Two pregnancies gave Kerri-Louise Hooper four beautiful children, but carrying two sets of twins also left her struggling to lead a normal life.
- Abdominal separation can cause back pain and incontinence for women who suffer the condition after pregnancy
- Private health insurers won’t pay for surgery to correct the condition because there’s no Medicare item number for it
- A Sydney woman has started a petition to Australia’s House of Representatives to restore the Medicare item number for the surgery
The Hobart mother’s abdominal muscles separated normally during pregnancy, but they didn’t rejoin afterward, leaving her with a condition known as diastasis recti, or abdominal separation.
“I have a hole in my abdominal wall that is bigger than my fist and my stomach muscles will not join again,” Ms Hooper said.
Women who have multiple births like twins or larger-than-average babies are more prone to abdominal separation after pregnancy, which can lead to problems including chronic back pain and incontinence.
Ms Hooper suffers from both.
“I’m a real estate agent, I’m running around, I don’t have access to bathrooms all the time, and when that urge happens, I have no support. There is nothing,” she said.
“My kids say, ‘Mummy you’re not the same anymore.’ My elder children [say], ‘You can’t play with us anymore, you’re always saying be careful of my back, you can’t stand up with us, you can’t go walking for long distances.’
“It just aches; my lower back aches, my stomach aches, everything just hurts.”
Mild abdominal separation after pregnancy can usually be fixed through physiotherapy and core-strengthening exercises, but in severe cases it must be repaired by abdominoplasty, also known as a “tummy-tuck”, a surgery during which a plastic surgeon sews the abdominal muscles together.
Ms Hooper has tried all the non-surgical treatments without success, but she will have to pay at least $12,000 if she wants an abdominoplasty.
Woman starts petition to make surgery cheaper
Abdominoplasty for women with abdominal separation after pregnancy was removed from the Medicare Benefits Schedule in 2016 because it was considered primarily a cosmetic procedure.
Without a Medicare item number, private insurers will not pay for the surgery or the hospital stay afterward.
Sydney woman Kerrie Edwards has started a petition that will be presented to Australia’s House of Representatives, asking for the Medicare item number to be restored.
The mother of twins, who also suffers from abdominal separation, said the surgery to fix the problem was unaffordable for most Australian women.
“It costs upwards of $15,000 out of pocket. There’s very few people who can afford that,” Ms Edwards said.
Ms Edwards said it was unfair there were Medicare item numbers for abdominoplasty following significant weight loss and to correct abdominal separation caused by a tumorous mass in a person’s abdomen, but not for pregnancy-related injury.
“Medicare recognises that injury occurs if you have an intra-pelvic mass, and so there’s an item number that covers them to have abdominal repair surgery following an intra-pelvic mass,” she said.
“But we’re discriminated against when that intra-pelvic mass is a foetus, which does just as much damage to your abdominals.”
“It’s definitely unfair that women aren’t looked after following pregnancy.”
Surgeon says many women endure unnecessary pain
Melbourne plastic surgeon Dr Kim Taylor has performed abdominoplasty on more than 100 women suffering abdominal separation following pregnancy.
She said women are often shocked to learn their private health insurers won’t pay for the surgery.
“Sometimes it’s really hard to explain that whilst I believe that they have symptoms from the muscle separation, there’s no way that we can let them use their insurance because there’s no Medicare item number for that,” she said.
Dr Taylor said the cost of the surgery often leads women to delay having it.
“Sometimes when I see women that present for this, their kids have left home and they’ve been suffering for 20 years maybe or more with issues and are finally at the point where they’re like ‘okay, I can afford to get this done now’.”
Dr Taylor is on the executive of the Australian Society of Plastic Surgeons (ASPS), which has tried unsuccessfully to get the Medicare item number restored, and plans to try again next year.
Study finds abdominoplasty relieves back pain and incontinence
The ASPS is hopeful the Medical Services Advisory Committee (MSAC) will consider recent evidence about how abdominoplasty can help women with abdominal separation after pregnancy.
Canberra-based Dr Alistair Taylor was one of nine Australian plastic surgeons who took part in a trial in 2018 that collected data about women’s level of back pain and incontinence before and after abdominoplasty.
“We had a significant improvement statistically between back pain and urinary incontinence,” Dr Taylor said.
He said one of the reasons the Medicare item number was eliminated was because of a lack of data at the time about the medical effects of the surgery.
“It was judged to be a cosmetic operation because we didn’t really understand the functional benefits of it, but now that we do, we think that it should be included in the Medicare schedule again.”
“Not necessarily all abdominoplasty, but if patients are suffering from significant back pain post pregnancy, and urinary incontinence, it should be included for those patients.”
Dr Taylor said when the MSAC reviewed previous applications to restore the Medicare item number it did not consider there was enough demand for the surgery.
In a statement the Commonwealth Department of Health said MSAC appraises new medical services and provides advice to Government on whether they should be publicly funded based on an assessment of its comparative safety, clinical effectiveness and cost-effectiveness, using the best available evidence.
“The committee found that although abdominoplasty had benefits for weight loss patients, there was insufficient evidence to justify Medicare funding of abdominoplasty for diastasis recti at this time.”