Deirdre Daly, assistant professor in midwifery, Trinity College, vividly remembers the woman who triggered her PhD topic and the birth of an important – and free - online course related to Women’s Health After Motherhood – the WHAM course.
Still practising as a midwife in 2017, one pregnant woman attending her antenatal clinic seemed to be holding something back.
“On the third visit she started sobbing,” Deirdre says, “and told me she had been leaking both urine and faeces since the birth of her first child two years earlier. All the misery she had experienced came pouring out.”
There was no data. We don’t collect any data on women once they leave the maternity hospital
While this mother was referred to Cinny Cusack and her (physiotherapy) team in the Rotunda Hospital (mentioned below) - and became continent again - her story sent midwife and academic Deirdre in search of statistics about the number of women who were affected by health issues after childbirth.
“I couldn’t believe what I found,” she says. “There was no data. We don’t collect any data on women once they leave the maternity hospital. That discovery led to the Maternal Health and Maternal Morbidity in Ireland (MAMMI) study.”
Deirdre knew this woman’s story wasn’t unusual because international literature showed her that one third to one half of women experience various health problems after childbirth so it was time for research action and more.
What emerged was that considerable numbers of women were experiencing one or more health problems at different times
“Our MAMMI longitudinal study recruited 3,000 first time mothers,” she says, “and looked at women’s health problems after childbirth - urinary incontinence, faecal incontinence, pain, mental health issues including depression and anxiety, physical issues like back pain and perineal pain and sexual health issues like pain during sex. What emerged was that considerable numbers of women were experiencing one or more health problems at different times.”
She lists off some unsettling statistics related to this research.
Three months after childbirth, one in two women was leaking urine, 12 months later it was two in five; with faecal incontinence, one in 20 women was leaking stool 12 months after childbirth. As regards mental health issues, one in seven women was experiencing anxiety or depression a year after their baby was born and with sexual health, one in seven was experiencing pain during intercourse a year later. Some problems also pre-dated pregnancy.
When these findings were presented back to the women involved, the unanimous request was that something be done.
“We got funding then to develop resources around the women’s statement ‘what I wish I’d known’,” Deirdre says. “It was obvious that many women had been suffering in silence.”
The WHAM online course is free.
“That’s because our philosophy is that this is women’s information that they shared with us and that no women should ever be denied information like this because of lack of finance.”
Biggest issue: focus is all on the baby
When Deirdre and her research team asked the 3,000 women what the biggest issue was for them they said it was that all of the post-partum care is about the baby.
“Even the woman herself will put the baby first because she wants to be the perfect Mom and do everything right and she is in the midst of the exhaustion of coping with everything and she lets her health become secondary to everything else. Months down the line she says, ‘Hang on, I’m not thriving here, something’s not right’. Women told us again and again and again that health services were ‘all about the baby’ too. Some struggled with being invisible in the middle of maternity services that are supposed to be focussed on them,” she adds.
Post-partum care ends far too soon
The 3,000 women described post-partum care as ending far too soon.
“Particularly first time mothers haven’t even come to terms with being a mother by the time they have their six-week check-up. It can take three to six months before women feel they are getting their heads around caring for the baby.”
What did women not know?
Often new mothers didn’t know what was and was not normal, she says. “That can come from our grannies saying, ‘It’s normal to leak a bit after having a baby,’ but that’s not true. These health issues are common but they are not normal and they can be treated. Leaking urine or faeces can have a serious impact on quality of life.
“Some women spoke of changing the type of clothing they wore and others even stopped exercising. That’s going to lead to all sorts of physical and mental health problems and have a huge impact on the whole of their life, including intimate relations. Women can be very miserable trying to hide and cope with those health issues.”
Her key messages are as follows:
Women should thrive – not just survive – after childbirth. They shouldn’t just be putting up with health issues that are preventable and treatable. “Get treated,” she says, “so that they don’t wear you down and wear you out.
“Women are becoming mothers now in the midst of the pressurised social media ‘perfect mom’ era,” she says.
“You are there trying to juggle so many roles and feeling miserable and it drives you back further into your shell. They need reliable, trustworthy information. WHAM provides that. No one knows the woman like she knows herself and if she feels like she is not surviving, it’s time to look at some of the issues in the course.”
The design used is as follows:
What is the health problem?What you can do to help yourself.How and when to ask for professional help.The four-week course (that can be dipped into at any stage) covers:
Maternal health.Physical health.Mental health.Sexual health and relationships. Rotunda physio manager
Cinny Cusack is physio manager at the Rotunda Hospital and is also a physiotherapist trainer. She was also involved in the MAMMI study.
“The commonest problem we would treat in women after childbirth is pelvic floor dysfunction,” she says.
“That can be a variety of conditions. It can be urinary or faecal incontinence, pelvic floor pain or numbness or loss or change in sensation as a result of the delivery. Physiotherapy can help with all these issues.”
After birth we would focus on the mother regaining muscle tone and the strength of abdominal muscles
Pelvic girdle pain can also be an issue. “For the majority this resolves after the delivery but 7-8% would have ongoing pelvic girdle pain either at the back or front of the pubic bone.
