6 weeks post natal and 'in the clear'? Think again.
So, you may have heard of the 6-week postnatal check. It is often viewed as the ‘holy grail’ for women for post-birth clearance. Whether it be to swim, to lift heavier than 4kg, return to exercise, to drive, or for some keen mummas to return to sex, the 6-week check can be long-awaited.
As it stands in Australia the check is performed by a GP, Midwife or Obstetrician in a 25-35 min appointment to assess everything from wound healing, uterus contraction, cessation of bleeding, mental health, family planning, mother and baby interaction, lactation, baby’s growth, and mother’s physical health, vaccinations and many other things.
A one-off 25-35 min is simply not sufficient to assess everything adequately, make recommendations or referrals let alone give clearance for tasks such as running (which quite frankly is something no one should be cleared for at 6 weeks post-birth). This is not the fault of the health professional doing the 6-week post-natal check, they are doing their best and feel the pressure too. It is simply a case of this is how it has always been done, but it is time for change.
The good news is in recent years a few things in postnatal care have progressed
Improvements in medical imaging of the deep pelvic floor mean an increase in understanding of the prevalence and severity of pelvic floor tears (avulsions) that are not able to be seen at the time of birth. This occurs in 20-40% of births and increases women’s likely hood of longer-term incontinence and prolapse. It is something that early identification and management are incredibly important, and one of the reasons all women should have a thorough check with a women’s health Physiotherapist including an internal pelvic floor exam.
The role of the Women’s Health Physiotherapist for women post-birth regardless of vaginal or caesarean is gaining recognition. There is more women’s health Physiotherapist trained worldwide than ever due to the increasing demand. In places such as France and Scandinavia pelvic floor Physiotherapy if offered to ALL women as a part of a routine government-funded postnatal care, which is exactly how it should be in Australia.
A women’s health Physiotherapist will assess physically everything that a GP, Midwife, Obstetrician simply do not have the time or skills to do. It can be essential for identifying issues before they turn into a problem, or address those already present minimising progression. Prevention is much better than cure.Women’s own experience, word of mouth and social media mean community awareness of pelvic floor symptoms that are not usually discussed as well as the importance of prevention is now a priority. Women are demanding a higher level of care and we can see this in the increase in the number of Women self-referring to women’s health physiotherapist.
And finally, the faculties of Obstetrics have recognised a need for a change.
In 2018 the American College of Obstetricians and Gynaecologists (ACOG) allocated a task force to redefine postnatal care, releasing a guideline titled ‘optimising post-partum care’. They conclude that rather than an arbitrary 6-week check that a woman should see their caregiver at 3 weeks postpartum and ongoing rather than a single encounter.
They recommend all women also be given a comprehensive full assessment of physical, psychological and social factors no later than 12 weeks. What I love is that they also identify that a policy change is required and that reimbursement policies to support postpartum care should be facilitated. Yes, yes, yes.
This comprehensive assessment that they recommend at no later than 12 weeks includes over 40 listed items to check including infant care, lactation, mood and emotional wellbeing, wound recovery, sexuality, family planning, sleep and fatigue, physical recovery from birth, exercise, chronic disease management, health maintenance and more.
This ACOG guideline is a wonderful step in the right direction and I am so pleased that all of the factors contributing to a mother’s wellbeing are finally being recognised. However, there is absolutely no way we can expect our GP’s, Midwives or Obstetricians to do a thorough check of all component both physically, emotionally and functionally and provide the mother with support and guidance that she needs. This guideline should also include a routine postnatal check with a women’s health Physiotherapist.
A women’s Health Physiotherapist specialises in the assessment of the physical post-natal body. They will spend an hour taking a detailed birth history and presence of symptoms, then undertake a detail assessment of pelvic floor function, tear recovery, scar tissue quality, anal sphincter function, bladder, bowel and uterus position, avulsion assessment, sexual function, prolapse risk, abdominal muscle function, previous injuries, and undertake a biomechanical assessment of the musculoskeletal system. The assessment will include an external structural assessment, real-time ultrasound and a detailed internal vaginal exam.
All findings combined with information such as woman’s pre-pregnancy fitness, her exercise goals and current functional capabilities then help the Physio to make an informed decision to guide a woman back to activity, exercise and intimacy based on what her individual body is ready for.
A post-natal check with a Women Health Physiotherapist is totally different from the routine 6-week check and it is important that women understand this. It is absolutely something that should be routine care, and in the years to come once policymakers catch up, I am confident it will be.
In the meantime, however, it is up to women to be advocates for their own recovering post-natal bodies, and seek out a Women’s Health Physiotherapist to help guide their post-natal body in an informed way. It truly can change the trajectory of a woman’s physical function, self-confidence, sexuality and wellbeing, which ultimately is not only beneficial for the woman, but for her family, friends and wider community.
Reference:
The American College of Obstetricians and Gynaecologists. Presidential task force on redefining the postpartum visit. Optimizing Postpartum Care. ACOG committee opinion Number 736. May 2018.