Posted by Madeleine Speed, the Pelvic Partnership, April 2016
Exploring techniques and approaches that could help
In Part 2 of this blog (see below), the focus was on what questions to ask frontline healthcare professionals to get what you want and starting to frame questions that might prompt a positive response. In Part 3 we look at approaches and techniques that may help you to realise your goals concerning pelvic girdle pain (PGP) particularly if you are currently expecting a baby.
What will help me get the kind of birth I want?
The Pelvic Partnership believes that women have the right to make their own informed choices about how and where to have their babies and this is certainly a right that the NHS upholds. PGP symptoms can result in pain, limited mobility and difficulty opening your legs. There are ways to reduce pain and avoid putting further stress on painful pelvic joints. Although PGP does require careful management during labour and birth, this doesn't necessarily limit your options, they are just altered. There are lots of ideas for ways to give birth with PGP which you can discuss with your midwife. Having PGP should not prevent you from considering giving birth at home, in a midwife-led unit or a hospital - it should be about what feels right for you. It's worth discussing the options with your midwife before choosing so you know what is involved. Do make time to talk to friends, family and professionals as well as to research the options available to you. By being aware of your needs and the choices open to you, you are more likely to find a way forward that suits you best.
Writing a birth plan
A birth plan can be very useful in helping you to get the kind of birth you want. It can be helpful while planning what sort of birth you want, to pull together information about PGP (to avoid compromising your pelvis). It can then be used by those who are caring for you in labour and to guide your midwife and carers about your preferences. The birth plan can take any form and work best if they are easily read, specific and not too long (click here to see an example birth plan) . Discuss your ideas and options with the team looking after you so everyone is clear about them ahead of when you go into labour. For example, discuss any strong views on what you want or don't want whilst still maintaining some flexibility to adapt to the baby's needs as labour progresses (because births are sometimes unpredictable and don't always go to plan). Include details such as any pain relief you want, the extent of your 'pain free gap' (ie when opening your legs), whether you would prefer to give birth 'on all fours' or on your side, or have a water birth, whatever feels right for you. Include details about the help and support you will need after you have had your baby. If you are in hospital, you may need to ask for specific help with your mobility, feeding your baby, moving around the ward or feeding yourself. Get extra copies made so you can have one in your notes, one each for all key staff in the team and a few extras in case there is a change of staff.
If you don't feel you are being heard or supported
You and your midwife will both want the same goal: the safe birth of a healthy baby. However, if you find your midwife doesn't seem to be sympathetic to you needs or supports your birth choice, then you may want to call on the services of the Supervisor of Midwives (SoM). SoMs are there to ensure that care is safe and woman-centred. Their role is independent of the hospital in which they are employed with the aim of ensuring that midwives are following the Nursing and Midwifery Council rules and also following national guidance as well as making sure that care is centred around a woman’s individual choices. A SoM is on call for every maternity service 24/7, and is available both to you and to midwives. You can call her to help with discussions about birth options with PGP between you and your midwife at a very early stage or to come and help if you are having difficulties in getting heard when you actually go into labour.
Who can you turn to when things don't go to plan?
Sometimes, despite good birth planning and everyone's best intentions, emergencies arise and things don't go well. These situations can be very difficult for all involved and you may find you need extra help and support afterwards. There may be physical issues for you to manage or emotional or psychological factors and with all of these, it is possible to find specialist support groups and people who will listen and help you - both within the hospital or outside. Whatever has happened, you may need to speak to someone straight away if you felt you haven't been listened to or have not received the good care you were expecting.
Most hospitals have a counsellor on site so you can talk things through although you may have to wait for an appointment. You might also want to speak to The Patient Advice and Liaison Service (PALS) which offers confidential advice, support and information on health-related matters including how to make a complaint. You may feel that you want to raise your concerns with the Clinical Commissioning Group (CCG) for your area and also the Chief Executive of the hospital. It may be that through no-one's fault, you have had a traumatic birth experience and would welcome one of the team to go through the notes about the birth with you, to answer any questions. Most hospital have a Birth Afterthoughts Service (although it may have a different name) and you can get in touch to go over your hospital notes, to help you understand what happened and to assist you if you want to plan another pregnancy but are worried about how to cope with going through pregnancy and birth again. There is a wealth of organisations geared to help with coping if the birth did not go to plan (whether you had your baby at home, in a midwifery unit or in hospital); the Pelvic Partnership website includes a number which members have found particularly useful: www.pelvicpartnership.org.uk/links
Where to go from here?
There's no doubt that 'Getting what you want' can require a large amount of effort and time to find people, information and resources that can help you to assess, treat and manage your PGP, give birth and then progress towards a good recovery. However, once you have gathered the information you need to feel comfortable about who to see and what to ask them, you should feel more confident about getting what you want. Once you are well informed about your options, there really are approaches and techniques you can adopt to nudge you away from failures and towards greater opportunities for success.
The next step in achieving greater success with your PGP symptoms is to have a good look at the Pelvic Partnership website and to see the topics we have made available to help you.