Report: Women’s Pain Matters: Rethinking Care – ANMF (Vic Branch) forum

ANMF (Vic Branch) thanks the members who joined us for the Women’s Pain Matters: Rethinking Care forum on 22 November. This important event saw hundreds of members – attendees and presenters – bringing to life the Branch’s submission earlier in the year to the Allan government’s landmark Inquiry into Women’s Pain.

With more than 90,000 members who identify as women, the Branch’s submission took advantage of our unique position to provide both professional and personal feedback to the inquiry.

Significantly, members told the Branch that they, when accessing care, felt dismissed by healthcare professionals and experienced barriers in accessing plans to help manage their pain. If this is a midwife or nurse’s experience with everything that we know and our knowledge of the healthcare system and how to access care, we can only imagine what it is like for our patients and the broader community trying to seek care.

This feedback overwhelmingly supported the existing evidence that chronic pain affects a higher proportion of girls and women than men, but that women are less likely to receive appropriate treatment for it. Unsurprisingly, this was also borne out by the final results of the inquiry, as reported in detail by Dr Louise Reynolds from Safer Care Victoria.

As frustrating as this reality is, and as upsetting as all the facts and data sets behind it are, the forum was an opportunity to seek solutions and alternatives – to leverage the collective knowledge, experience and wisdom of ANMF members and the duality of our reality as a lived experience workforce.

Among the inquiry’s key findings, Dr Reynolds reported, were that 64 per cent of respondents experienced pain scores of 7 to 9 out of 10, with more than half saying this pain was constant or experienced several times a day. For almost 90 per cent, they had experienced this pain for a year or more, and more than 80 per cent said it also impacted their mental health. A quarter reported thoughts of self-harm due to their pain.

Clearly, we need change; we need solutions. In seeking them, a key theme that was echoed throughout the day, by speakers and by members during interactive sessions, was around the vital role of education and training, as well as that of collaboration.

The findings are due to be presented to the Victorian Women’s Health Advisory Council meeting this month, and will be shared in full with members when available.

Top four takeaways from the day

1: Education, education, education

‘We all know about sex-based inequities,’ said Professor Rochelle Wynne, Deakin University Chair of Nursing, in reference to the differences between men and women when it comes to cardiovascular healthcare, research and heart attack survival rates. ‘They’re less well-recognised in the community and I think that’s where we all have a part to play in engaging people.’

The resounding message of the day is that more comprehensive women’s health education is required in all spheres of healthcare, and across all facets of society.

2: Collaboration

Sarah Grundy is an endorsed midwife with Maryborough District Health Service’s sexual and reproductive advice clinic. Not that long ago, she told the audience, Maryborough was in danger of losing its maternity service. The reason they’re still here comes down to an innovative model of care – Midwifery Group Practice – that prioritises collaboration between healthcare practitioners, and between healthcare services and the community it serves.

‘We don’t work in isolation,’ Sarah said. ‘I’m a hugely experience midwife but a novice in sexual and reproductive healthcare, so the collaborative support of my colleagues has been vital.’

3: Nurse- and midwife-led models of care

Cathy Halmarick, a sexual health nurse practitioner at Peninsula Health, talked about the strength of nurse-led models of care, and shared the fantastic results from introducing the ‘green whistle’ – Penthrox – into Peninsula Health’s options for women during IUD insertion.

After hearing from a woman that her IUD insertion was the most traumatic experience of her life and that she wished she’d never done it, Cathy was shocked. ‘We have to have something else in our toolbox,’ she thought, and after much research and discussion with colleagues, Cathy concluded that Penthrox / Methoxyflurane was the way forward.

It took almost two years to get approval for use in the sexual health clinic but it has revolutionised care. ‘We thought we might have maybe two out of ten women requesting the green whistle for the procedure but it’s closer to seven out of ten,’ she said. Women are even travelling from as far as NSW to have access to the medication. ‘So I would really encourage other services to adopt this as part of their care,’ she said.

4: Culturally safe and trauma-informed

Jill Gallagher AO, CEO of the Victorian Aboriginal Community Controlled Health Organisation, talked about the critical importance of cultural connection and cultural safety for Aboriginal women’s health, citing the success of programs like the Beautiful Shawl Project in increasing breast cancer screening rates among Aboriginal women, and the importance of services like the Koori Maternity Services program. Her key theme was ‘nothing for us without us’.

Nurse Practitioner Marie Jones from the African Women’s Clinic at the Royal Women’s Hospital agreed, citing the fundamental importance of listening to women – which can be challenging when working with interpreters. Cultural competency is also vital, as women’s expression of pain may be culturally influenced. Body language is also important.

Trauma-informed, culturally safe and individualised care is also vital when working with rainbow families and LGBTQIA+ patients and consumers, with survivors of family violence, and with neurodiverse clients.

What’s next?

In summing up the day, Branch Maternity Services Officer and Acting Assistant Secretary Nicole Allan said it is critical that the Allan government’s inquiry results in action that improves attitudes towards women’s health and women’s pain.

The Branch is highly committed to this work. Acting Secretary Madeleine Harradence represents the Branch on the Victorian Women’s Health Advisory Council and Nicole on the Victorian Maternity Taskforce. The Branch has committed to holding an annual woman’s health forum to ensure that our members are engaged and leading the way forward on this critical piece of reform.

Other initiatives and work already underway, or in the pipeline, include:

1. Continuing to advocate to government for increased funding – over and above the recent $153 million investment into women’s health.
2. Building on gender discrimination clauses in our enterprise agreements and improving access to flexible working arrangements.
3. Building community awareness. Media attention surrounding the pain inquiry has been important, and the impending release of the final report will hopefully trigger more reporting but we will be keeping the pressure on them.
4. Advocating for changes to the undergraduate and postgraduate curriculum to embed women’s health education throughout – not just a single unit, or a couple of mentions here and there.
5. Challenging the gender bias in healthcare through education within our own sphere of influence and utilising resources such as the ANMF Education Centre.
6. Advocating for the Victorian government to move forward with the idea of a Women’s Health Research Institute to link in with services, institutions and clinicians and help drive much-needed clinical trials into women’s health.
7. Advocating for more nurse- and midwife-led models of care. We have extraordinary nurse practitioner and endorsed midwife members already working in such models, but we need to replicate them more widely.
8. Empowering and resourcing First Nations women, women from culturally and linguistically diverse backgrounds, and LGBTQIA+ women and trans and nonbinary folk to develop their own services.
9. Promoting and highlighting the work that our members are already doing in the women’s health space.
10. Building on our collective strength as a union of nurses and midwives to better the lives of our members, and of the women and girls they care for.

What did attendees think of the day?

‘Hearing the experiences of other women has made me realise I am not alone. There are people having similar experiences as me, and I am realising that it is not me that is the problem; it is the health system that needs to do better.’

‘It was fantastic to hear about what’s happening in other health services. I was particularly interested in hearing about the advancements being made at one of the other major health services in the sexual and reproductive health department, and have some very practical and tangible improvement suggestions that I can take back to my own workplace for discussion.’

‘It was good to hear from people involved in a diverse range of fields related to women’s health.’

‘As a male, it is not my lived experience and a topic I am unfamiliar with. Our nursing education provided little specific information on this area, which affects so many.’

‘It was incredible to hear all the recommendations and suggestions for future change made by clever and passionate nursing and midwifery colleagues.’