In April I had the chance to speak to a bunch of midwives about pelvic floors at the MaMa Conference. Actually, it was in Edinburgh's poshest room, full of Sleb Midwives - 300 women at the top of their game, passionate about delivering the best care possible. So, not intimidating at all, then.
And, me, waving a plastic pelvis about and making weak jokes about pelvic floors.(seewhaddadidthur?)
I met Jaque Gerrard, director of the Royal College of Midwives in England (I resisted the urge to curtsey) and we got chatting about the draft joint statement between the CSP (my governing body) and the one that she's in charge of.
I was really excited - getting different professions to collaborate on continence services is the best way to solve the problem of incontinence. Multi-faceted approaches work, and what better than a collaboration between physios and midwives to deal with pelvic floors?
And, then, I read the draft.
It's awkward, when you read something which has been a huge piece of work, and is valuable - but...you don't like it.
The joint statement says that midwives should be delivering pelvic floor education to women, ehm, because the women like it. Eh? So, when a bunch of pregnant women were asked "would you like this embarrassing stuff to be taught to you by your midwife that you already know and like - or by a physio whom you've never met?" they all voted for their friendly, brilliant midwife? Fair enough....
...ehm, <nervously puts hand up from the back of the class> what about the women who aren't pregnant? What about the women who have never been pregnant? What about the men?
See, I'm worried that a joint statement like this will fuel more cuts to continence services. We need MORE physios in womens' health - not fewer!
So, I've written to the CSP's magazine, Frontline. I hope they'll publish it (though, it is quite wordy - you know how I can go on.
(for the record - I luffs midwives. Especially Deirdre. When she moved area, I stopped breeding. Cause and effect, people)...
Dear Frontline
I applaud the collaboration between the CSP and the Royal
College of Midwives (RCM) in writing the joint statement on pelvic floor muscle
exercises (http://www.rcm.org.uk/college/policy-practice/joint-statements-and-reports/)
However, I am concerned by this: "
A recent study of patients and health care professionals showed
that a majority of pregnant women would prefer to be taught PFME by their
midwife. This was also the case for midwives, because a majority in the study
agreed with the women"
In my experience, women in the
antenatal period are only really interested in information pertaining to getting
the baby out. Postnatally, they want to know about how to feed the baby
and how to get some sleep. Women do not listen to pelvic floor advice at
that stage in their lives, their pelvic floor is put on to their "to do"
list, and they never quite get around to doing their list.
1:3 women aged 35-55 have continence
issues. Read that again - a third of our women wet themselves.
Once they are over 55 it's half of the female population. That is not
acceptable, and, I consider that the CSP will be letting women down if we allow
the RCM to be responsible for the majority of pelvic floor education.
Of course, I accept that it is vital
that midwives include pelvic floor education in their services - but,
what about those women who are not pregnant or more than 11 days
post-partum? Or, even, goodness, say, a man with pelvic floor
dysfunction?
The figure of £117 million pa to the
NHS is flawed. It does not take into account the secondary costs
- eg. a third of people with incontinence are also depressed; women who leak
when they run stop running, diseases of inactivity like cardiac disease is one
of UK's biggest killers; an unknown number of hip fractures are caused by
elderly people hurrying to go to the toilet at night, 25% of women over 80 who
break their hip will be dead within a year. We do not even count how many
people have to move into residential care purely for continence care.
Australia includes secondary costs and
calculates the burden of incontinence is $42.9 BILLION (http://www.continence.org.au/data/files/Access_economics_report/dae_incontinence_report__19_april_2011.pdf)
Harriet Harman has announced a
Parliamentary Review of women in sport (https://www.labour.org.uk/harriet-harman-calls-for-parliamentary-inquiry-into-womens-sport)
Part of her five point plan is to encourage young women to participate in
sport. Well, in order to keep women active we first need to keep them
dry. Physiotherapists should be at the forefront of this parliamentary
enquiry - but, we are not.
It is my belief that physiotherapists
are letting women down. Our under-grad courses do not teach continence and
pelvic floor exercises. We do not ask our orthopaedic patients whether the
reason they fell was because they need to get up for a pee every three
hours, and even if we did, would we be able to teach the patient how to use a
bladder diary? We do not campaign to make continence mainstream - and
now, we are handing over the job of pelvic floor education to our midwife
colleagues who have contact with women until 11 days post-partum because a
survey said that's what women want.
This joint statement reinforces women's
beliefs that it is inevitable to be a "leaky new mum". And, I do not agree
that midwives are best placed to prevent these women from progressing
to "smelly old lady".
In my opinion, it is vital that
pelvic floor education is given outwith maternity services. I'd like to
see this information delivered in schools as part of sex education and make it
as normal to do your exercises as it is to brush your teeth.
Physiotherapist are best placed to do this. We could be more dynamic,
deliver pelvic floor education through social media, and break the
taboo which prevents women from seeking help.
Incontinence interferes with every
single aspect of their lives and causes real suffering. Simple stress
incontinence is a condition which can be completely cured by
doing exercises.
Which part of a condition which causes
pain and suffering, affects anyone at any point in their lives and which
can be cured by exercise is NOT part of the job description of a
physiotherapist?
