Vaginal birth can seem scary when you have difficulty moving about and parting your legs. However, if you have a supportive team with you, it can be a very manageable and even enjoyable experience, and avoids the risks and pain associated with a caesarean section.
It is important to think about your PGP and how it affects what you can and cannot do (e.g. can you lie comfortably on your back or side, 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 labour starts and record your preferences on your birth plan. The key to preventing stress to the pelvis is controlling the position of your legs. You should measure your ‘pain-free gap’. This is the distance you can open your legs without pain and make sure that this is not exceeded. Write it in your birth plan and make sure that your birth partner and all those involved in your birth know about it.
Positions for labour and birth with PGP include:
- Upright positions, standing, leaning forward, supported kneeling or on all fours, on your side and lying with the upper leg supported.
- 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.
Pain relief for labour and birth
Many women find that the PGP they experience during pregnancy makes labour contractions seem less intense. Although increased pain is often one of the main concerns women have during pregnancy, labour often turns out not to be as painful as they expected.
You have a wide range of options available in most birth settings. Epidurals are only available in a hospital, but all the other forms of pain relief are available at home or in midwifery units.
- Back massage can provide relief during and after contractions, and this is something your birth companion can help with.
- Labouring in water in a birthing pool gives pain relief from the warmth of the water and also helps you to move around and change position. A bath or shower can also help to use the warmth of the water for pain relief.
- Gas and air (nitrous oxide) is an inhaled gas which helps with pain relief during contractions. It wears off quickly once you stop breathing it in, so you can use it in a birthing pool or in any birth setting.
- Pethidine or meptid are opioid medications given by injection which have a longer-lasting effect. They can make you quite drowsy so you can’t use them if you are planning to use the pool, although once the effects have worn off (usually after about two hours), you may be able to go in the pool if your labour is going on for a long time. The medication may have side effects for you including nausea and sleepiness, and also pass through to the baby which may make the baby drowsy if they are given close to the time of birth. They are usually given in the early stages of labour for this reason.
- Epidurals are only available in hospital as they are given by an anaesthetist and usually require you to be monitored electronically once you have one. They are given through a very fine tube into the space around the spinal cord, and numb the lower half of your body. They can be given at a low dose that enables you to continue to keep moving around. Research shows that an epidural can prolong labour so you are more likely to need to have your labour speeded up with a drip if you have an epidural, and there is a higher chance you will need an assisted birth using ventouse or forceps. An epidural removes all pain completely but you should be aware that it masks not only the labour pains but also the pain of PGP. This means that you need to be extra careful 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 effect of the epidural can last for some hours so you need to be aware of this after as well as during the birth. You should also take care to be helped to change position regularly so your joints do not ‘block’ in one position and increase the chance of needing an assisted birth.
Birth is unpredictable and complications can and do sometimes arise. 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 may need to be flexible as things may change during the labour and birth. It is worth thinking in advance about certain complications and how you would deal with them – in 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 birth 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.
If you are making choices which you are told are unusual or not able to be supported for some reason, you can ask to speak to the Professional Midwifery Advocate or Consultant Midwife. They are there to promote safe practice and support women’s informed decisions, so will be able to discuss the pros and cons with you. They can help to produce a written plan detailing any concerns you have and how the team caring for you can address these concerns and support your choices. You should have a copy of this plan, and a copy will be kept by the unit where you are due to give birth.
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