7. What treatments are available to mothers who become incontinent as a result of injury during childbirth? OAQ(5)0118(HWS)

I thank the Member for the question. All maternity services in Wales work in collaboration with both physiotherapist and specialist continence services. These services provide assessment and identify continence problems with referral to specialist continence services for treatment and individualised care planning.

One in 10 women have anal sphincter injuries as a result of childbirth. It’s hardly ever spoken about because people feel too embarrassed to raise it. But I’m glad to say that it’s rising up the medical agenda: there’s a conference being organised by a new charity, which is championing mothers with anal sphincter injuries in childbirth, and it’s being held at the Royal College of Medicine. A lot of eminent physicians and surgeons are involved, and the president of the Royal College of Midwives. So, I very much welcome a light being shone on something that is rarely spoken about, because it causes misery to women across Wales.

So, I’m really concerned that Wales is not going to necessarily be at the forefront of tackling this issue. I wondered if you could tell us why Cwm Taf recently had its application for sacral nerve stimulation therapy for faecal incontinence turned down by the efficiency-through-technology fund, even though Wales is the only country in the UK that doesn’t offer this NICE-approved treatment. Would you be prepared to look at it again, given that there will be a lot more pressure on us to establish why it is we are not able to offer this service to so many mothers?

I have slightly certain different figures on the incidence. The incidence that I have is 6 per cent in first-time deliveries as opposed to 10 per cent, but I recognise that there is a significant proportion of women give birth who will suffer this particular injury. It’s partly about the conversations that should take place in good midwifery care about the preparation for birth and being fit and ready for birth but also recovery afterwards too. In the particular issue that you raise about the Cwm Taf application to the efficiency through technology fund, we allocate funds on a competitive basis, looking at the particular level of gain to be made from each application. And it is a simple truth that there are more good ideas and more ways in which we could usefully use that fund than the fund itself can provide. But the point that you make is actually about: I recognise it is NICE approved and it should normally be undertaken in specialist units. Where those specialist units are not available in the local hospital, it’s about making sure that there is access to them and each health board needs to make sure that there’s a proper network to do so. I will, though, given that you’ve raised a particular issue, undertake to go away and look at the particular issue within Cwm Taf and look at how that service is provided to women who give birth in Cwm Taf and how they’re able to access this part of their care after birth.

Thank you very much, Cabinet Secretary.