A new online course for Australian midwives aims to reinforce the importance of women’s pelvic floor health during pregnancy.

With statistics showing one in three women who have a baby will wet themselves, the course raises awareness about the prevention and better management of incontinence among mothers.

The Continence Foundation of Australia has joined forces with the Australian College of Midwives (ACM) to develop an eight-hour CPD course for midwives, Continence promotion: The importance of the midwife.

Launched last year, the course, which is free to ACM members and available to non-members for a fee, covers the anatomy, physiology and function of the bladder along with the bowel, pelvic floor and perineum.

It also details the impact of pregnancy and childbirth on the bladder, the bowel and on pelvic floor health, alongside postnatal care and long-term issues.

In her dual roles as a physiotherapist and midwife, New South Wales practitioner Heather Pierce wrote the course that aims to equip midwives with the latest evidence on pelvic floor health in a bid to improve women’s health outcomes.

Clinical studies show pelvic floor muscle exercises can prevent and effectively treat incontinence among pre- and postnatal women - and should be part of a daily routine.

Ms Pierce, chair of the Australian Physiotherapy Association’s (APA) Continence and Women’s Health group, says while there’s often a focus on the risks to the pelvic floor from childbirth, the antenatal period is critical.

She says research shows women who are pregnant for the first time, who complete a training program for the pelvic floor muscles, have better continence outcomes after the birth.

“Having an understanding of what we can do in preventative health care and how we can help women to maximise their outcomes and reduce the risk of continence problems after the birth starts right from the antenatal care, with first-time mums,” she says.

“This is such a critical period and so many women do have problems.

“There are also other lifestyle issues that contribute, and things that we can change and things that we can’t change.

“There are things like the ageing process; the older we get the more likely we are to develop a continence problem whether we are a male or a female, and obesity; if you are carrying extra weight you have twice the risk of someone with normal weight of developing urinary leakage.

“Other risk factors would be things like a chronic cough, heavy lifting; so having repeated strain on the pelvic structures, and all of these things lead to weakening of the structures, perhaps dysfunctions in the organs, so they are not doing their job and people develop problems with control…sometimes there’s back passage problems as well.”

Ms Pierce says it’s vital the role of midwives in raising awareness and education around prevention and treatment for urinary incontinence is not underestimated.

“Midwives are frontline primary care practitioners,” she says.

“They are with women, they are walking with them through their pregnancy, labour and after the birth, and so they have that maximised opportunity of contact with women to be able to start implementing care and to also be able to refer.

“If we can grab that opportunity to promote a Grade A recommendation of evidence, then we can hopefully stem the tide of people who go on to develop these problems.”

Midwifery-led awareness will also help pregnant women and mothers to discuss what’s often considered an embarrassing problem, Ms Pierce says.

Continence Foundation of Australia statistics, from a study of 1000 Australian mums, show 72 per cent of women have experienced incontinence - with 81 per cent of those women failing to seek help from health professionals.

“We know that 50 per cent of pregnant women, at some time during the pregnancy, leak urine and that’s one in two - that’s a huge statistic,” she says.

“A lot of women will probably not record that or just see that as a normal part of pregnancy that goes away after they’ve had the baby.

“Talking about it and making it less embarrassing and helping to direct them to the evidence which is what it’s all about really - helping women to know that you don’t put up with that leakage, there is something that can be done about it.”

A physiotherapist of 30 years who also moved into midwifery more than 10 years ago, Ms Pierce is a casual academic at the University of Technology Sydney, who recently had an article accepted for publication in the Journal of Advanced Nursing on ‘Pelvic floor health - a concept analysis’.