World Congress on Physical Therapy 2017: Dr. Ginger Garner presents Global Maternal Health Crisis: Delivering a Biopsychosocial Model of Care involving Women’s Health Physiotherapy in the Postpartum Period
On July 2 I had the honor of presenting our research on the global maternal health crisis and what physical therapy can do in the postpartum period. My fellow authors and I had worked had over the last year to compile this evidence and present it in a way that relayed the appropriate urgency. It is long overdue for acting on the declining maternal health outcomes across the globe. There are definitive ways that physical therapy can help create new standards of postpartum care which would stand to greatly improve quality of life for all mothers worldwide. It is time we start caring for our caregivers.
Read our abstract below and watch a short video of my speech in South Africa.
Authors: Dr. Ginger Garner, Dr. Susan Clinton, Dr. Holly Jonley, Wendy Langshaw, Heba Shaheed, and Maria Elliott
The WHO have outlined that the world is experiencing a maternal health problem, especially in the postpartum period. There is a lack of accessible, affordable, understandable, customer-centric postpartum care globally. Postpartum women are suffering from pelvic organ prolapse, urinary and/or faecal incontinence, dyspareunia, diastasis rectus abdominis and pelvic pain.
This has a significant short and long term impact on the individual, their families and communities, with significant costs to the healthcare system, which could be avoided with appropriate care at the appropriate time. Women’s health physiotherapists are ideally placed to provide early intervention postpartum care.
To establish the global and local maternal health problems, and introduce a biopsychosocial, systems-based care model, with women’s health physiotherapy as the primary service provider, as an economic model to improving healthcare delivery and transforming healthcare culture.
A literature review was undertaken of current statistics of maternal health concerns and of service delivery within major western healthcare systems including the US, UK, Canada and Australia.
Leading women’s health physiotherapists from within these healthcare systems provided insight into their respective localities’ service delivery of postpartum care.
50% of women experience pelvic organ prolapse with symptoms of bladder and bowel dysfunction (Hagen et al, 2004), 45% of women suffer urinary incontinence 7 years postnatally (Wilson et al, 2002), and 66% of women with DRAM suffer from either stress urinary incontinence, fecal incontinence or prolapse (Spitznagle et al, 2007). 24% of women reported dyspareunia at 18 months postpartum (McDonald et al, 2015), and 58% of women report pain at the site of incision after caesarean section (Declercq et al, 2013).
A biopsychosocial systems-based model of care is proposed, led by early women’s health physiotherapy assessment and intervention. Prenatal and postnatal assessment and screening of every pregnant woman is proposed at 20 weeks and 32 weeks gestation and 6 weeks postpartum. Education of women and families preconception, during pregnancy and after birth is advocated.
Physiotherapists have unique opportunities to develop rapport, educate and inform regarding prevention and management of common postnatal issues. Physiotherapy has proven to be a successful adjunct to the care of many pregnancy and postpartum related impairments however often access is limited or it is not included as standard member of the interprofessional team for screening and management (ACOG, WHO, Australian Health Ministers’ Advisory Council 2012, RCOG 2015). Early identification and referral for postnatal issues is considered best practice and provides cost benefits alongside quality of life improvements (WL NICE Guidelines, NHS continence costings).
There is a significant disparity between women’s health physiotherapy involvement in postnatal care between the healthcare systems reviewed, with no standardised offerings across healthcare systems even on a local level. There is limited visibility of women’s health physiotherapy as an integral part of the maternity team within national and international guidelines and key strategic decision making.
This study concludes that maternal healthcare services should be provided to all pregnant women pre and post birth to minimise issues postpartum, improving women’s health and reducing the burden on long-term healthcare services.