“After birth we would focus on the mother regaining muscle tone and the strength of abdominal muscles and we would offer routine advice around how to manage back pain after a baby also. New mothers do a lot of sitting and bending so we would look at how to sit well, how to pick up the baby, how to avoid heavy lifting and have support when breastfeeding so that you don’t get upper back pain. After that there is rehab – how to return to exercise safely. New guidelines related to this were released in 2018 and they really help. A lot of women are keen for their mental health to return to running so we can give evidence-based advice to women about returning to normal activities and exercise.”
Women can self-refer back to us for six months if they’d had their baby here
Cinny mentions that there are very few physiotherapists available via primary care but that the bigger maternity hospitals run a very good service for mothers experiencing problems.
“Women can self-refer back to us for six months if they’d had their baby here, for example,” she says,” but often what you find is that by the time mums are in a position to look after themselves the six months have passed.”
A Donegal physiotherapist’s experience
Lorraine Boyce of downbelowphysio.ie is a chartered physiotherapist based in Donegal and saw the need for a dedicated pelvic floor physiotherapy clinic in her rural county. This led her to concentrate on “down below physio”.
“So many women have pain and pelvic floor problems ‘down below’ such as bladder/bowel incontinence, prolapse or painful sex as well as pregnancy complaints,” she says.
“It’s important then that women should have supportive, confidential environments to discuss their symptoms, and access information and treatment services to improve not just their physical pelvic health but their quality of life as a whole.”
As reported by Deirdre Daly, lead author of the MAMMI study, Lorraine’s experience is that women often have concerns like these for a long time and sometimes think they are the only ones with these worries.
I, for one, feel that it’s vital to speak as a physiotherapist as openly and honestly as possible
“They also think they have to put up with their symptoms,” says Lorraine, ”and that there’s no hope so it is very rewarding when someone is treated and says they are so relieved to be feeling better. Many thought they never would. That’s why pelvic health education is so important. I, for one, feel that it’s vital to speak as a physiotherapist as openly and honestly as possible on one’s social media about all the down to earth realities of pelvic health issues.
“It’s great also that now online video consultations and online pelvic floor/pilates programmes are available now via many chartered physiotherapists’ clinics so these services are accessible to everyone, no matter where they are.”
Useful info
There is also a companion course Journey To Birth on the same
futurelearn.com platform
rotunda.ie
Read more
School preparation in a COVID year
Text neck? What to do to stop it being a pain
Dealing with health issues during pregnancy
Deirdre Daly, assistant professor in midwifery, Trinity College, vividly remembers the woman who triggered her PhD topic and the birth of an important – and free - online course related to Women’s Health After Motherhood – the WHAM course.
Still practising as a midwife in 2017, one pregnant woman attending her antenatal clinic seemed to be holding something back.
“On the third visit she started sobbing,” Deirdre says, “and told me she had been leaking both urine and faeces since the birth of her first child two years earlier. All the misery she had experienced came pouring out.”
There was no data. We don’t collect any data on women once they leave the maternity hospital
While this mother was referred to Cinny Cusack and her (physiotherapy) team in the Rotunda Hospital (mentioned below) - and became continent again - her story sent midwife and academic Deirdre in search of statistics about the number of women who were affected by health issues after childbirth.
“I couldn’t believe what I found,” she says. “There was no data. We don’t collect any data on women once they leave the maternity hospital. That discovery led to the Maternal Health and Maternal Morbidity in Ireland (MAMMI) study.”
Deirdre knew this woman’s story wasn’t unusual because international literature showed her that one third to one half of women experience various health problems after childbirth so it was time for research action and more.
What emerged was that considerable numbers of women were experiencing one or more health problems at different times
“Our MAMMI longitudinal study recruited 3,000 first time mothers,” she says, “and looked at women’s health problems after childbirth - urinary incontinence, faecal incontinence, pain, mental health issues including depression and anxiety, physical issues like back pain and perineal pain and sexual health issues like pain during sex. What emerged was that considerable numbers of women were experiencing one or more health problems at different times.”
She lists off some unsettling statistics related to this research.
Three months after childbirth, one in two women was leaking urine, 12 months later it was two in five; with faecal incontinence, one in 20 women was leaking stool 12 months after childbirth. As regards mental health issues, one in seven women was experiencing anxiety or depression a year after their baby was born and with sexual health, one in seven was experiencing pain during intercourse a year later. Some problems also pre-dated pregnancy.
When these findings were presented back to the women involved, the unanimous request was that something be done.
“We got funding then to develop resources around the women’s statement ‘what I wish I’d known’,” Deirdre says. “It was obvious that many women had been suffering in silence.”
The WHAM online course is free.
“That’s because our philosophy is that this is women’s information that they shared with us and that no women should ever be denied information like this because of lack of finance.”
Biggest issue: focus is all on the baby
When Deirdre and her research team asked the 3,000 women what the biggest issue was for them they said it was that all of the post-partum care is about the baby.
