More education is required during the antenatal care process around options to reduce third and fourth degree perineal tears, according to the APA, who says not enough women are offered pelvic floor assessments with a physiotherapist during pregnancy.

“The practice I work in is a multidisciplinary practice with obstetricians, midwives and a physio,” says APA member and women’s health physiotherapist Natalie McConochie.

“All patients are offered the option of seeing me.

“Not every patient chooses to take this option, but they are at least made aware that this service does exist.”

Ms McConochie was involved the development of the new Clinical Care Standard, released last month, which aims to reduce the risk of serious perineal trauma in childbirth.

Third and fourth degree perineal tears affect around five per cent of Australian women having a first vaginal birth, which can result in short and long-term complications to physical, psychological and sexual well-being.

“Perineal tears and birth trauma have often been considered a taboo topic, but starting these conversations early during the pregnancy can help improve understanding and empower women to make more informed decisions,” says Ms McConochie.

“Physiotherapists play a critical role in preventing and treating perineal trauma, and while this Clinical Care Standard is a momentous leap forward for women’s health in Australia, funding is urgently needed for physiotherapy in the anenatal and postnatal period.”

Pelvic floor muscle training (PFMT) is the combination of both contraction and relaxation of the pelvic floor muscles.

“The contraction phase is what people are most familiar with. It is important in the hold and support of the organs, and also helps keep us continent.

“What people are less familiar with is the relaxation phase. This is equally important to allow us to perform normal bodily functions. For example; passing urine, passing bowel motions, and birthing babies.”

For birthing to happen more easily there needs to be good relaxation of the pelvic floor muscles. They also need to be able to stretch adequately to allow the baby to descend the birth canal.

“A physiotherapist can assist in the later stages of pregnancy to help prepare a woman’s body for birthing.

“This may be in the form of working with restoring muscle balance with more attention on the relaxation phase of PFMT.

“It may include ways to help stretch the pelvic floor if there is contracture – shortening - of the pelvic floor muscle.

“It may even be that a woman is contracting her pelvic floor muscles with pushing rather than relaxing them and the physio can help to retrain this patterning.”

But while antenatal pelvic floor muscle training and postnatal rehabilitation with a physiotherapist is vitally important in the prevention and management of severe perineal tears,  there is currently no funding for women to receive these services.

“There is significant physical, emotional and economic cost of these types of tears immediately after and going forward into midlife and older age.

“Better access to funding for physiotherapy services is pertinent in the antenatal and postnatal period to ensure women have better lifelong outcomes.

“I hope in the future this is the gold standard across Australia.

“Prevention is better than cure.”