Megan Hutchison says issues following the birth of her daughter, Emmie, didn't become problematic until a year later.
Megan Hutchison is a busy mum of two who runs her own business and, as a seasoned F45-goer who worked out right up until the day she had her first child, likes to keep fit and active.
But when the Herald spoke to Hutchison, 33, recently, she was recovering from a $23,000 surgery, covered by health insurance, for issues that began to plague her after the birth of her second child, Emmie.
“I didn’t know there was something wrong for almost a year after my daughter’s birth. Except that I did have some discomfort. I just attributed that to the effects of having a vaginal birth,” the Auckland mum tells the Herald.
“It wasn’t until this year that I discovered what I had was common and that it could actually be fixed,” she says of being diagnosed with prolapse and issues relating to an episiotomy - a surgical incision to avoid tearing during childbirth.
“Obviously there’s a lot of ads targeted at women with incontinence but I never had incontinence. I think it’s important that women know incontinence is not the only thing to be aware of. It’s the weakening of those pelvic muscles … I had never considered the word prolapse because I would have interpreted that as being an external prolapse. I was in no pain but I was occasionally uncomfortable and it was beginning to affect my daily life.”
Hutchison saw a physiotherapist, expecting she’d be recommended some exercises and could move on.
But she got “a real wake-up call” when she was told she’d be looking at surgery to correct things.
“I realised I had lived with this for two years thinking that I was just waiting for my pelvic floor muscles to recover from birth. It was a pretty scary realisation that what was going on was not going to heal itself. That was the first time that I realised this is not a normal part of recovery from birth - and I use the word normal quite loosely because actually, this is normal. But I suppose in a medical sense,” says Hutchison.
“What I learned is those muscles would become even more important as I go into menopause because they will weaken again in those areas. If you’re already having issues and you’re in your early 30s, then there’s a chance that it will get worse if you don’t look at it now.”
So Hutchinson went ahead with surgery, armed with warnings from her surgeon.
“She really warned me about the side-effects of the surgery, [potential] failure of the surgery and the difficulty in recovery. She said I might want to wait until my children were older because obviously having small children, I’m not allowed to lift them for six weeks.
“I spent weeks talking to my husband about whether or not I would do it. And crying and saying ‘I can’t lie in bed for six weeks. I don’t want to be in pain.’ But I trusted my surgeon and despite the warnings I knew she wouldn’t offer it to me if she didn’t think it was a good option.”
Deciding to go ahead with surgery and choosing the wintertime because it’s traditionally quieter for her Forget Me Not journals business, she still estimates she’s lost thousands in sales because she’s unable to lift boxes or actively market her product at expos and shows like she normally would.
“I’m essentially on medical leave but nobody is paying me because I’m self-employed.”
Hutchison doesn’t qualify for ACC under the new birth injuries legislation because, firstly, she had her daughter before the cover came into effect in October last year.
Before going ahead with her insurance-covered surgery, Hutchison had to pay $175 per physio appointment, $290 to see a gynaecologist and will need to continue to see and pay for physiotherapy after her surgery.
She says she originally applied for physio under ACC.
“I thought I would be covered as I understood they were covering birth injuries, but learned at that first physio appointment that it wouldn’t be due to the date.”
Hutchison says “if the [ACC] bill wants to address the challenges women face, why exclude women who have already been affected?”
But Dr Emma Jackson, clinical director of obstetrics and gynaecology at Te Whatu Ora, Waitaha (Canterbury), who was also one of the experts consulted by the Ministry of Business, Innovation and Employment regarding the proposed list of ACC-covered birth injuries in 2021, says when it comes to retrospective care, it would be hard to “draw the line”.
She notes there are about 60,000 births per year in Aotearoa and approximately 42,000 women who will birth vaginally.
“And 85 per cent will have some form of trauma so you’re looking at 35 to 36,000 women and birthing persons who may qualify for funding for perennial tears.”
She says the most common post-partum surgery is “for prolapse, sometimes surgery for incontinence . A number of women end up with pain. Particularly things like pain from intercourse, pain associated with a scar or problems with healing . Sometimes that can obviously have an ongoing impact. Any of those things also can have a psychological impact on women and [can lead to] PTSD.”
Jackson says “we would like to think that the public system is able to provide equitable access to care for everybody to meet their health needs. But we know that there are a number of women and patients not making the threshold for care currently. Which is why the whole problem arises, doesn’t it? You get an advantage by being covered by ACC and I suppose the issue would be where do you draw the line?”
