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Are you getting what you want? Part 2: Questions you could ask your GP, midwife or physiotherapist

Posted by Madeleine Speed, the Pelvic Partnership, March 2016

Exploring techniques and approaches that could help

In part one of this blog (see below), the focus was on looking at how to take a lead in finding what you want and need to recover from pelvic girdle pain (PGP) symptoms. In Part 2, the emphasis is on what questions to ask frontline healthcare professionals to get what you want. This is followed by a look at how to frame the questions that might prompt a positive response.

facts mythsWhat are some questions to ask?

If you are new to the symptoms of PGP, then have a look at the Pelvic Partnership website and particularly the first three sections: 'What is PGP', 'Symptoms' and 'Treatment'. There's also a really useful 'Stickmum' leaflet that Pelvic Partnership launched at the end of last year which you can download free from the website and perhaps show your GP or midwife. These will give you some useful background information. Then it is worth noting down your symptoms and some questions you might want to ask your GP or midwife ahead of seeing them as these are the key healthcare professionals who can get you a referral to see a physiotherapist (physio) on the NHS. Before you see a physio, if you don’t know about their experience of treating PGP you may want to ask:

  • I have: lower back pain, (or pain in the front of my pelvic), difficulty walking, pain when turning in bed, etc. Have you ever seen this before?

  • Have you ever treated this before? How many times?

  • Will it be possible to have an individual assessment of my condition?

  • Do you offer manual therapy to provide relief?

  • How quickly am I going to start to improve?

Keeping the questions and the preamble short and simple will make the most of the time with the practitioner. These questions can also be used if you want to try a private physio, osteopath or chiropractor through a sports injury clinic or perhaps a private women's health clinic. Have a look at our 'What to expect from treatment' page on the website as this shows what you should expect from an assessment. You can ring ahead before you actually book an appointment and ask to speak to one of the physio team and see if their responses tie up with the key information on the Pelvic Partnership website and in the literature. If you aren't happy with the answers to your questions, you may decide to choose a different manual therapist .

If you are in the middle of some treatment and feel you are not seeing improvements after a number of treatment sessions, you have every right to ask questions. You might want consider the following questions:

  • I am concerned that there has been little progress so far; can we discuss this?
  • What are my options? (This shows that you have a choice and implies that it is your prerogative to choose).
  • I’m feeling... (as no-one can counter that with “no you are not!”) and, I was wondering, what can you do for me?
  • When you raise your voice like that, I feel uncomfortable, could we discuss...what do you think could be done?

Help inside or outside the NHS?

Another question is whether to look inside or outside the NHS for help. As the NHS is free to (most of) us, it is a good place to start and there are some excellent physios within the NHS. However, a downside is that sometimes women find the waiting list for NHS treatment is not just weeks but months and in that time PGP symptoms can become worse. In some areas women are invited to learn about PGP in a group session and need to specifically book a subsequent one-to-one session for an assessment and diagnosis of their PGP. In the past, exercises alone were the basis of treating PGP within the NHS. The Pelvic Partnership believes that treatment is more likely to be successful if it features manual therapy to relieve 'stiff and stuck' pelvic joints and asymmetry of movement of the pelvic joints. Exercise can be useful to strengthen core muscles (to keep the pelvis aligned and functioning well) once manual therapy has helped to normalise joint movement and reduce pain.

There are some wonderful professionals in the NHS, so it's worth looking at the NHS for help ahead of searching for private treatment. If you are very close to your due date and time isn't on your side, you could always ask your GP or midwife to refer you and to see if there's a cancelled appointment before looking for other options. If you haven't found relief from PGP symptoms within the NHS, is it worth looking outside? Again there are pros and cons. Private manual therapists (such as physios, osteopaths and chiropractors) charge a fee for treatment. Whether you opt for manual therapy through the NHS or to a private practitioner, it is important to keep checking whether or not the experience is helping. You should come out feeling better than you went in (although some people do feel initial soreness after a session but this should settle down within a day or so). Even if progress is slow, you should feel some difference after treatment such as freer movement, greater mobility and less pain.

Whoever you see, it is important to give the practitioner a chance. With PGP, just one session of hands-on treatment to address a misalignment may not sort out the problem, so having realistic expectations can help as can checking the literature on the subject, making contact with our support helpline (via phone or website) and generally giving an appropriate length of time for the improvements to appear. Overall, there should be steady improvement in your symptoms, and if this doesn't appear to be happening, you have the right to question the care and lack of progress.

Confidence in askingIs it just my hormones

Having the confidence to speak out can be very difficult and particularly when you are feeling tired, frustrated and in pain. Noting down some questions and anticipating responses from healthcare professionals can help you to prepare what to say. Sometimes it gets easier to ask questions if you keep practising so that, over time, sheer experience will help you to be more assertive and confident. However, if you feel that your confidence is undermined because you are in too much pain, or feel too upset or too vulnerable to do the asking on your own, then why not ask someone to come along and support you? Taking someone with you to act as your advocate can help you to confront a situation where you may otherwise say nothing. A friend, your partner or your mum could accompany you, so that if you are asking the questions, they can back you up or raise the questions you don’t feel confident to ask. Sometimes, just having someone with you can help you to feel empowered to ask the questions you want answered.

Some approaches can work better than others

Your approach to asking a question can sometimes influence how you are answered. For example, talking to someone you see as an authority figure by starting a conversation with “Sorry to bother you but could you...” which suggests that we are not worth seeing, treating and so on. Similarly, if we experience frustration and counter it by becoming angry, the anger is unlikely to be helpful if we are short or rude to someone while trying to obtain information or a service from them. This frustration is particularly understandable if we have had a lack of success in asking for a referral, the kind of treatment or birth we want, for example, and quite rightly feel a strong sense of injustice. However, becoming cross or irritated seldom works in getting a positive outcome from the person confronted at the time. In fact, our experience of venting anger will recall many more negative responses than positive ones. However, anger can be very useful because it can drive your determination to get answers and results. So, even after a number of setbacks, it can help you to keep looking for the right person to help you to overcome your PGP.

How did you find the right person and quickly?

It may not be easy to find the right person straight away but you will need to be persistent and to keep trying. Sometimes the help can come from places you might not expect at first. For example, excellent care for PGP can arise from sports physios rather than through the more obvious route of through a midwife to a physio attached to the maternity hospital. Similarly, keep taking opportunities to ask family, friends and any health professionals you meet about anyone who has had PGP or is used to using manual therapy to treat it because their knowledge and experience could prove useful to you. 

Click here for the third part of 'Are you getting what you want,?', the blog will look at other ways that can help to get you the kind of birth and support you want and what to do if you don't feel you are being listened to or cared for in the way you want.

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.

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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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