A guiding voice

Experts say nurses have a large role to play in helping pregnant women overcome incontinence. 

Half of all pregnant women experience incontinence and midwives have an important role to play in reducing the numbers.

“In the vast majority of cases, urinary incontinence during pregnancy and after childbirth is preventable,” Rowan Cockerell, deputy CEO of the Continence Foundation of Australia says. “Nurses and midwives have an important public health role to play in raising women’s awareness of the potential issues and specific risks of incontinence during their childbearing years.”

Cockerell says the prevalence of incontinence is due to the extra weight women carry during pregnancy and the stresses of childbirth that can strain or damage a weak pelvic floor.

Additionally, up to 1-in-4 women have anal incontinence in later pregnancy, with 1-in-5 still experiencing the problem after birth.

The Continence Foundation is launching a national campaign called Managing the Mother Load to be launched during World Continence Week, towards the end of June.

The aim is to raise awareness, amongst health professionals and those at risk, of the importance of maintaining pelvic floor health prenatally, throughout pregnancy, and afterwards.

“Unfortunately, a significant number of women ignore the problem or accept it as a normal part of having children,” Cockerell says. “But urinary incontinence isn’t normal, and may get worse if ignored and left untreated.”

The project also encourages mothers and pregnant women to do pelvic floor exercises that have been shown to help prevent and even cure urinary incontinence. During World Continence Week, a pregnancy guide booklet and Pregnancy Pelvic Floor Plan smartphone app will be launched.

The Continence Foundation collaborated with the Australian College of Midwives (ACM) to develop an educational program that focuses on the impact of pregnancy and childbirth on pelvic floor dysfunction. The e-learning course content has been compiled by experts in the field, and will be free for ACM members; non-members will be able to access the training package for a fee.

The course is made up of three modules that cover anatomy and pelvic floor dysfunction, the impact of pregnancy and childbirth, and postnatal care and long-term issues. The program also provides CPD points.

“[Midwives] are ideally placed to provide antenatal education, early screening, and detection and management of women at risk of long-term continence issues,” Cockerell says.

Rosey King, program co-ordinator of the Graduate Diploma of Midwifery at Federation University of Australia, agrees midwives are ideally placed to promote bladder and bowel health.

“Continence issues can impose long-term health problems and restrictions on people’s social interactions and their mobility; in addition, bladder or bowel incontinence is a primary factor influencing admission of the elderly into long-term care facilities,” she explains.

King says nurses will also work with patients who have experienced or may be at risk of continence issues.

“Ideally nurses and midwives will grasp every opportunity to discuss and promote good bladder and bowel health in the specific contexts of their own workplaces,” she says. “All nurses can be informed about good bladder and bowel health and be aware of clinics or other practitioners providing consultation, assessment and management for men and women of any age who are experiencing continence issues.

“This person may have a medical, nursing, physiotherapy or midwifery background and has gone on to pursue further studies in continence assessment and management.”

Janine Armocida, a continence nurse and midwife, agrees that if midwives encounter pregnant patients with incontinence issues and don’t feel equipped to help, they should refer them to a specialist within the hospital or the community who can assist the person.

To determine whether a patient has such problems, she says, asking women if they are experiencing any trouble is important. Addressing these issues throughout pregnancies is ideal, as the patients are a captive audience. Armocida says management needs to be involved in this, by keeping questioning surrounding incontinence is on the clinical pathways to ensure it is being done.

She says midwives and nurses can try to identify those who are at risk by looking out for women with connective tissue abnormalities, a greater BMI, or who have had more children. Furthermore, she says when midwives are checking the perineum antenatally and postnatally, they can ask the patient to “draw up” to see if the pelvic floor is working.

Should any issues be found, Armocida agrees that pelvic floor exercises should be recommended. She adds that they are also beneficial in reducing the size of prolapses. Half of all women who have given birth experience prolapse. Armocida says, “The risk of prolapse certainly increases and if their mother or sisters have had prolapses or if they’re carrying extra weight [it further increases].”

Armocida urges midwives and nurses to teach patients how to do pelvic floor exercises. “If they are experiencing any problems they [need to] learn to draw up,” she says. “Times when they cough or sneeze or pick up children, they’re more prone to leakage because they’re increasing their intra-abdominal pressure, and you want to teach them how to engage their pelvic floor first.”

She adds there are serious problems that come with incontinence. “I work as a maternal and child-health nurse as well, and I see a lot of women who are experiencing depression and you certainly want to rule out incontinence as being another contributing factor to that,” she says, adding that self-esteem, relationship and sexual issues can arise among sufferers of incontinence and they may become isolated.

Stress urinary incontinence – the most common type of urinary incontinence – was found to have detrimental effects on the quality of life in almost 55 per cent of all pregnant women.

By talking about the issue, Armocida says, the myths and stigmas surrounding it will be removed and people will start to feel more comfortable talking to their GP about it and accessing services.

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