Day: March 22, 2019

Birth trauma – comment on SMH article 22/03/2019

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An Article I read today in the SMH prompted me to write this post.  It was about women who felt disempowered, traumatised and depressed regarding their birth experiences and the short term and longer term after-effects.  In particular, the main woman in the article had been significantly physically and emotionally traumatised by her birth experience, (having sustained a third degree perineal tear and an avulsion injury to her pelvic floor muscles), after an instrumental delivery.  The article then went onto discuss that many women were not often given the chance to make decisions during labour about the proposed interventions and had not given their express “informed consent”,  for certain more interventional procedures.  Also mentioned, was the lack of warning of the potential risks to the woman, of such procedures.

Whilst obtaining “informed consent” is the ideal in the world of patient care,  I think any of us who have either been through a “successful”, (or attempted, but unsuccessful) vaginal birth, would agree that we are not always thinking rationally, or able to make great decisions in the face of immense pain and often great fear.  With the birth of my (almost 10lb) first child,  when my wonderful obstetrician arrived, if he had have told me he was going to slice me from neck to pelvis to get this baby out, and end the excruciating pain I was experiencing, I would have screamed my agreement.  Thankfully he did not…lol, but thanks to expert forceps manoeuvring and a fairly large episiotomy… (oouch…that 19 years later still sends a shiver down my spine)  ..both my big boofhead of a son and I, got through the experience relatively unscathed.  And I will be forever grateful to my wonderful obstetrician for this!!

This is why expectant parents need to do thorough research, ask questions and seek advice, prior to engaging their medical team.   They need to find an obstetrician/team, with whom they feel comfortable, can relate to, and that they can trust will make the best decisions (based on their expertise), at such a time, that they are incapable of making good decisions themselves.  Discussing possible birth scenarios, the pros and cons, the medical rational for one type of delivery as opposed to another and the varying options, should all be discussed prior to labour and delivery.  The vast majority of obstetricians and midwives, (particularly those that I work with, anyway), are deeply concerned about achieving the best possible outcomes for the mums’ under their care, and of course the safe delivery of a healthy baby.  We need to trust in their decision making and care… after all that is what we pay them for….

 

Next week…. the importance of a 6 week post-natal physiotherapy check..

BODY AWARENESS

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As suggested, a comment on body awareness.  Body awareness is the knowledge of where your body or body parts are in space.  Most of us take this for granted, but for people that have been injured or have undergone postural changes (for a variety of reasons, including pregnancy) the awareness or perception of where our body is in space may be altered or distorted.  For example: you may feel that you are sitting up straight until someone points out to you in the mirror that you are slouching or leaning more to one side….you may think you are standing with even weight on both legs until someone puts a set of scales under each foot and shows you that not.  This altered perception of how your body moves in space, over time can become your “normal”, and may result in you not moving in the most efficient way, leading to muscle fatigue and ultimately pain.

This is where a physiotherapist can help.  We can make you become more aware of your posture and how you are moving and give you some tips to readjust your “normal”.  This may involve strengthening certain muscles, it may involve exercises in front of a mirror, it may be giving you hands on feedback…

Body and spacial awareness results from quite a complex set of processes and skills, including a combination of good proprioception, balance, muscular control and posture.  Physio’s spend their entire working life (and not just at work), looking at how people move and thus can help you to recognise your imbalances and start to correct them…..

And yes, when physios are out shopping and doing our normal day activities,  we are watching how you walk and move and trying to analyse why… its been ingrained, its in our nature and we can’t help it!! Sorry..lol

That is my last blog for the week.  Hope ,everyone did a few extra pelvic floor exercises this week!! Have a wonderful weekend…..

Cheers Kristy

 

PROLAPSE

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Did you know that it is estimated that up to 70 percent of women who have delivered vaginally will have a degree of vaginal prolapse in the first few months postnatally??  Most women are not aware of this as it is not causing them any symptoms.  For those that are aware however, the realisation that something is there in the vaginal that shouldn’t be can be confronting and quite distressing.

The good news is that in the vast majority of cases this will resolve given time for the pelvic ligaments to tighten up and the pelvic floor muscles to strengthen.  Also important, is not stressing the pelvic floor doing high impact/intensity exercise until this has resolved.  For those girls who are continuing to experience symptoms, there are conservative measures to relieve the symptoms such as vaginal support devices and an intensive pelvic floor exercise program.  It may be necessary for you to modify your exercise program for a whilst to allow the pelvic floor to strengthen.  Later in the year I will be trained in the fitting of vaginal support devices….stay tuned….

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