more potential pelvic floor trauma.
What doctors refer to as ‘normal’, ‘just a graze’ may feel anything but for the woman on the sharp end.
There is currently no standardised pathway of care postnatally. The GP check is NOT ENOUGH, yet is often all some women get as a physical check post-birth, even post-caesarean.
Retraining muscle after injury is essential as inhibited muscle does not automatically reactivate and retrain. (Stener & Petersen 1962)
Training post birth after experiencing pelvic girdle pain in pregnancy using a specific stabilisation exercise programme, results showed significant reduction in pain and 50% reduction in disability. This tells us that specific stability exercises [such as Pilates] are useful for reducing pelvic girdle pain after pregnancy. (Stuge et al 2004)
Even safe, clinically uneventful deliveries can be a shockingly violent departure from women’s expectations or everyday experience.
Society focuses on getting your post-baby body ‘back in shape’ & into your pre-pregnancy jeans … this focus should be instead on making your insides fit and functional.
We don’t broach pelvic floor dysfunction adequately pre-birth.
We should be empowering pregnant women with the right information and the tools to optimise their recovery.
We need to reduce the embarrassment and shame that can surround birth injuries. Mental health issues thrive in the taboo, shame and silence.
A feminist issue
Women’s bodies have long had secondary status.
Birth injury isn’t treated as injury worth rehabilitating: ‘Wait until you’ve completed your family and then have surgery’ is the prevailing message.
But 1/3 women who have surgery will suffer prolapse/dysfunction again –as the root cause isn’t dealt with. The Mesh Scandal last year shows how inadequately this system is serving women.
Pelvic floor dysfunction is often dismissed: ‘You had a baby, what do you expect?’ ’You’re fine, this is normal’. Women feel minimised and not heard.
King’s hospital gynaecological department has posters of comments and discoveries harvested from ongoing research into birth injury. The common denominator is the surprise expressed by women that incontinence and prolapse are both horribly ‘normal’ yet never discussed. But they can be life changing.
‘I had to push to even get diagnosed with prolapse – apparently a quick poke to discover ‘normal baggy vaginal tissue’ trumps my 30 years of living with my own vagina and knowing what shape it really isn’t meant to be. It is shit that if I’d been less pushy/less confident about my own knowledge of my body, I wouldn’t have accessed any of the amazing support I finally did get once I was referred for physio’ Amy, mum of 1.
THE VAST MAJORITY OF WOMEN KEEP QUIET AND STRUGGLE ON. AND THE TENA LADY SECTION OF BOOTS IS EVER GROWING.
I’ll post the second half of my talk in the next blog – but in the meantime – what has your experience of postnatal health and wellbeing been? Have you suffered from pelvic floor dysfunction? Are you suffering in silence? I’d love to hear from you. There is help out there.