Yours faithfully
Elaine Miller
www.gussetgrippers.weebly.com
@gussiegrips
And, me, waving a plastic pelvis about and making weak jokes about pelvic floors.(seewhaddadidthur?)
I met Jaque Gerrard, director of the Royal College of Midwives in England (I resisted the urge to curtsey) and we got chatting about the draft joint statement between the CSP (my governing body) and the one that she's in charge of.
I was really excited - getting different professions to collaborate on continence services is the best way to solve the problem of incontinence. Multi-faceted approaches work, and what better than a collaboration between physios and midwives to deal with pelvic floors?
And, then, I read the draft.
It's awkward, when you read something which has been a huge piece of work, and is valuable - but...you don't like it.
The joint statement says that midwives should be delivering pelvic floor education to women, ehm, because the women like it. Eh? So, when a bunch of pregnant women were asked "would you like this embarrassing stuff to be taught to you by your midwife that you already know and like - or by a physio whom you've never met?" they all voted for their friendly, brilliant midwife? Fair enough....
...ehm, <nervously puts hand up from the back of the class> what about the women who aren't pregnant? What about the women who have never been pregnant? What about the men?
See, I'm worried that a joint statement like this will fuel more cuts to continence services. We need MORE physios in womens' health - not fewer!
So, I've written to the CSP's magazine, Frontline. I hope they'll publish it (though, it is quite wordy - you know how I can go on.
(for the record - I luffs midwives. Especially Deirdre. When she moved area, I stopped breeding. Cause and effect, people)...
Dear Frontline
I applaud the collaboration between the CSP and the Royal
College of Midwives (RCM) in writing the joint statement on pelvic floor muscle
exercises (http://www.rcm.org.uk/college/policy-practice/joint-statements-and-reports/)
However, I am concerned by this: "
A recent study of patients and health care professionals showed
that a majority of pregnant women would prefer to be taught PFME by their
midwife. This was also the case for midwives, because a majority in the study
agreed with the women"
In my experience, women in the
antenatal period are only really interested in information pertaining to getting
the baby out. Postnatally, they want to know about how to feed the baby
and how to get some sleep. Women do not listen to pelvic floor advice at
that stage in their lives, their pelvic floor is put on to their "to do"
list, and they never quite get around to doing their list.
1:3 women aged 35-55 have continence
issues. Read that again - a third of our women wet themselves.
Once they are over 55 it's half of the female population. That is not
acceptable, and, I consider that the CSP will be letting women down if we allow
the RCM to be responsible for the majority of pelvic floor education.
Of course, I accept that it is vital
that midwives include pelvic floor education in their services - but,
what about those women who are not pregnant or more than 11 days
post-partum? Or, even, goodness, say, a man with pelvic floor
dysfunction?
The figure of £117 million pa to the
NHS is flawed. It does not take into account the secondary costs
- eg. a third of people with incontinence are also depressed; women who leak
when they run stop running, diseases of inactivity like cardiac disease is one
of UK's biggest killers; an unknown number of hip fractures are caused by
elderly people hurrying to go to the toilet at night, 25% of women over 80 who
break their hip will be dead within a year. We do not even count how many
people have to move into residential care purely for continence care.
Australia includes secondary costs and
calculates the burden of incontinence is $42.9 BILLION (http://www.continence.org.au/data/files/Access_economics_report/dae_incontinence_report__19_april_2011.pdf)
Harriet Harman has announced a
Parliamentary Review of women in sport (https://www.labour.org.uk/harriet-harman-calls-for-parliamentary-inquiry-into-womens-sport)
Part of her five point plan is to encourage young women to participate in
sport. Well, in order to keep women active we first need to keep them
dry. Physiotherapists should be at the forefront of this parliamentary
enquiry - but, we are not.
It is my belief that physiotherapists
are letting women down. Our under-grad courses do not teach continence and
pelvic floor exercises. We do not ask our orthopaedic patients whether the
reason they fell was because they need to get up for a pee every three
hours, and even if we did, would we be able to teach the patient how to use a
bladder diary? We do not campaign to make continence mainstream - and
now, we are handing over the job of pelvic floor education to our midwife
colleagues who have contact with women until 11 days post-partum because a
survey said that's what women want.
This joint statement reinforces women's
beliefs that it is inevitable to be a "leaky new mum". And, I do not agree
that midwives are best placed to prevent these women from progressing
to "smelly old lady".
In my opinion, it is vital that
pelvic floor education is given outwith maternity services. I'd like to
see this information delivered in schools as part of sex education and make it
as normal to do your exercises as it is to brush your teeth.
Physiotherapist are best placed to do this. We could be more dynamic,
deliver pelvic floor education through social media, and break the
taboo which prevents women from seeking help.
Incontinence interferes with every
single aspect of their lives and causes real suffering. Simple stress
incontinence is a condition which can be completely cured by
doing exercises.
Which part of a condition which causes
pain and suffering, affects anyone at any point in their lives and which
can be cured by exercise is NOT part of the job description of a
physiotherapist?
Yours faithfully
Elaine Miller
www.gussetgrippers.weebly.com
@gussiegrips