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Why is it important for midwives to know all about continence?

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Thoughts & musings on midwifery related topics for the January Education Newsletter. 

Ruth King, Midwifery Advisor, Education Unit


In 2014, I heard Julie Tucker (RN RM CPC Continence) talk to a packed room about anal incontinence.  At the time, I had very little understanding of the emotional and social impact anal trauma from childbirth has on women.  I hadn’t considered who was most commonly affected by this condition – young women who are generally fit and healthy.  

The majority of marketing is on urinary incontinence and never really seems to touch on anal incontinence.  You just have to be watching television to see the ads for pads and the lighthearted ways that women with “light bladder leakage – or LBL” are portrayed. I have yet to see any marketing campaigns for women with anal incontinence – is it still taboo to talk about poo for anyone older than a toddler?

Julie’s webinar bought home to me that as midwives we need to be doing more–be it education or practice–to ensure that women’s perineal muscles are less traumatized during birth and that instances of 3rd and 4th degree tears are minimised wherever possible.  Plus, we need to be candid in our conversations with women who have experienced this type of perineal trauma, so that they really get an opportunity to let us know what is happening for them.  Too many women are conceal the anxiety and stress that they experience out of shame or embarrassment, but also due to lack of openness and opportunity to talk about their condition with people who understand and are willing to listen – that should be us! 

All midwives are supposed to be able to talk with women about urinary leakage and to discuss with them the importance of their pelvic floor and perineum.  We should all be able to provide descriptions and instructions that resonate with the woman, in addition to helping her locate and then strengthen these muscles.  But at what stage do we talk to women about anal incontinence?   

I call on you all to take a staged approach to your learning and self-reflection around continence, so that together we can improve the outcomes for women and also improve women’s experiences, especially those with 3rd or 4th degree trauma.

REFLECT: Using the ACM Reflective Activity template, take a look at your practice and current knowledge, then use this to identify where you might need or want to learn more. Once you’ve completed this task, create a plan!

PLAN: In the lead up to World Continence Week (24th - 30th June 2018), the aim for all midwives should be to reduce perineal trauma and to better support women who do experience trauma.  That gives you 3 months to improve your skills and knowledge, thus becoming a true ambassador in WCW for all women you work with.

To start with you could WATCH the ACM webinar, Anal incontinence following obstetric anal sphincter injury (OASIS). ACM Members dont forget that you can now access this for FREE – SAVING $50.00 

Feedback from the webinar…
“The quotes from affected women were astounding!”
“This area of OASIS is very important as women are really suffering. It needs to be out there so woman are comfortable with getting help”
“I found the stats and the explanations most helpful”

And then we recommend that you ACCESS the amazing online course, Continence: the importance of the Midwife, which was developed in collaboration with the leaders in this space in Australia, Continence Foundation Australia. This 8 hour CPD Recognised course, comprehensively covers all aspects of perineal care from the basics of anatomy and physiology through to supporting women through the postnatal period.   You can choose to do the entire course in one go, or select the specific modules you want to address (there are 6 to chose from).  The most cost effective option is the entire course.  ACM Members pay just $88.00, SAVING 50% off the non-member rate of $176.00, that’s just $8.80 per CPD hour! (or $22/module if completing individually)

Feedback from the course…
 “I found it most useful that I had the ability to do it at home in my own time.”
“It was very easy to understand the information and … the activities were good in reinforcing learning”
“I liked working at my own pace ….this was most beneficial to me in my current practice”
“It was a great revision”
“It is relevant to my midwifery practice”
“The course content was perfect, not too long, but informative!”

Then you can ASSESS what you have learnt by heading back to your ACM Reflective Activity, and do a review of what you have learnt against what you had identified as needing to address.  Maybe you will highlight some new areas to investigate… but most of all we hope you have improved your knowledge, skills and practice to the betterment of women.