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Are you getting what you want? Part 1: Taking a lead

Posted by Madeleine Speed, the Pelvic Partnership, February 2016

Exploring techniques and approaches that could help

On 23rd February 2016, NHS England announced the outcome of the Maternity Review which has been taking place over the past year. We contributed by attending the Birth Tank event as well as one of the listening events, and raised the profile of Pelvic Girdle Pain (PGP) with the review team. We are really pleased to see the focus on choice in the final report, and hope that this will improve things for women with PGP. A pilot project will start later this year ahead of a full roll-out in 2017. The aim is to improve safety and enable women to exercise real choice about their pregnancy and birth, particularly about where to have their babies. Although current maternity services are already underpinned by a policy of encouraging choice, evidence suggests that women are not routinely offered the range of options available and this certainly seems to be reflected by the statistics where a large percentage of women are giving birth within hospitals. In 2014, of 664,543 births in England, 87% were in hospitals, 11% in midwife-led units and 2% at home, although almost half would have preferred to give birth in a midwifery-led unit and 10% would have preferred to be at home .

Getting what you want part oneDo you feel you are getting what you want?

This news item about encouraging choice prompted the topic of this month's blog. The NHS has a policy of women-centred care and this should be apparent to us as women with PGP both in terms of seeking treatment for it but also in the support we receive to exercise choice in where and how we give birth to our babies. Do you feel you are getting what you want?

Sometimes it's easy to get what you want: a GP appointment is offered at exactly the date and time you requested, the book you'd like suddenly becomes available at a sale price, or the plumber responds immediately to your call to fix a leak. Sadly, it isn't always that simple and it can feel that, on balance, the disappointments outweigh the successes. This is where taking a step back can help and a new focus on factors that might influence the successes over the setbacks. If you compare the occasions when there's a successful outcome concerning your PGP, with times of failure, you might see a useful pattern. There may be ways for you then to exert an influence over events so that the successes outnumber the failures. You might find that all it takes is a slight shift in technique, approach or perspective to get you what you want more often. So read on, compare notes and see if this tactic can work for you in your quest to get what you want with your PGP.

Taking responsibility

There are some wonderful healthcare professionals out there. Sometimes it is hard to find them and many of us may have encountered one or two who haven't been well informed about PGP and how to treat it. We may not be responsible for how professionals respond to us but we can take responsibility for acknowledging that something isn’t right with our health and that we need to be directly responsible for taking action individually to get help.

With PGP, what we say and do can often reveal whether or not we are really taking responsibility for our health. Are we prone to just grumble with frustration or to use that dissatisfaction to drive us on to finding a way forward? For example, we could be proactive in sending off for information, finding out about the condition, talking with friends, family or healthcare professionals we meet about it in case they know anything that would help. It can be time-consuming and difficult at times but this can also be a source of great satisfaction when you know your efforts have delivered a little progress. The fact that you have got this far in reading the blog suggests that you are motivated to push for more help (and we hope that exploring the Pelvic Partnership website, as a further step to demonstrate your persistence, will find you both support and up-to-date information about PGP).

Getting what you want and need from your care

What experience do you have of approaching a healthcare professional for help in combating PGP? GPs and midwives can make referrals to an NHS physiotherapist for an assessment and diagnosis of PGP. When PGP is diagnosed, the physio should then outline a proposed treatment plan to you which ideally includes the use of 'hands on' manual therapy. Within the Pelvic Partnership team, some of us found relief from PGP symptoms with our first contact with a physio (or an osteopath or chiropractor) while for others it took a while to find one who seemed to be 'right for us'. You will want to find someone who knows their facts and also has a good 'bedside manner'. However, even if this person seems well-informed, if they don't appear to be listening to you or responding to what you ask or say, then they may not be the best person to help you get what you want.

Click here for the next part of 'Are you getting what you want?' we will explore the kinds of questions you could ask your GP, midwife or physio.

Continuing to work when pregnant and with Pelvic Girdle Pain (PGP) symptoms

Posted by Madeleine Speed, the Pelvic Partnership, January 2016

The Pelvic Partnership receive a number of calls and emails from our members about how to keep working when pregnant and managing PGP symptoms. On balance, most are from women who want to continue working for as long as they can ahead of going on maternity leave but aren't sure how to bring up the subject at work.

workHow is it for you?

PGP symptoms in pregnancy are usually caused by stiff or stuck pelvic joints and an associated asymmetry in the pelvis which can hamper efficient function. The symptoms can include pain and difficulty walking and performing other routine tasks and movements. With good manual therapy, you will be aiming to stop the symptoms getting worse by releasing the stiff or stuck pelvic joints and realigning the pelvis. You should then start to notice improvements in function and relief from pain. However, this does depend on finding a manual therapist experienced in treating PGP, which may take some time. In the meantime, you may have to cope with the challenging symptoms of PGP at work.

No two women are the same so PGP symptoms can vary in severity and the associated level of pain and immobility can similarly differ from one woman to the next.

