pelvicpartnership.org.uk

It is natural for any woman to feel excitement tinged with a certain amount of fear when it comes to the prospect of delivering a first baby. It is only natural for you to feel some anxiety about how the delivery will go and how much it will hurt. As many babies are weighing in at well over 9 lbs, it is not surprising that you may worry about how you will ever be able to stretch to accommodate a large baby and even a small one seems an enormous challenge. With PGP these kinds of fears can increase as the pregnancy develops. You may already be finding that your mobility is limited, that you are already experiencing pain and that you cannot part your legs more than a few centimetres.

PGP does require appropriate management during childbirth but it need not limit your birth options. There is still a wide range of possibilities open to you and with an understanding of PGP and how the condition affects you, it is possible for you to make an informed choice about the kind of birth that you would like to have.

It may come as a considerable relief to learn that having PGP does not mean that your birth options are limited. It does not mean that you automatically need a caesarean section, or that you must give birth standing up, or surrender any kind of pain relief. You might also be relieved to learn that having PGP does not mean that you will necessarily have an awful time – many of our members have had very positive birth experiences. However, having PGP does mean that you should think about and plan your delivery carefully. You should also take time to discuss it with your partner, your midwife and any other medical professionals who may be caring for you, e.g. your consultant, physiotherapist, etc.

PGP is only one aspect of your pregnancy; others will also impact on what manner of delivery is appropriate for you. The ultimate goal is to have a healthy baby whilst avoiding anything that may cause undue stress on the pelvis.

• Vaginal birth

• Caesarean section

• Water birth

• Home birth

• Complications

> Vaginal birth

Think about your PGP and how it affects what you can and cannot do (e.g. can you lie comfortably on your back, stand unaided, walk without crutches, remain in one position?) It is unlikely that what you can and cannot do will change dramatically during labour, so it is worth noting which positions are comfortable – and which are best avoided. PGP may mean that some suggested positions for giving birth are not appropriate for you. Experiment before the onset of labour and record your preferences on your birth plan. The key to preventing stress to the pelvis is controlling the position of the legs. You should measure your ‘pain-free gap’ as the distance you can open your legs without pain and make sure that this is never exceeded. Write it in your birth plan and make sure that your birth partner and all those involved in your delivery know about it.

Positions for labour and birth with PGP include:

• On all fours, on your side and lying with the upper leg supported or in a supported kneeling or standing position.

Avoid:

• Lying on your back with your feet in stirrups (the lithotomy position). This position is often used for suturing (stitching), but you can ask for this to be done whilst you are lying on your side with your upper leg supported. This can be quite a tricky procedure and you may have to ask for a senior midwife or consultant to do it. Sometimes it is necessary to use the lithotomy position. If so, you should ensure that both legs are moved at the same time and that they are up for the shortest time possible.

• Putting your feet on the midwife’s hips or shoulders to push as this puts a lot of strain on your pelvic joints (and on their backs!). Please note that you should never be asked to do this.

You should also consider what method of pain relief you would like to use. An epidural completely removes all pain but you should be aware that it not only masks the labour pains but also the pain of PGP. This means that you need to be extra vigilant about the position of your legs as you will not be aware of whether something hurts. The pain-free gap should not be exceeded and all movements need to be symmetrical. The anaesthesia of the epidural can last for some hours so you need to be aware of this after as well as during the delivery. You should also take care to be helped to change position regularly so your joints do not ‘block’ in one position.

You should be aware that research shows that an epidural can prolong labour and increase the chance of needing an assisted delivery.

> Caesarean section

For most women having PGP is not a reason to need a caesarean section, although there may be other factors that make it necessary, such as the position of the baby or if there are other medical problems. However, some women with PGP choose to have a caesarean section. There are valid reasons for doing so, particularly if you are very immobile, very frightened, if the delivery is likely to be problematic or if you have had a traumatic previous delivery. Choosing to have a caesarean section can be quite a contentious issue and you should take time to discuss the matter fully with your midwife/consultant. A caesarean is a major surgical procedure and as such there are risks involved. These are explained in recent NICE guidelines (www.nice.org.uk/CG013quickrefguide).

You should also be aware that you will have pain from the abdominal wound in addition to your PGP pain, that you will have to stay in hospital for several days and that your recovery time may be longer overall than a woman who has no symptoms of PGP. There is also a limit on how many caesarean sections you can have – so if you are planning to have lots of children this may not be the right option for you. Despite these issues several of our members who have had caesareans have reported it as being a very positive experience, one that was absolutely the right choice for them.

As with a vaginal birth, you should make sure that everyone in the medical team knows that you have PGP and is aware of what you can and cannot do. The pain-free gap should not be exceeded and you should remain aware of the masking effects of pain relief both during and after surgery.

For further information, visit the following page;

• Tips from people who have had caesareans

> Water birth

A water birth can be a great option if you have PGP. The water is warm and comforting and provides natural pain relief. Many women report a sense of freedom of movement that they haven’t experienced for some time, and it makes it very easy to change position. Most hospitals ask that you are mobile enough to get in and out of the pool without their assistance (although your partner can help) and that you are able to get out relatively quickly should an emergency arise. It is usually easy to get in if you perch on the edge of the pool with someone behind you and someone to lift your legs in, then you can slide into the water, or you can have a high stool or even a turntable board which helps you to swivel round and get in.

> Home birth

You can also choose to hire a birthing pool for a home birth. PGP does not mean that you cannot have a home birth. In lots of ways it is an ideal choice – you can give birth in an environment where you are comfortable and at ease, you have already assessed and dealt with any mobility and access problems and you can have people you are close to at hand to help you with your care and the baby’s care after the birth.

> Complications

Birth is unpredictable and complications can and do arise. Whilst birth plans are very useful in describing concerns and wishes for the birth, it is important to remember that things don’t always go to plan. There is no right way or wrong way of giving birth and you should be prepared to be flexible as the need arises. It is worth thinking in advance about certain complications and how you would deal with them – that way you can make an informed decision at the time, should the need arise. For example: would you consent to a forceps or ventouse delivery that involved the lithotomy position? What would be the other options? You can explore the most common complications (and how you might deal with them) with your partner, midwife, consultant and other healthcare professionals in advance of going into labour.