Giving birth stretches a woman’s body to the limit (and sometimes beyond). And the changes that occur in the pelvic tissues are akin to those that occur in a contact sports injury. Yet, women aren’t informed of this, their risks of pelvic floor trauma and the solutions to these problems.
In a survey I conducted of over 800 women, I asked them if they would like to know about their individual risk factors for birth-related pelvic floor problems. 85 per cent of women indicated they wanted to be informed before birth, nine per cent indicated that they would just deal with it after birth and only two per cent indicated that being informed would scare them.
There has been this long-held belief in the medical and health professions that informing women of birth-related injuries will scare them. However, the survey clearly demonstrates the opposite. As does the despair of mothers who reach out to me for women’s health physiotherapy advice and treatment.
“Why didn’t anyone tell me this could happen?” This is the most common question I hear from mothers when they find out they have pelvic organ prolapse, anal sphincter tearing, or levator avulsion (tearing of the pelvic floor muscle).
Women are mature, capable beings who have the right to be informed so that they can prepare for, and prevent, any adverse pelvic floor outcomes. It is now my belief that withholding this information is stripping women of their autonomy.
I now ask every women: “Would you like to know your own individual risks for any type of pelvic floor problem?” And the answer is almost always “Yes”. I will then look at a number of different factors such as her genetic history, age at first birth, ethnicity, height, weight, size of the baby, and the size of her perineum.
Research shows that women who have a mother or sister with urinary incontinence or anal sphincter tearing will have almost double the risk of this in their own birth. They also have double the risk of pelvic organ prolapse if their mother has one, and almost five times the risk if their sister has one.
Women who have a forceps birth are at a higher risk of prolapse, incontinence, pelvic floor tearing and anal sphincter tearing. Women with babies over four kg have a much higher risk of pelvic organ prolapse and anal sphincter injury.
It is a great disservice when we fail to educate women prenatally about birth-related pelvic floor problems. Worse still is the abandonment women feel in the postpartum period. Beyond the six-week check, which is poorly attended in some areas, there is very little support for women after birth, and very little education about pelvic health solutions.