Working as a senior chartered physiotherapist in a large maternity hospital allows me to work with a variety of conditions and, more importantly, to work among a team of dedicated chartered physiotherapists in women’s health and continence.
Due to the high demand for our services and the sheer volume of referrals received from within the hospital and the multidisciplinary team, the department runs a variety of classes so that we can see as many women as possible when they need our help. My typical daily caseload involves a mixture of classes and treating patients individually in our outpatient department.
The physiotherapy department, in conjunction with our colleagues in midwifery, places a huge emphasis on antenatal education. At present the department runs eight classes per week, which complement the midwifery classes. Our aims are to educate and empower women to take an active role in their pregnancy and labour.
Pregnancy
In our early pregnancy physiotherapy antenatal class we discuss the importance of general exercise, safe exercise in pregnancy, back care, posture and the role of the pelvic floor in pregnancy, birth and later life. This is important as the body experiences many changes during pregnancy that can lead to stress, strain and discomfort.
Research has shown that women who participate in pelvic-floor exercises antenatally have a better outcome post-delivery regarding pelvic-floor dysfunction and incontinence.
One in three women are affected by pelvic-floor and bladder problems but they may not discuss these among their peer group even though their quality of life may be severely affected.
In our classes women are taught how to perform pelvic-floor exercises correctly and are educated in good bladder habits to encourage lifelong continence. We also advise women about when they should seek advice.
Labour
Our subsequent antenatal classes concentrate on encouraging women to use their own resources, such as deep relaxation, rhythmical breathing and comfortable positioning, for managing labour.
The physiotherapist aims to promote a woman’s confidence in her body’s own ability to give birth. Non-pharmacological methods of pain relief, including the use of the Tens machine, are discussed. We also address how to get your tummy, lower back and pelvic floor muscles in shape post-birth, give tips on enhancing your baby’s development in the first few months, and advise about car seats, bouncers and other equipment parents may use.
The classes are a lovely way for women to meet other expectant mums and share their experiences.
It is really satisfying when women tell us they feel so much more confident approaching birth after attending our classes.
Pain
Some pregnant women and new mothers can experience challenging lower-back pain or pelvic girdle pain (PGP). Symptoms can include pain in the pubic bone, hips, lower back and pelvis, or a combination of places. This can typically affect the ability to walk, transfer from one position to another, and produce pain with dressing, driving, using stairs and turning in bed.
We have up to 9,000 women a year giving birth here and the physiotherapy department frequently receives up to 200 referrals a month. This can be very challenging with such small staff numbers, so in order to reduce waiting times we initiated low back pain/PGP classes, which we hold three to four times a week.
Women are shown safe exercises and techniques to strengthen and stretch the affected tissues. Practical advice and tips on how to reduce strain during labour and birth are also discussed. Support belts can be beneficial and are provided if appropriate for the patient.
Having attended the class and adopted the tips and strategies, if a patient feels the need to have an individual appointment, the physiotherapy team can then assess them individually and treat with manual treatment techniques as needed.
Postnatal
All women are encouraged to attend the postnatal physiotherapy class once they have had their baby. This class revises the pelvic-floor exercises, enables their tummy muscles to be checked and teaches women how to return to exercise gradually and safely. We also teach mothers about enhancing their baby’s development.
A large component of our work addresses pelvic-floor dysfunction, whether post-birth or later in life. Common problems experienced by new mothers include various types of urinary incontinence or waking during the night to pass urine.
Bowel function can also be affected, giving rise to faecal incontinence, faecal urgency or loss of control of wind. Prolapse and/or a feeling of a bulge in the vagina or something coming down are not uncommon. Pelvic floor pain is another condition and this can lead to pain during intercourse and can really affect a person’s relationship and their quality of life.
Physiotherapy can be very effective in treating all of the above conditions. I recently treated a lady who attended physiotherapy who had been diagnosed with endometriosis and was referred for the treatment of pelvic floor pain.
It had a huge impact on her intimate relationship, which was very upsetting for her.
Our treatment included explaining the function of the pelvic floor and I used manual therapy to release the tight and tense pelvic floor muscles.
The patient attended a number of sessions over a few months and her goal of resuming normal intimate relations was achieved; her quality of her life and that of her partner was much improved.
There was a real sense of achievement for me that this woman was able to reach her goal.
Bladder
Patients will initially attend a bladder class in which they are educated on the conditions and factors affecting the pelvic floor and bladder. As a nation of tea and coffee drinkers, we educate patients on the importance of drinking adequate and suitable fluids.
We also discuss correct pelvic-floor muscle exercises and good bladder habits. Women will then be assessed individually by one of our specialist physiotherapists who will perform a vaginal assessment to assess the pelvic-floor muscles properly and commence the appropriate treatment.
At the Coombe we also provide physiotherapy to many babies with a variety of conditions including positional plagiocephaly (flat head), which is very common these days, and babies with developmental dysplasia of the hip (clicky hips). We also follow up premature babies and any other babies who might have developmental delay including babies with Down syndrome and those at risk of cerebral palsy.
Variety
My weekly caseload provides me with the opportunity to treat a large variety of conditions, and no two days are the same. As a chartered physiotherapist in this field, one gets to meet lots of patients and share their individual life experiences.
Patients share very intimate details and can often shed a few tears when discussing their problems, but it is lovely when your treatment has been successful and the patient says “My quality of life is back to normal. I can now dance at a wedding without leaking,” or “I can now leave the house without worrying where the next toilet is.”
A highlight of my day is when I meet a woman who attended my antenatal classes and see her excitement as she shows off her newborn baby. I hope the next generation will take a more proactive approach to their healthcare and I believe specialist physiotherapists will play a vital role in empowering women to do so.
