Obstetric History, Pelvic Health and Military Occupations: a Study of a Cohort of Australian Female Military Personnel and Veterans

Background:
Pregnancy and childbirth have been shown to be key risk factors for pelvic health issues, such as urinary incontinence, in women. Approximately 85% of women will become pregnant within their lifetime; therefore, long term pelvic health, and the impacts it can have on the lives and lifestyles of women, needs to be considered. With a growing number of women joining the Australian Defence Force (ADF), the physical requirements of many military roles, as well as the likelihood that many women will have children during their Service, the relationships between obstetric history, pelvic health and military service warrant consideration.
Aim:
The aim of this investigation was to explore the relationships between obstetric history and pelvic health in a cohort of Australian female military personnel and veterans.
Method:
A cross-sectional anonymous online survey was conducted in adult biological females who had actively served in the ADF for at least six months. The survey explored the pelvic health of female military personnel, including the prevalence, types, severity, and risk factors for pelvic health issues, as well as management strategies and occupational impacts. This paper focuses on findings related to obstetric history, pelvic health, and military service.
Results:
A total of 491 active servicewomen (60%) and veterans (40%) participated in the survey (52.7% Army, 25.7% Air Force, and 21.4% Navy). 71% of respondents had been pregnant, with a mean of three pregnancies reported (range 1 – 10), and a mean of two during Service (range 0 – 8). The mean number of births servicewomen experienced was 1.9 (range of 0 – 9), and vaginal delivery accounted for 71% of all births. The most common pregnancy and/or perior post-natal pelvic health complications reported were perineal tears (20%), pelvic pain (17%), urinary incontinence (15%), episiotomy (14%), and sexual dysfunction (11%). Of those women reporting complications, one third experienced ongoing issues
that affected their subsequent military work (i.e. modifying usual duties, delayed return to work). Parous women were more likely to report concerns about their pelvic health (80.4%) than nulliparous servicewomen (56.1%). Parity was also linked with prevalence of pelvic health symptoms, including urinary urgency, urge urinary incontinence, stress urinary incontinence and pelvic organ prolapse.
Discussion:
The survey found it is common for female ADF personnel to experience pregnancy and childbirth during Service, and a small proportion of those women experience complications that influence their return to and/or subsequent work within the military. Consistent with other studies of female pelvic health in general populations, parity had a relationship with prevalence of pelvic health symptoms, such as urinary incontinence and pelvic organ prolapse. This has implications for the growing population of women in the ADF, and suggests that providing support to pregnant and post-partum members may provide long term benefits to both servicewomen and the ADF.
Conclusion: Pregnancy and childbirth is a particular time unique to females that can have a significant effect on pelvic health. Given the physically demanding nature of many military roles and annual fitness assessment requirements, support and management of female personnel during pregnancy, as well as their post-partum return to work planning and preparation needs to recognise the potential pelvic health implications to enable them to efficiently and effectively return to their roles.