Childbirth trauma – part 2

In this podcast, experienced urogynaecologist Dr Deepa Gopinath will be discussing the topic of childbirth trauma. This is the second podcast in a two-part series on childbirth trauma. Part 1 focused on what childbirth trauma is and how patients typically present. Part 2 will be discussing the specific treatment options & the role of health professionals.

• Transcript
  Please note this is a machine generated transcription and may contain some errors.
  *As always, all in this PODMD podcast is intended for health professionals and the comments are of a general nature. Information given is not intended as specific medical advice pertaining to any given patient. If you have a clinical issue with one of your patients please seek appropriate advice from a colleague with expertise in the area.

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  Welcome back to the PodMD studio Deepa

  In our last episode, we discussed the details and presentation of Childbirth Trauma. In this episode, we are delving into the treatment options.

  To get started Deepa, can you describe the role that a GP plays and what other help is available for them in the community?

  Deepa : The GP plays a pivotal role in identifying a woman who needs help. Given the psychological consequences, its highly likely that a GP would be the first port of call many of these women will have. This may be at the 6 week post-natal visit or earlier. Probing deeper into the cause may identify symptoms of a physical injury which then can be assessed further by a simple clinical examination. Acknowledging their concerns and validating their symptoms are important especially as many women have felt that their symptoms were dismissed as part of routine post partum recovery.

  The main community support for a physical injury is a specialised pelvic floor physiotherapist who would be able to assess the pelvic floor further and commence treatment strategies. The other professionals who may be accessible include a community midwife or a continence nurse. A psychologist involvement alongside is essential due to the interrelated nature of the trauma

  Question 1
  When is a specialist referral required?

  Deepa: Any woman who is suffering from severe physical injury should be referred to a specialist. This also allows the woman an opportunity to explore the events leading to causation during childbirth, discuss unmatched expectations as well as give them an opportunity to discuss future childbirth.

  The specialist can be a urogynaecologist, a general gynaecologist or even a colorectal specialist depending on the presenting symptom. They can assess the severity of the problem, perform required diagnostic tests and discuss management. This may be in the form of supportive devices like vaginal pessaries or medications like low dose vaginal oestrogen. There are also treatment strategies specific for pain including massaging the scar, injections, vaginal dilators etc as indicated. A multidisciplinary team approach is required with the allied health specialists and GP in the team..

  Question 2
  What is the prognosis of physical trauma? Is it likely to be a lifelong problem?

  Deepa: Majority of the cases of physical injury there is a good chance of recovery in the first 12-18 months with supportive therapy. This is due to the reversal of the pregnancy related changes and the improvement in the level of mum’s oestrogen once weaning starts. However, women do have to maintain a healthy lifestyle avoid becoming overweight, constipated and continue to perform pelvic floor exercises to minimise the recurrence in future. Women can experience worsening of symptoms around menopause due to the drop in oestrogen level in the body but still be amenable to conservative therapy.

  Question 3
  What other help is available for a woman who has sustained childbirth trauma?

  Deepa: There are many support systems that can be accessed easily online if women are struggling perhaps to get a GP appointment or not sure of what they are going through. ‘For when’ (forwhenhelpline.org.au) is a government funded support for perinatal mental health services in Australia that are managed by health professionals. (Mon-Fri). There is also PANDA that is accessible over longer hours from Monday to Saturday for perinatal mental health support. There are other organisations like the Australian birth trauma association and Birthtalk which are charities also providing a wealth of information and peer support.

  Concluding question
  Thank you for your time here today in the PodMD studio. To sum up for us, could you please identify the three key take home messages from this podcast series on childbirth trauma?

  Deepa: 1. To the women, do not suffer in silence- speak to a health professional -help is available
  2.To the Health professionals not to be dismissive of women’s symptoms as normal post-partum recovery.
  3.To the Specialists to manage this as a multidisciplinary team with the physiotherapists, psychologist, GP and other specialists as required with woman centred care

  Thanks again for your time and the insights you have provided

  Deepa: Thank you