A group of mothers, personal trainers, and physiotherapists have joined together to try to address New Zealand’s lack of post-birth care. Here’s why.
In the year ending March 2020, 59,238 people gave birth. Many of them (more than you’d think) will suffer from urinary incontinence and vaginal prolapse. When you give birth you roll the dice – it’s estimated one in three births will end in loss of urinary control with the prevalence of urinary incontinence even higher in adult Māori women at 47%. It’s estimated at least half of women who’ve had more than one child have some degree of vaginal prolapse.
In order to bring what they believe are serious issues around post-birth care into the open, a group of mothers and health professionals from across the country have started a petition calling for all birthing people in New Zealand to have a free pelvic floor check by a qualified pelvic health physiotherapist during pregnancy, free postnatal pelvic floor checks during the first two years after giving birth, and education in birthing and antenatal classes on pelvic floor dysfunction, wound care, and how to correctly perform Kegel exercises. It’s also requesting more funding for Continence New Zealand to employ nurses and increased DHB funding for pelvic health physiotherapists and birth trauma treatment funding from ACC.
One of the authors of the petition, Kirsty Watt, experienced the lack of post-birth care first hand after the birth of her child. “The care that we receive as women is shit and that’s putting it politely,” she says.
“I had no idea what a pelvic floor physiotherapist even was when I was pregnant. After the birth of my first child seven years ago I was given a pamphlet about pelvic floor health from the physiotherapist at the hospital and that was the last time it was mentioned. I had an amazing midwife, no intervention, no stitches, just a weak pelvic floor. I was told I could go back to exercise, without any form of a check-up. I was going to a boot camp, targeted at mums, but was jumping and running and basically ignoring the fact I had to take a leak after every jump squat. It got worse as time went on.”
Watt became a personal trainer and she said just ten minutes was spent on “women’s bodies” and pelvic floor exercises during the course. During the birth of her second child, she suffered a severe injury to her tailbone.
“He came accidentally in our kitchen, I literally didn’t have to push. The issues came later. I couldn’t sit properly for about 15 months. I was never offered physiotherapy and I was never referred to the hospital by my GP. I asked if my pelvic floor was alright and she said it was fine.”
Over the coming weeks, Watt developed urge incontinence which causes a sudden, overwhelming urge to urinate. Two years later she began seeing a physiotherapist. Watt was diagnosed with a hypertonic pelvic floor which meant her pelvic floor struggled to relax which meant it was always “switched on”.
“But I was also leaking, which was confusing as I thought my pelvic floor was weak, but without a proper assessment you just don’t know,” she says.
Watt, who’s doing much better now, wants to see a change in how post-birth care is delivered. “The system doesn’t work. From the way we are managed post-birth from our GPs and DHB to the education that we don’t receive, no one seems to ask any continence issues. And we’re generally told to just do Kegels, but there’s no diagnosis or checks to see if you’re doing them correctly or if you are in fact overdoing it. Women need help.”
Personal trainer Jess Baker supports the petition. She runs a free online group called SLAM which is an acronym for “strong like a mother”. She says there are gaps in knowledge for many personal trainers and gyms who might be causing further damage to mothers because they don’t understand pelvic health.
“There’s a real battle in our industry to put the women front and centre. There’s a need right now to cut through the bullshit that feeds a mother’s mind to ‘snap back’ and ‘lose the baby fat’,” says Baker. “There are many programmes, trainers and gyms that have no knowledge of pelvic health, but they’ll target mothers because it’s easy money whilst feeding into their insecurities. But at what cost to the mum? We’ve seen mothers losing bowel control while in the line for school pick up, her uterus descending down and out of her vaginal opening because she was pushed to keep going [at] CrossFit class, or spending $4,500 on physio treatments because she was advised at six weeks by her GP to get back into running, with no pelvic floor checks, and now when she fast walks she wets herself.”
The petition comes at a time when many are speaking out about the treatment of women before and after birth. Writer and influencer Emily Holdaway often talks about pelvic health with her followers on Facebook and Instagram. She’s spoken openly about her vaginal prolapse and her road to recovery.
“We don’t really know if it was my cervix, a bladder prolapse, a rectal prolapse, or a combination of all three,” she wrote at the time.”But I didn’t care. It was a prolapse and I felt like my body was breaking down. Plus we were six weeks deep into life [with two babies]. I cried a lot. I felt yucky. Gross. I felt broken. I felt like the birth I had been looking forward to, that I was so pumped for, so ready for, had instead shattered me.”
With the help of a physiotherapist she recovered from her prolapse but she continues to share her story in the hopes that it might help others.
“We’ve all heard the jokes about birth and vaginas. How they are ruined. Wrecked. Like watching your favourite pub burn down and all of that. And it really pisses me off.
“For a while it’s funny, and yeah I suppose it gets people talking about it, [but] it doesn’t help! … It normalises the idea that once you give birth your vagina will be ruined, you will pee when you sneeze and that’s your lot for the rest of your life and hard luck, deal with it, ‘insert ode to the vag here’. And that’s shit!”
Her advice for birthing people is simple. “If you think something is not right with your body after giving birth, please, see someone. It’s not shameful. Your GP, women’s health physio, midwife, has seen it all. The trampoline jokes, the sneeze peeing jokes, the busted vagina jokes. Yeah, they’re funny, but they don’t help. Getting help helps.”
But ensuring every birthing parent has access to help is a challenge. Physiotherapist Frances Tague says New Zealand is “massively lacking” in postnatal care compared to other countries around the world.
“A lot of people talk about France as the gold standard because women in France routinely get postnatal checks, not the baby. Everyone here gets their six-week check for the baby and I think the most that happens there for the woman is a conversation around whether there are any signs of dysfunction and if there aren’t, they’re literally told they can go back to anything and everything they used to do, which is just crazy,” says Tague. “In France, a woman has up to six fully funded appointments with a physiotherapist and every single woman has a vaginal examination and pelvic floor muscle training, often with instruments to measure strength or electric stimulation for women who struggle to initiate a pelvic floor reaction. And that’s just routine care.”
Tague says the most women here get in support is “advice and a leaflet”, and despite the frightening statistics, the issue just doesn’t seem to get political traction.
“Those of us who are trained in this area know that it’s hugely common,” she says. “Even the statistics around faecal incontinence – being unable to control your bowels – are massively high. It’s hugely distressing, life-changing stuff. It can cause women to be socially isolated [as] it’s something they feel afraid to talk about with their family.
“We’re not just talking about incontinence here, but postnatal pelvic pain, pain with intercourse [which are] all really common and none of them are dealt with routinely.”
Of course, many of us have theories as to why the topic of women’s health is ignored politically. This week, author Clementine Ford offered one suggestion, encouraging folks on her Instagram to consider what post-birth care would look like if cis men carried babies.
“You’d best believe there would be fully funded treatment centres in every town throughout this country to make sure they found a solution and ASAP,” she wrote.
“It simply would not be borne that fatherhood posed a natural end to men’s sexual function and enjoyment! So why is this loss of something many of us see as an essential core of ourselves just so casually dismissed as part and parcel of the supposedly more important experience of becoming a mother?”
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