Secondly, had Hutchison fallen within the time frame for cover, she still may not have qualified because an episiotomy is not listed by ACC as a birth injury.
Jackson explains that instead it’s done “to avoid an injury.
“But if you have issue with that, it’s not covered. And that is quite an issue because in a situation where tearing is more likely, a third and fourth degree tear, is when we make one.
“When we do an instrumental birth, the evidence actually supports cutting an episiotomy, particularly with forceps because it actually protects against getting a more significant third or fourth degree tear.
“An episiotomy, currently under ACC legislation, still doesn’t count as an injury, because it’s actually part of the treatment. So, it has to have been done incorrectly or not done when it should have been, or have something else arise from it, like an extension of the episiotomy. So unfortunately, what that means is that a woman who’s had an appropriately performed episiotomy as part of her birth won’t be covered under the ACC legislation, even if you have problems with it. But without that episiotomy, she may have suffered more significant tearing but would have been automatically covered.
“The birthing parent needing the assistance of an obstetrician who’s trying to avoid a bad tear by cutting an episiotomy might in fact be worse off than taking the risk of having no episiotomy at all.
“And yet the injury and the symptoms caused by a tear and an episiotomy, and an extension of the episiotomy, would all be very similar, and at present ACC will only cover two of those. It’s a bit of an anomaly in that the injury itself is not treated as an injury because it is the treatment.”
While ACC’s acting chief clinical officer, Dr Dilky Rasiah, advises that the list is up for review “to make sure it is adequate”, Jackson says looking ahead, providing birth injury care could be challenging.
“We haven’t increased our capacity in the public system to meet what was previously an unmet need that is now partly funded by ACC.”
She says she has “real worries” about how things might play out in the future.
“Yes, we are getting women referred who need surgery. And I think there’ll be some obviously going into the private sector who need surgery, but it’s still relatively early days because we know that prolapse can come as a later consequence, but certainly, as time goes on, we’ll see more and more of that surgery in the private sector and it’s going to potentially drive a move [of gynaecologists and physiotherapists] to more lucrative ACC contracts, away from the Te Whatu Ora hospital system.
“And at the same time as they go, we’re also looking then at our obstetric workforce because most specialists in New Zealand are in both obstetrics and gynaecology, so it will be slightly ironic in that we’ll have people to repair and also operate on you pelvic floor after birth , but we may not have enough doctors left to actually staff the hospitals to help assist and deliver the babies if there’s a problem.”
While recovering from her surgery, Hutchison, who has described her experience as “a really lonely journey” shared her case on Instagram and was overwhelmed by the response from over 100 people in 24 hours.
“They were asking about my symptoms. These are women who, they’re not asking for fun. They say they know something’s not quite right for them.”
Last week senior physiotherapist Renee Malyon told the Herald in her practice she’s not seeing women with post-partum issues soon enough and pointed to a disconnect that seems to be happening between women leaving the care of their midwife at six weeks post-birth and discovering later that they are experiencing ongoing issues.
She advises seeing a pelvic health physio postpartum “at six weeks at least, then three months and six to nine months, just to get checked because sometimes things can come on later. It may not be straight away. It may be down the track.”
Currently there is no standard “comprehensive screening” or postnatal pelvic floor assessment available, notes Jackson.
“There isn’t a really comprehensive screening right across the board or a detailed assessment of the pelvic floor postnatally. Lead maternity carers aren’t specifically trained to assess a woman’s pelvic floor as it’s not within their frame of standard training or within their normal remit.
“Although they will obviously be looking at, how is your scar healing, how are you feeling, and they’ll look at any problems with the scar healing. That’s quite different than a kind of proactive rehabilitation programme.”
In a statement from Te Tatau o te Whare Kahu, New Zealand’s Midwifery Council, current guidelines “enable midwives to refer birthing people to a physio for pelvic floor care at any time during pregnancy and up to six weeks post birth.
“Midwives can also lodge ACC claims within their scope of practice for birthing parents in their care who experience a maternal birth injury. Midwives can make referrals within the six-week postpartum period, and do so, or direct women to self-refer to a pelvic physio.”
Hutchison says after what she’s been through she feels it’s important that women know that if something doesn’t feel normal they need to see someone about it.
“I lived with this for so long because I wasn’t aware of my body and I wasn’t aware that there were potential remedies. Nobody ever talks about it.
“We live in a real sort of darkness around awareness over what can go wrong and the support we can get.”
Rebecca Haszard is a senior lifestyle and entertainment writer, co-host of the Herald’s parenting podcast One Day You’ll Thank Me and a former digital and magazine editor, including Girlfriend magazine.
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