“Even the woman herself will put the baby first because she wants to be the perfect Mom and do everything right and she is in the midst of the exhaustion of coping with everything and she lets her health become secondary to everything else. Months down the line she says, ‘Hang on, I’m not thriving here, something’s not right’. Women told us again and again and again that health services were ‘all about the baby’ too. Some struggled with being invisible in the middle of maternity services that are supposed to be focussed on them,” she adds.
Post-partum care ends far too soon
The 3,000 women described post-partum care as ending far too soon.
“Particularly first time mothers haven’t even come to terms with being a mother by the time they have their six-week check-up. It can take three to six months before women feel they are getting their heads around caring for the baby.”
What did women not know?
Often new mothers didn’t know what was and was not normal, she says. “That can come from our grannies saying, ‘It’s normal to leak a bit after having a baby,’ but that’s not true. These health issues are common but they are not normal and they can be treated. Leaking urine or faeces can have a serious impact on quality of life.
“Some women spoke of changing the type of clothing they wore and others even stopped exercising. That’s going to lead to all sorts of physical and mental health problems and have a huge impact on the whole of their life, including intimate relations. Women can be very miserable trying to hide and cope with those health issues.”
Her key messages are as follows:
Women should thrive – not just survive – after childbirth. They shouldn’t just be putting up with health issues that are preventable and treatable. “Get treated,” she says, “so that they don’t wear you down and wear you out.
“Women are becoming mothers now in the midst of the pressurised social media ‘perfect mom’ era,” she says.
“You are there trying to juggle so many roles and feeling miserable and it drives you back further into your shell. They need reliable, trustworthy information. WHAM provides that. No one knows the woman like she knows herself and if she feels like she is not surviving, it’s time to look at some of the issues in the course.”
The design used is as follows:
What is the health problem?What you can do to help yourself.How and when to ask for professional help.The four-week course (that can be dipped into at any stage) covers:
Maternal health.Physical health.Mental health.Sexual health and relationships. Rotunda physio manager
Cinny Cusack is physio manager at the Rotunda Hospital and is also a physiotherapist trainer. She was also involved in the MAMMI study.
“The commonest problem we would treat in women after childbirth is pelvic floor dysfunction,” she says.
“That can be a variety of conditions. It can be urinary or faecal incontinence, pelvic floor pain or numbness or loss or change in sensation as a result of the delivery. Physiotherapy can help with all these issues.”
After birth we would focus on the mother regaining muscle tone and the strength of abdominal muscles
Pelvic girdle pain can also be an issue. “For the majority this resolves after the delivery but 7-8% would have ongoing pelvic girdle pain either at the back or front of the pubic bone.
“After birth we would focus on the mother regaining muscle tone and the strength of abdominal muscles and we would offer routine advice around how to manage back pain after a baby also. New mothers do a lot of sitting and bending so we would look at how to sit well, how to pick up the baby, how to avoid heavy lifting and have support when breastfeeding so that you don’t get upper back pain. After that there is rehab – how to return to exercise safely. New guidelines related to this were released in 2018 and they really help. A lot of women are keen for their mental health to return to running so we can give evidence-based advice to women about returning to normal activities and exercise.”
Women can self-refer back to us for six months if they’d had their baby here
Cinny mentions that there are very few physiotherapists available via primary care but that the bigger maternity hospitals run a very good service for mothers experiencing problems.
“Women can self-refer back to us for six months if they’d had their baby here, for example,” she says,” but often what you find is that by the time mums are in a position to look after themselves the six months have passed.”
A Donegal physiotherapist’s experience
Lorraine Boyce of downbelowphysio.ie is a chartered physiotherapist based in Donegal and saw the need for a dedicated pelvic floor physiotherapy clinic in her rural county. This led her to concentrate on “down below physio”.
“So many women have pain and pelvic floor problems ‘down below’ such as bladder/bowel incontinence, prolapse or painful sex as well as pregnancy complaints,” she says.
“It’s important then that women should have supportive, confidential environments to discuss their symptoms, and access information and treatment services to improve not just their physical pelvic health but their quality of life as a whole.”
As reported by Deirdre Daly, lead author of the MAMMI study, Lorraine’s experience is that women often have concerns like these for a long time and sometimes think they are the only ones with these worries.
I, for one, feel that it’s vital to speak as a physiotherapist as openly and honestly as possible
“They also think they have to put up with their symptoms,” says Lorraine, ”and that there’s no hope so it is very rewarding when someone is treated and says they are so relieved to be feeling better. Many thought they never would. That’s why pelvic health education is so important. I, for one, feel that it’s vital to speak as a physiotherapist as openly and honestly as possible on one’s social media about all the down to earth realities of pelvic health issues.
“It’s great also that now online video consultations and online pelvic floor/pilates programmes are available now via many chartered physiotherapists’ clinics so these services are accessible to everyone, no matter where they are.”
Useful info
There is also a companion course Journey To Birth on the same
futurelearn.com platform
rotunda.ie
Read more
School preparation in a COVID year
Text neck? What to do to stop it being a pain
Dealing with health issues during pregnancy
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