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I recently was interviewed on two occasions on two different days by two different journalists.
I was doing my spiel to them – giving statistics about urinary incontinence; giving the heads up on the prevalence of prolapse; and how many people with pelvic floor dysfunction are sitting in a doctor’s surgery and don’t disclose their problems ……with their GP. It was all riveting stuff – the journalists were engaged, shocked at the numbers I gave them and saying ‘Woh there’s so much of a story here!’
But then both of them said something that almost stopped me in my tracks.
Each of them, when I said I thought that every woman who has a baby, should see a Women’s Health physiotherapist……deserves to see a Women’s Health physiotherapist, said ‘Oh we don’t want an over-servicing situation’.
Now I had to keep talking, spruiking our worth, not lose a beat- but I was simmering away with this conversation going on in my head: What did she just say?’ And then, it happened again…….‘You’ve got to be kidding- she just said the same thing that journalist said last week?????’
Over-servicing! Women seeing a physio after pushing a baby out is classified as over-servicing? Have I been seeing so many women in this predicament, that I have a biased, distorted view of how important a post-birth consultation with a Women’s Health physio is? That in fact, women should just get on with looking after their baby and no need for individualised post-baby care for their bladder, bowel, vagina and pelvic floor.
Here is my argument stating the case for more routine individualised assessment and treatment for every woman after she has had a baby ……. regardless of the mode of delivery.
What follows is a wonderful image from Professor John de Lancey’s bio-engineering unit in America. It was created by the engineers based on the dimensions of a baby’s head, the size of the female pelvic outlet and the distensibility of the pelvic floor muscles. If you want to read the full article, here is the link. 

The biomechanical engineers conclusion? A vaginal delivery doesn’t seem to work!
There are many women who will attest to this. They will be the ones sitting awkwardly on a rubber donut cushion (don’t do this by the way) and an ice-pack at the same time. They will be the ones who are at play group with the women who have had the Caesar, who are sitting laughing at the jokes, while the vaginal delivery mothers still can’t sit without pain. They will be the ones who have just been told by their Women’s Health physio that they have had a significant birth injury and that is why they can’t feel their pelvic floor muscles working anymore.
These women might be faecally incontinent; they may have pelvic pain; they may be incontinent of urine or have prolapse.
Or have all of the above!
So I suppose the journalists would grant immunity to those women- they have definitely earned their visit to the Women’s Health physiotherapist.
They would be assessed, educated, counselled and supported for as many visits as the patient / and or the physio felt they required. For the majority of women it may be an initial long consultation of one to one and a half hours and then perhaps a month later, a half hour visit, and if recovery is going well, then a couple at the 3 and then 6 month mark.
But I believe all women deserve to see a Women’s Health physio in order to be reassured; to be well-educated about what is normal with the bladder and bowel and what might go wrong; the appropriate rehab of their abdominals; advice regarding any lingering pelvic or back pain; the importance of return to exercise, but also of appropriate rest. All of this without being made to feel guilty about over-servicing.
After all this is (sort of) the reality.

A 4kg watermelon
And what of the women who have had a Caesarean – but didn’t realise there was a problem going whenever they fancy to the toilet to pass urine? They get to 45 yrs of age and suddenly have frequency, urgency and urge incontinence, just because they didn’t get the opportunity to learn some basic facts about bladder and bowel control at a younger age after they had their baby. What if the woman had a vaginal delivery- there was no tear, no pain, she felt great and decided to go back to exercising at 3 weeks and started with some burpees and tractor tyre lifts and developed on a prolapse?
Every woman who has been pregnant and had a baby should be able to source the services of a Women’s Health physio and not have it labelled as over-servicing.
And for journalists, whose responsibility is to inform without judgement and to spread information without prejudice and fear mongering, I am interested why that word over-servicing was used? Is there a message from the Government – like from Medicare, from the health funds? Is it simply an unfortunate coincidence that two female journalists both used the same words within a week of each other? Or is childbirth so underrated that women are seen as weak if they are having problems? Are women just getting the short straw with their health? Or is the ignorance about the financial burden of urinary incontinence and the other consequences of pelvic floor dysfunction on Australia’s bottom FINANCIAL line so huge that the politicians haven’t seen it as a priority and the silence surrounding this burden for women continues?
Why is a dental check up every 6 months acceptable and rebated very handsomely by the health funds?  Does tooth decay create more quality of life issues than urinary and faecal incontinence?
France has recognised the importance of the pelvic floor following childbirth. Every woman is funded for ten (yes 10) visits to the pelvic floor physiotherapist. (I do wonder if sex and French men does have some role to play here- I may be wrong though.) Imagine in Australia, if when you walked out the door after having a baby, you picked up your Bounty bag (the sample bag of goodies from a variety of suppliers) and you also got a 10 pack of vouchers to the pelvic floor physio? Now that would be prioritising pelvic health!
The evidence is building about the importance of early intervention with the prevention of pelvic floor dysfunction. I have mentioned a couple of articles in my previous blog alluding to this. Incontinence of bladder and bowel are one of the leading cause of admission of older women (and men) to nursing homes. Our population is ageing and the future numbers will be staggering.
To me it is stating the bleeding obvious that this area should be appropriately and routinely funded and women should be demanding automatic routine follow-up for their daughters and sisters, before and after they have had a baby. The payback in the future, in savings for our economy, will make this investment in health public policy worthwhile.