  •  Some women with mild PGP can continue working during their pregnancy until a week or so before their estimated due date. They may be tired and find it difficult to stand or walk for long periods during their job but generally, they are fine and continue with the day-to-day tasks involved in their role.
  • Other women may find that their PGP symptoms become more pronounced just a few weeks after falling pregnant so that as the pregnancy progresses, the symptoms make it very difficult to function as before either at home or at work. Again, the symptoms might be OK one day and then flare up the next. 

You may not know how you might feel with PGP as you continue in the pregnancy but you may already have a clear idea about whether or not you can manageto stay at work. Sometimes it isn't really a practical option to stop working early as you need the income particularly as there's a new baby on the way. Other women may plan to finish work with the birth of their baby and not return until they have completed the family and the youngest is ready to start school. Whatever your situation, if you want to stay at work but are worried about how you will manage, here are suggestions that may help you to bring up the subject with your employer so you can explore options together.

What can you do and what will you struggle to do?

It is worth having a chat at home with your partner about how you are managing at work. Whatever you decide to do about staying for as long as you can in your work role, it is important to have your partner on board so you feel that your family is behind you and backing your decision. It will then be easier to concentrate on how you think you will need to adapt to keep working for as long as possible. Aspects to consider:

  • Just as each woman will find PGP symptoms may affect them slightly differently, so too will the demands of a particular job. If you have a very demanding physical job your challenges with PGP are going to be different from someone whose role is fairly sedentary or involves no driving between sites.
  • Have a look at aspects of the job that are going to prove hard for you as the pregnancy progresses and see if you can come up with some ideas for managing. It may be that the loos and meeting rooms require trips up or downstairs so it may be a good idea to think of ways you could move your desk to a higher or lower floor to avoid having to use the stairs all the time.
  • You may have a colleague who would be happy to work more closely with you to fetch and carry without causing problems to either of you.
  • Have a good list of the tasks that will be hard for you and some constructive ideas about how you could get around this. You might be nervous about suggesting that you work for some of your time from home but if you can show that it can be done in your role (and that you are much more likely to keep managing the work), then you will probably find your request is looked upon favourably.

Approach your boss about PGP as soon as you can

It is worth talking to your boss about your situation as soon as you can so that there is some time to plan a transition in the way you work. In this way, preparations are more likely to go smoothly and your employer is less likely to feel they have to react quickly without proper thought and consideration for your situation.

  • Book some time to talk about the situation so your line manager has your full attention and you aren't likely to be interrupted.
  • Set up a further meeting so you can let the information about PGP sink in before you suggest ways to alter the tasks or the way you do them.
  • Draw up a list of the tasks you find difficult and how you might get around them.
  • Explain that if you can work together to manage the PGP, you are much more likely to cope in the job without needing time off because you aren't coping.
  • Try and come up with some positive ideas of how to manage your job so that your line manager recognises that you are positive and constructive. shopping
  • Encourage your line manager to set up a meeting with your personnel or Human Resources department so you have their expertise and support to help you.
  • If you can show that your work can still be covered with help from colleagues, with some extra equipment and with some time spent working from home, your boss is much more likely to support your ideas.

Both you and your employer have an interest in how you are doing

Companies have invested time, money and resources to train you up and if you have been in your post for more than a few years, your line manager will value the experience and the skills you bring to the job. Replacing you will be costly and undesirable in many ways so it is usually to your boss's advantage as well as yours to have you stay in post for as long as possible. If you are worried about how your boss will react, see if there is a senior colleague who is sympathetic to your situation who can join in any meetings to support you.

"I was nervous about talking to my male manager about my problems with PGP during pregnancy. When I finally had the courage to arrange a meeting to discuss it, he had already noticed I was struggling and anticipated that there was a problem - he had lots of ideas for supporting me." Sreela.

"My boss wasn't very good about the situation and said he thought I was making a fuss about the pregnancy and shouldn't be at work. However, his line manager is a woman whose sister had PGP so she was very helpful and intervened to smooth away the friction and come up with ways that were acceptable to my immediate boss and really helped me." Jane.

"I found that we could delegate some of the more physical aspects of my role to a junior in our team who I then supervised and mentored and this worked really well for both of us. A bit of creativity and some goodwill on both sides can usually help to find a solution through some of the difficulties." Liz.

"My immediate line manager thought that I would be 'off sick' for much of my pregnancy because of my PGP symptoms. As a result, initially she seemed very negative and unhelpful. However, when we set up a meeting with personnel to start planning, it was obvious that she suddenly 'got' that we just needed to make a few tweaks and practical changes to help me to keep working. Once the penny had dropped and she became supportive, the relatively minor changes we made helped me to continue working right up to the week before my baby was due." Sandra.

 

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Please note, the Pelvic Partnership consists of volunteers who have had Pelvic Girdle Pain and wish to support other women. We aim to pass on information based on research evidence where available. We are not medical professionals and cannot offer medical advice. The Pelvic Partnership takes no responsibility for any action you do or do not take as a result of reading this information.
 
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