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New analysis highlights failings in post-natal care

5000 new mothers each week will develop serious long term health problems because of the poor post-natal advice and guidance that they receive.

This is the claim of Barry Fowler, author of The Kegel Legacy (ebook gbp1.99), based on a new analysis of published data.

With around 60,000 births per month in the UK, it is widely acknowledged that a third of these new mothers with develop long term health problems such as stress incontinence and prolapse because they are not encouraged to follow an effective post-natal rehabilitation programme.

The scale of the problem was highlighted by NICE in the new Clinical Guidelines on the treatment of incontinence in women (CG171) which stated that incontinence alone, largely caused by pregnancy and childbirth, affects between a half and two thirds of women and that there is a general belief amongst women that there is no effective treatment.  NICE acknowledges that the awareness problem is so bad that many women may wait up to ten years before seeking medical help.

Fowler, who has worked in the field for 15 years, says this raises a fundamental question: “With so many sufferers, how do we arrive at a situation where the general perception amongst women is that they are unusual and alone with the problem; that there is no point in seeking advice and help from their GP; and that there is no effective treatment anyway?”

He believes that the answer is very simple.

“In reality, there is a simple, clinically-proven and very cost-effective treatment that can be prescribed by all GPs and it costs just a few pounds. But instead, like generations of women before them, new mothers and existing sufferers are being offered little or no effective help and guidance.”

“Our research shows that the best most can expect is a suggestion that they ‘do’ pelvic floor or Kegel exercises. Some may be offered a locally produced leaflet. I have studied the medical literature going back 50 years and I cannot find one clinical trial that demonstrates that giving out leaflets confers any benefits. It is just not a clinically proven treatment.”


He is also dubious of the benefits of the primary treatment recommended by NICE – a three month course of physiotherapist supervised pelvic floor muscle training.  “It is widely acknowledged that this approach fails to offer any real improvement in symptoms in any realistic timescale, so it is no surprise that a general perception develops that there is no hope. The fact that the techniques taught lack any rigour, and fail to even acknowledge the principles proven in early clinical trials, must lead to the conclusion that they are not fit for purpose. The fact that there are two year waiting lists for physiotherapy in some parts of the country just compounds the problem.”

Fowler is at a loss to explain the reluctance of the medical profession to face the problem and questions the fact that, despite intense lobbying, the new NICE guidelines ignored developments in lifestyle management and physical therapies and focussed exclusively on much more expensive pharmaceutical and surgical interventions.

He highlights the example of The PelvicToner™ exercise programme which has been available on prescription for nearly three and a half years.
“The PelvicToner is clinically proven to be as effective as a three month programme of physiotherapy yet it costs one tenth as much and does not take up scarce physiotherapy resources.

But The PelvicToner is another one of those treatments subject to a ‘postcode lottery’ imposed by local commissioning groups or medicines management committees. “In parts of the country physiotherapy departments are so frustrated that their local GPs will not prescribe this device that they are buying and distributing them from their own limited budgets!”

Fowler believes that a review of post-natal rehabilitation is urgently required. “There are an estimated 7 million women living with the embarrassment of Urinary Stress Incontinence in the UK and potentially 60,000 new mothers join them every month. Most could prevent or cure their problem within a couple of weeks but instead they support a multi-million pound industry supplying designer incontinence pads that just did not exist thirty years ago. You would think that someone somewhere would grasp the nettle!”

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