I’ll just say it; Living outside of a major city in Australia puts you at a disadvantage. Don’t get me wrong, I live regionally, and I love it. I have no desire to return to the chaos of the capital city I studied in. I appreciate the slower-paced, coastal and walkable community I call home. However, I do not believe that this is some sort of moral failing which means I should have less access to healthcare than my metropolitan counterparts.
In Australia, most women who give birth will sustain some degree of pelvic floor injury,1,2. Yet access to pelvic health physiotherapy services remains inadequate at best for most of us.3 Collectively, we need to do better to get pelvic health physiotherapy services out to the regions to every person who needs them.
I have worked in musculoskeletal physiotherapy for years, and as I entered the world of pelvic health, the disconnect between the way we treat people depending on where their injury is has been astounding. During my pelvic floor physiotherapy training, one of the most eye-opening moments was when one of the teachers said “Your pelvic floor muscles are just that – muscles. They’re just in a very private area.”. It was an eerily cartoonish moment for me where I could almost feel a lightbulb appear above my own head.
Of course! Our pelvic floor muscles don’t suddenly work differently to every other muscle in our body because they’re in our pelvis. So why do we treat them so differently in terms of access to healthcare? If you injured a muscle in any other part of your body, you can (and should) expect access to healthcare professionals who are trained and able to help you. We communally recognise that there is no heroicism in not seeking help and pushing through symptoms. Why do we not treat the pelvis the same way? Echoes of “Well of course. What did you expect after having a baby?” would not be accepted if we were to apply it to dysfunction of any other muscle group.
So how do we demand better for ourselves and be a bit clever about getting pelvic health physiotherapy to everyone who needs it?
First and foremost we need to be very honest about the huge barrier for a lot of people to accessing the care they need – the cost. There is a lot more information here along with a petition you can sign in favour of including Medicare-funded pelvic health physiotherapy appointments as part of routine care before and after birth (just like they already do in a number of European countries!).
But even once we address the cost – we need to figure out how to physically get the right physios to the right people. Funding is all well and good until you have to drive a 5 hour round trip to get to your nearest pelvic health physiotherapy clinic. Who has time to do that with a baby in tow?
The good news is that emerging from the shambles of the last few COVID-dominated years comes a solution. A large body of evidence shows us that pelvic health physiotherapy delivered via telehealth (an online appointment similar to a Zoom call) is very effective at reducing incontinence, improving pelvic floor muscle function and overall quality of life.4 It also means that we can get these important services out to the areas they’re needed – wherever that might be.
I have become one in a long list of physiotherapists who turned to practicing in pelvic health after experiencing my own traumatic birth. I feel a deep sense of purpose in my role devoting my time and energy to help others throughout the pregnancy, birth and postpartum periods the way I wish I had been helped.
As part of my dream to see every single person who needs a pelvic health appointment be able to access one, because outside of the cities, we have missed out for far too long. Sadly, telehealth is still a pretty new concept for most. Yet we know just how important it is to get these services to the people who need them; and the profound positive effect on someone’s life which that can have. We also know that the idea of accessing pelvic floor physiotherapy can bring up a large range of emotions – particularly following a traumatic birth experience.
About the author
Eloise Simpson B.HlthSc. M.Physio. Grad Cert (MSK Physio). Grad Cert (Pelvic Floor Physio). Current PhD candidate.
Eloise is a physiotherapist who grew up in regional Victoria and has always cared deeply about rural and women’s health. She is currently a PhD candidate investigating management of diastasis of the rectus abdominis muscles (DRAM) in the early postpartum period and the secondary effects on the pelvic floor. She is the founder and director of Connect Physio Co (www.connectphysioco.com.au), Australia’s first fully online physiotherapy urgent care clinic which also offers both standard and pelvic floor physiotherapy appointments Australia-wide via telehealth. You can reach her at admin@connectphysioco.com or via the website www.connectphysioco.com.au
References
Dietz HP. Pelvic floor trauma in childbirth. Australian and New Zealand Journal of Obstetrics and Gynaecology. 2013 Jun;53(3):220-30.
Chen Y, Geng X, Zhou H, Wang W, Liang Y, Zhang C, Wang L. Systematic review and meta-analysis of evaluation of selective cesarean section in postpartum pelvic floor function recovery under perineal ultrasound. Annals of Palliative Medicine. 2022 Feb 1;11(2):730-42.
K. Alcorn, A. O’Donovan, J. Patrick, D. Creedy, G. Devilly, A prospective longitudinal study of the prevalence of post-traumatic stress disorder resulting from childbirth events, Psychol. Med. 40 (11) (2010) 1849–1859.
da Mata KR, Costa RC, Carbone ÉD, Gimenez MM, Bortolini MA, Castro RA, Fitz FF. Telehealth in the rehabilitation of female pelvic floor dysfunction: a systematic literature review. International urogynecology journal. 2021 Feb;32(2):249-59.
