Some of the thousands of comments people wrote when signing a petition calling for better postnatal care and rehabilitation in New Zealand. Image / Vinay Ranchhod, RNZ
By Michelle Cooke of RNZ
Corinne had prolapsed after giving birth to her first child and had to wait five months to see a district health board physiotherapist.
For Samantha, it's been a year since she had a caesarean but she is in excruciating pain, cannot twist more than 10 degrees and is still waiting to get help.
Leanne says after four births she developed diastasis recti - abdominal separation - which was repaired with the help of a private pelvic physio specialist and over four years of power plate and pilates, but she's aware many other mums won't be able to access the same support.
Amelia says she was injured while giving birth but can't afford rehabilitation.
Ashley says she has issues post-birth and hasn't seen a doctor "because of the cost when I know I really should".
Rachel simply says she "doesn't feel cared about".
These women are among 55,000 people who signed a petition calling for better postnatal care and rehabilitation in New Zealand.
Some men signed the petition too, but the signatures are overwhelmingly female - mums, nurses, physiotherapists, osteopaths, grandmothers, and women who hope to have children one day and want to receive adequate postnatal care.
Kirsty Watt launched the petition last June because she strongly believes women aren't receiving the care they need after giving birth. Thousands of comments on the petition echo her concerns, with many mums sharing their experiences of tears, prolapse, depression, incontinence and pain.
Over and over they say they did not know who to get help from, and if they asked for it their concerns were often dismissed or they were told they had to go private, or spend months waiting in the public system. Some have been living in pain for years.
"There's nothing for a mother after you have a baby - it's all about the baby," Watt says. "It's just that everyone deserves to be looked after, after birth, and we aren't getting that cover - no one is asking the questions."
Watt says GPs don't always check how new mums might be feeling, and midwives, who are overworked and underfunded, are primarily focused on providing care for the babies post-birth.
She says some new mums might be handed a pamphlet on pelvic floor exercises to do or they might be shown a video - but no one is following up to see if women are doing the exercises properly, or if they're working.
Many birth injuries are not funded by ACC, forcing women to seek treatment privately if they can afford it. Even when women ask for help Watt says they are often dismissed and left to think it's "something they have to live with".
Watt, a personal trainer and mum, says this lack of care can affect women for the rest of their lives, physically, financially and mentally.
The petition calls for free pelvic health checks from a specialised physiotherapist during pregnancy and in the two years after giving birth, better education on pelvic health and wound care management, substantially better funding for Continence NZ to employ more continence nurses, better access to pelvic health physiotherapists and for physical and mental health birth trauma treatment to be funded by ACC.
Having reached just over 55,000 signatures - close to the number of births in New Zealand each year - Watt closed the petition today. She's meeting with MPs next month, hoping they will support the petition and present it to the petitions committee, then have it escalated to the health select committee where it will be discussed by MPs.
Hannah May Lee says her first child was delivered via emergency C-section "due to getting very stuck" and she had extremely bad vaginal pain following the birth.
"I could not use tampons and struggled to cope with the pain of sex even one year post-delivery.
"I talked to my GP about this multiple times and not only did they not refer me to a specialist, but they didn't offer any advice or support on this," she says.
"No-one had also diagnosed me with diastasis recti. This was another issue I was only made aware of via an old friend who was diagnosed with it. Over 12 months after delivering my second child, I discovered I had this. When the GP checked and confirmed this was the case they did not refer me anywhere or offer me any advice."
Lee says she has had to work through the issues by herself.
"It seems crazy to me there is no specific post-partum ongoing care for women after the first six weeks. Or at least a safe place women can access to talk about post-partum health issues.
"I know a young woman who waited over two years to see a physio for post-partum incontinence - it turned out she needed surgery to fix this issue. These issues are so common it floors me that it is so difficult to access support."
"My first birth didn't go well. The ligaments in my pelvis ruptured - which I only found out four and a half years later, after I'd done enough research to know I would probably need surgery and asked my GP to refer me to a gynaecologist," a Wellington mum says.
"I had a prolapsed bowel, small intestine, bladder, and urethra. I was in chronic pain, even getting up the stairs from our house to the road felt like too much in the first few months postpartum. I paid for private physio, but improvement was slow."
The mum says things got worse after her second baby, but her surgery was covered by private health insurance and the standard of care was excellent.
"But as a matter of fairness and quality care, ACC needs to cover these sorts of injuries. Pelvic floor damage requires the full rehabilitative support ACC offers, just the same as other ligament and muscle injuries."
"I suffered nerve damage after tearing a muscle in my left thigh during labour - to the point where I could stick pins in my leg with no feeling as a party trick," Alexandra says.
"I was told to lose weight (I had a three-week-old baby) and not wear tight underwear. I could barely walk. No ACC claim, no public help. Years of private osteotherapy and only in the last few years has feeling come back."
"It is difficult to prioritise your own health when you have a baby, and it is also very hard to know what is 'normal' after giving birth to your first child in terms of recovery," says a 38-year-old mum of two.
"However, I realised after three months that numbness in huge sections of your groin, inability to sit cross-legged, bear weight, manage stairs and incontinence were really not 'normal', so I sought help."
She says her GP directed her to a private women's health physio, who "brushed off" her questions about ACC funding, telling her it was very difficult to get, and she was reluctant to help.
It was not until she sought treatment from an osteopath that an ACC claim was made.
"I had to do a very in-depth application, followed by a phone call where myself and my osteopath had to assure ACC that I had injured myself in the natural act of birthing my baby and not in the interventions I received, namely ventouse.
"I found this one of the most galling, humiliating and bewildering processes. ACC should be simple and easy for any women who injure themselves in birth. It should not be on us to show how we injured ourselves, and where the line between medical intervention/natural causes is."
The mum says she finds it really sad that mothers' bodies and health are not given anywhere near the same attention as babies', whom they care for, sometimes while in pain.
"Women's bodies are monitored so closely in pregnancy, our health prioritised and support offered, but it feels like this all drops away post-birth."
Pelvic health physiotherapist Liz Childs says pelvic floor problems resulting from childbirth are common, and often accepted as normal.
She says there should be better funding for education of all pregnant women, so they know how to do pelvic floor exercises and have self-help strategies.
Women also need to know what can go wrong and the symptoms to look for so they know when to see a GP or midwife for help.
"There is strong evidence supporting pelvic health physiotherapy treatment to help with prolapse and incontinence. It would be great if we had a situation in New Zealand where women had better access to the education and help they need for pelvic floor dysfunction, both during pregnancy and after childbirth.
"This would result in fewer people suffering the impacts of pelvic floor problems, that can at times be lifelong issues."
Rotorua mum of three Annie says her first birth, seven years ago, was traumatic and she had a lot of internal stitches but received no follow-up care.
"I remember it being three to four months before I felt normal down there and felt I could exercise. And the first time I exercised I completely wet my pants, so I kind of felt from there I wasn't really able to exercise and with my first I had postnatal depression, so feeling you're not able to exercise plays a huge role in postnatal depression as well."
She started seeing Kirsty Watt, the personal trainer who started the petition. Watt and a pelvic floor physiotherapist have helped her immensely, but she still suffers from a bit of stress incontinence.
Annie wants things to change for women, for them to receive better education and access to the care they need.
"I would like to see every woman who gives birth receive at least one pelvic floor check or have the ability to choose whether they do that or not. I know, looking back to me post-birth as a 24-year-old who had no idea what I know now, I think that would be really beneficial, not only for my whole health but my mental health as well," she says.
"Our wāhine deserve better. We don't need to be forgotten about."
- RNZ
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