Abstract
This study explored New Zealand women’s experiences of pelvic health physiotherapy following an obstetric anal sphincter injury.
Perineal tears are common during vaginal birth. Depending on the structures involved and the extent of trauma, they are classified into varying degrees of severity. Third- and fourth-degree tears, commonly known as obstetric anal sphincter injuries, are the most severe and a major cause of maternal morbidity, often having a substantial effect on a woman’s life after childbirth. These injuries are commonly associated with pelvic floor dysfunction, including pain and bladder and bowel issues. Pelvic health physiotherapy is an area of physiotherapy involved in the assessment and treatment of issues related to pelvic, bladder, bowel and sexual function. Although physiotherapy is often recommended as a conservative intervention for women recovering from these injuries, referral is not routine and there is a lack of published research to guide clinical practice.
A qualitative descriptive approach was taken to explore New Zealand women’s experiences of pelvic health physiotherapy within the 24 months after an obstetric anal sphincter injury. Semi-structured, one-on-one interviews were conducted with ten women based in Northland who had attended public hospital physiotherapy services and/or private community clinics. Data was analysed using inductive content analysis.
Five key themes were identified; Physiotherapy helped me understand my injury; Being examined gave me reassurance; Empowered to recover through physiotherapy; Promoting physiotherapy for every woman and; Barriers to accessing and continuing physiotherapy. Participants described physiotherapy as reassuring, validating, and empowering, helping them understand their injury, regain confidence, and adopt practical strategies for ongoing rehabilitation. Physiotherapy was viewed as playing a crucial role in supporting recovery. Although referral pathways have historically been inconsistent, recent legislative and service changes in New Zealand are beginning to improve access. By hearing women’s voices, this study contributes evidence to inform practice, strengthen obstetric anal sphincter injury management, and guide the development of more accessible models of postnatal care. In doing so, it reinforces the important role of pelvic health physiotherapy and the need to establish it as an integral part of postnatal care for women with these injuries.