This year’s theme for International Women’s Day (March 8th) is #BalanceforBetter and I can’t think of a better hashtag to represent what we pelvic health physiotherapists face every day, when in clinic treating patients who have pelvic floor dysfunction.
We have to assess the patient and use critical thinking, in conjunction with the patients’ wishes and desires, to work out what the patient can do every day, without over-thinking her every move and what the patient maybe should modify to prevent their problem worsening.
This is the dilemma.
We need to assess and treat – the Whole Woman.
Not just her pelvic floor. Not just her bladder. Not just her bowel. Not just any one part, but the whole of that woman who sits before us, pouring out her most vulnerable self; allowing us into her most personal corners of her being and giving us the privilege of hearing her story and giving us an insight into her personal nightmare. And let me reassure you – pelvic floor dysfunction for women can be a real living nightmare.
We have to treat her brain – her happiness, her thoughts, her anxieties, her beliefs to name a few.
We have to treat her cardio-vascular system and we do this by getting her back to exercise so her heart is strong and her blood vessels are pumping efficiently.
We have to treat her bones, her joints and her muscles in her body – again by encouraging her to exercise despite any changes that may have happened following pregnancy and childbirth.
And we have to treat her psyche – the very essence of her being a woman because a traumatic vaginal delivery may turn her female-world upside down affecting her sexuality, her confidence and her ability to do very basic things without feeling fearful and anxious.
We need to get the woman back in balance after the changes that pregnancy and childbirth bring to her.
Every day in our pelvic health practice we see patients who have a myriad of issues that arise as a result of a pregnancy, a vaginal delivery or a caesarean birth. Nowadays patients can easily access the same information about these issues as their physiotherapist or doctor. Many research articles are freely available on the internet and modern patients are very often good researchers.
Many are also very active on Social Media- they are members of many Facebook Groups that discuss childbirth issues and mothering problems – including all the joys, successes, heartaches and failures and can be very well-informed, but also absolutely terrified by what they have read.
Happy and oblivious! I was untrained in both baby caring and my bodily changes and I was a physio! And worse still, Facebook was not a thing
The patients arrive armed with pre-knowledge, primed with anxiety and fears and already have diagnosed many problems (that may not be even accurate, but the fears are difficult to let go of). Don’t get me wrong though, many of these Facebook support groups have been a lifesaver for women and brought them back from the brink.
Many arrive with complex problems that have completely trashed their former lives and because we focus on the ‘one day of labour’ instead of informing women about potential changes that can happen – women are completely unaware and not expecting these serious complications that have come out of left field for them. These patients can be sad….and bewildered………and angry at the same time.
Then because we see having the baby as the line drawn in the sand, rather than the beginning of the fourth trimester (more on that in a moment), women are handed this baby and sent home without due respect being given to any changes that have happened to their bodies.
Some women feel abandoned by the health system.
(The fourth trimester is a period described by expert Dr. Harvey Karp, an American pediatrician and children’s environmental health advocate, as the first three months of a baby’s life- a time when a newborn is adjusting to life outside of the womb. Many writers and commentators are now viewing the fourth trimester as a period of time for the mother to be ‘rehabilitated’ and as such are lobbying governments to fund regular visits to a pelvic health physiotherapist as a routine like they do in France).
Some of these women have played competitive sport.
Some are recreational joggers.
Some had hoped they would eventually kick a ball in the park with their child as they got to toddler status, without leaking urine (or gas or faeces).
Others had hoped to get back to sexual intimacy sometime before the child headed off to school.
Call me biased but I just don’t think governments and health funds take women’s health seriously.
Because if they did there would be serious attention and funding given to prioritizing the immediate period after having a baby like there is in France.
The evidence is clear. Pelvic floor dysfunction costs our economy a lot of money. Incontinence alone was estimated to cost the Australian economy $40 billion back in 2010. (Access Economics Report)
So if we want to indeed strive for #BalanceforBetter for women, we should become more vocal about financial support for mandatory assessment and treatment for every woman who has had a baby – regardless of the mode of delivery.
And if we want to indeed strive for #BalanceforBetter for women as they age, we should also become more vocal about incentivizing women to attend a pelvic health physiotherapist regularly every year through all the life-stages to encourage long-term adherence to pelvic health programmes.
Today, while waiting on the phone to my health fund to enquire about the new (whiz-bang) changes to the name of my level of private health coverage (all $6025 per year for two of us) – now called Gold Level (I wanted to see if Silver, Bronze or Wood … would still keep me alive and kicking and cost substantially less) there was a pre-recorded message to lull me into a stupor (and thus rendering me oblivious to the length of the wait).
Instead the pre-recorded message made me angry.
My health fund was telling me that I was entitled to two visits to the dentist per year for a fully funded visit (absolutely nothing out-of-pocket) for an inspection, clean and scale – BECAUSE WE ALL KNOW HOW IMPORTANT DENTAL HEALTH IS TO OUR GENERAL HEALTH AND WELL-BEING! said the recording. This equates to $225 twice a year for every member on the coverage. No out-of-pocket expenses.
I was shouting back at the pre-recorded message: YOU KNOW WHAT? PELVIC HEALTH PHYSIOTHERAPY- GETTING YOUR BLADDER, BOWEL AND PELVIC FLOOR IN ORDER – IS PRETTY DAMN IMPORTANT TO YOUR GENERAL HEALTH AND WELL-BEING ALSO!!
Shouting at the pre-recorded message on the phone won’t get us anywhere.
What might help is to write to your parliamentarian (they are always all ears when there’s an election looming), ring your private health fund and ask them to record your complaint about this inequity (dental rebates versus physio rebates) and perhaps share this blog on Social Media.
Enough of expecting women to shut up and put up with pelvic floor dysfunction!
Here is the link to another blog I have written about this inequity.
#BalanceforBetter #pelvichealthphysiotherapy #treatthewholewoman #InternationalWomen’sDay #IWD2019