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 Photo: RNZ / Richard Tindiller
Photo: RNZ / Richard Tindiller

ParentsJanuary 21, 2019

Why are so many birth injuries not covered by ACC?

 Photo: RNZ / Richard Tindiller
Photo: RNZ / Richard Tindiller

Pregnancy and birth-related injuries are all too common, but with ACC requiring proof of that treatment or other external force was to blame, many new mothers are forced to live with excruciating, untreated pain. Sarah Bichan reports.

It’s almost taboo to talk about birth injuries.

Some people have never heard of pelvic floor dysfunction (vaginal or bladder prolapse and damage to vaginal, perineal and anal tissue). Some have no idea about the intense pain and discomfort, bleeding, urinal and faecal incontinence issues women are facing every day due to their pregnancies and births. Carpal tunnel syndrome and repetitive strain injury leave parents suffering numbness, pain, loss of strength and difficulty lifting; pelvic rotation and tailbone injuries make normal movement difficult and sitting for prolonged periods painful; symphysis pubis dysfunction can cause back, pelvic and leg pain which becomes worse when parting your legs, walking, going up or down stairs or moving around in bed; separation of the midline abdominal muscles (diastasis recti) can result in lower back pain, constipation, urinary incontinence and difficulties with movement and breathing  … the list goes on.

And that’s just pregnancy and birth. A 2012 study found that “risk factors for musculoskeletal disorders are present to a significant degree” when mothers lift normally developing children in the home. Childcare-related injuries are all too common.

And if they’re common, is our healthcare system properly set up to support those who’ve recently given birth?

Beth*, suffered a vaginal prolapse during the birth of her first child. She was surprised to find there was no routine free postpartum check-up system in New Zealand.

“There must be thousands of women living undiagnosed and unable to afford the medical care to help manage symptoms.”

Anna* was referred to maternal mental health, but only after three different referrals. In the end, the wait was too long and she sought out a private specialist. “I still have anxiety and PTSD-like symptoms.”

Jane* was offered physio for her fractured tailbone but she was in the depths of postnatal depression and never attended the appointment. “By the time it was picked up I was past the ‘recovery time’ anyway. So I just kind of suffered for about two years”.

So what is being done to support these women? Claiming through ACC is one option. When I spoke to an ACC spokesperson, he said that ACC covers treatment injuries; that is, the injury must be sustained during a delivery with medical intervention by a registered medical health professional. If a mother suffered a tear during a birth with no such intervention, this wouldn’t be considered a treatment injury and so wouldn’t be covered. He added that there could be scope for a claim that doesn’t meet treatment injury criteria but that it would need to involve an external force. This means many birth injuries aren’t covered, even though they are what I would consider “accidents”.


The ‘no fault’ fallacy: Looking back at our 18 months of ACC hell

For those whose injuries are not covered by ACC, treatment may be completely unaffordable and therefore inaccessible. Sam* suffered pelvic rotation while giving birth and ended up with one leg shorter than the other.

“I’m surprised there is no ACC or similar subsidy for birth injuries. I had osteopathic treatment which worked really well but was expensive”.

A recent investigation by Stuff found that ACC pays out less to women and is far more likely to reject claims made by women. It’s an open question how many of these rejected claims are related to childbirth and childcare.

Natalia* believes that all too often women are expected to just keep calm and carry on. Like Sam, she suffered from pelvic rotation due to childbirth and lived with the pain until she found the money to seek treatment. “I think of how long I was just putting up with it and I feel sad. I just don’t think there is enough focus on awareness of our physiology and the changes that pregnancy and birth can bring. Then layer on a general expectation for women to put up and shut up… and the ‘at least…’ dialogue. I mean, when did the ‘least’ become our benchmark?”

It’s been said before that the way our maternity system operates needs attention. Shouldn’t it be easier for those with birth injuries and ongoing problems to be referred for and to receive specialist treatment?

Claire* waited two years before she got an appointment with an occupational therapist for her pregnancy-related repetitive strain injury. “I couldn’t believe there wasn’t such a thing as a pregnancy or perinatal occupational therapy service”.

Annabelle* finally got a referral to a gynaecological physiotherapist after 12 months, but couldn’t access the surgery she needed because the wait meant she was now outside the window of time in which she could claim financial support.

“I still can’t walk to the letterbox half the time.”

So how can we support parents’ physical and mental health during pregnancy and after childbirth? Many women are unaware of the risks involved in having children, so developing more in-depth antenatal education could be a good starting place. We also need to develop better postnatal education, more extensive and extended postnatal checks, more paid (and shared) parental leave and better access to financial and general support.

We could also look to other countries for ideas. In France, mothers are assigned a trained physiotherapist specialising in pelvic floor rehabilitation for 10 to 20 sessions. In the Netherlands, mothers get a free professional maternity nurse for the first 8 to 10 days. This nurse is responsible for the well-being of the child, but also closely monitors the mother’s recovery.

We need better support and treatment for women who have experienced pregnancy, birth and childcare injuries, those who’ve suffered through traumatic births, and those who experience mental health issues related to this period in their lives.

We need to support our midwives and we need to think about outcomes for women and parents in general, as well as for babies.

We can also only hope that Sir Geoffrey Palmer’s recent call for “a radical expansion of ACC to cover people incapacitated by sickness and disability” will include physical injuries and mental health issues related to birth and childcare as well.

Because in 2019 is it acceptable that a mother just lives with an injury that means she can’t walk to her letterbox?

*Not their real names.

 If you’ve suffered from a traumatic birth experience or think you could be experiencing postnatal anxiety or depression and want to talk to someone, try contacting the following organisations.

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