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Discover more about the award winning, midwifery-led continence service at Lyell McEwin Hospital’s Women and Children’s Division.

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Lyell McEwin Hospital’s Women and Children’s Division has a dedicated midwifery-led continence service, which provides care for women across the lifespan. The service has been running for over 18 years with a predominant focus on women of reproductive age.  The team comprise of a diverse group of Midwives and Nurse, who were privileged to be awarded the ACM Excellence in Clinical practice award. I am Julie Tucker the Nurse/Midwife consultant who is fortunate enough to work with such a dynamic team in a great location Women and Children’s Division LMH.

Why would you want to work in the field of continence?

Most days I am asked why I have chosen to work as a continence midwife. Those who have asked me recount the disgust of dealing with urine, faeces and pelvic floor assessments, often stating there are better things to be doing when caring for women. These statements no longer challenge my thinking about the importance of my role, instead they promote dialogue on the importance in care of the whole woman during her life journey.

Upon reflection of our Nursing and Midwifery careers, and if we are all honest, continence rates very low on the priority scale for many nurses and midwives, but it is a basic element of care.

I trained as a Registered Nurse and Midwife (old school with hospital-based training) where I was immersed in the nursing theory’s that underpin and guide holistic patient care.  There was also the baptism of fire cleaning the pan room and giving glycerine and oil enemas at 5am in the morning often with explosive consequences!

I ventured into the Graduate Certificate of Continence purely by chance. Eleven years ago, I was keen to learn something new and the mental health course I wanted to start was not running so continence it was. Initially I questioned the relevance to Midwifery and then the analogy of “if only I knew then, what I know now….I would have delivered care differently”! It was a quantum head shift for my practice.

So why is continence not given priority in how we deliver holistic Midwifery care?

There are two areas often intertwined and raised during discussions with those who believe continence is not a concern for Midwives. Firstly, continence is not sexy and midwifery is all about the birth. Secondly, the stigma and beliefs surrounding continence is a big boundary. For example… 

Would you rather be delivering the baby or assessing void parameters during birth and postnatal? Would you rather be suturing after delivery or teaching intermittent self-catheterisation?

Realistically they are not really fair choices as they are all equally important.  Aren’t they?

The sexy parts of Midwifery practice are often viewed as the acute delivery and/or suturing, yet making sure we have optimised bladder and bowel function, and pelvic floor strength in the acute and long-term are equally important but are lost in translation.

Take for example anal sphincter tears: 

As a midwife do you understand the short and long term risks of anal incontinence, compounding injury to a weakened anal sphincter or chronic constipation on the sphincter muscle? Or, How does the reduced sensation to void postnatal affect bladder over distension or long-term bladder health?

These are all questions I began to ask myself when I discovered continence was indeed sexy and important.

The global view of optimising short and long-term health outcomes with bladder, bowel and pelvic floor function is discounted when women do not appear to have a problem. Yet the management of women during their pregnancy, birth and postnatal period can have significant impact on these areas in the not too distant future. Caring for the whole women, is not just during her reproductive years, but optimising her entire life journey. She will thank you for that!

Passion is a driver

Do we ask about sneaky bladder and bowel loss along the pregnancy birth continuum? Societal taboos influence how all of us address continence issues, you can see this through verbal and nonverbal body language. Yet Nurses and Midwives are in a privileged position to promote healthy outcomes for women in healthcare and so should ask the questions.

Research identifies that if you do not ask a woman she will not divulge concerns around continence. This is compounded by women often believing incontinence is part of birthing!! Further, pregnancy and birthing can worsen symptoms. Starting the conversation promotes disclosure and assists with identifying what strategies Midwives can put in place to optimise health outcomes for these women.   

I do not know about you, but I think I would like some skills or strategies early to reduce the embarrassment, self-isolation and potential financial burden that continence can have on a woman’s life.

Therefore, I think you get the drift why I believe that continence care is an integral part of Midwifery care.

Midwives are in a privileged position in caring for the whole woman and many midwives will see the same woman in a subsequent pregnancy.  How does it make you feel knowing that you have optimised her pelvic floor function?  It is a light bulb moment when you realise that continence truly matters. I encourage every Midwife to share my passion, and to promote and optimise pelvic floor function for women of reproductive age.

 

Regards,

Julie Tucker

Nurse/ Midwife Consultant Continence

CNA, RN, RM, BN, MN, MNSc, PhD candidate

Continence Nursing Service

Family Clinic

Lyell McEwin Hospital

Haydown Rd

Elizabeth Vale, S.A. 5112