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Take the next steps in our 'Stickmum' campaign and unite to push for change!

Posted by Madeleine Speed, the Pelvic Partnership, March 2017

PGP is treatable campaign website

International Women's Day on Wednesday 8th March is a perfect catalyst for us to join together in handing out 'Stickmum' leaflets to GPs, midwives and physiotherapists.

The aim of this campaign

The Pelvic Partnership 'Stickmum' campaign aims to encourage women to join with us to raise awareness of pregnancy-related Pelvic Girdle Pain (PGP) which is a common (affecting one in five women) but not a 'normal' part of pregnancy. The good news is that PGP is treatable, but sadly PGP and its treatment are often poorly understood. We want women to be able to access treatment easily on the NHS, not just in private practice. Help us to increase our campaigning power and reach as many healthcare professionals as possible by forming a chain of women across the UK, united in spreading the word about what PGP is and that it is treatable.

Be bold, get involved and join us in taking action!

Can you help us to join together in distributing our 'Stickmum' leaflets to the key healthcare professionals involved in your care: GPs, midwives and physiotherapists? This upbeat leaflet explains concisely how to recognise the symptoms of PGP and how to go about treating it by using 'hands on' manual therapy. By working together we can extend our reach much further and effectively push for greater recognition and understanding of this debilitating condition. PGP causes pelvic pain and immobility so that walking, driving, turning in bed or even standing can become uncomfortable and challenging. Every woman with PGP has a right to be assessed and treated promptly so please help us to spread the word.

Why International Women's Day?

Why not? And this year the organisers of International Women's Day on 8th March are asking us to #BeBoldForChange. To "call on the masses or call on yourself to help forge a better working world - a more inclusive, gender equal world." So we thought it would be a great opportunity to ask you to help us make another bold statement in our 'Stickmum' campaign. Please reach out this year and help yourself and other women who have PGP, by raising awareness with healthcare professionals simply by giving them a copy of our 'Stickmum' leaflet.

Please take a leaflet to your GP, local women's health physiotherapy department, midwife, local children's centres or maternity unit. Just one leaflet passed on will make a difference and we aim to reach as many healthcare professionals as possible. To make this even easier, in March, you will be able to order 10 free 'Stickmum' leaflets - please click here to order 10 free leaflets today.

So what is PGP and how does manual therapy help?

The key and fundamental message about PGP is that it's a biomechanical problem and not caused by hormones. PGP is usually due to stiff or stuck pelvic joints and a slight asymmetry in the pelvis. A stiff or stuck pelvic joint can mean that the ring of bones making up the pelvis no longer functions together properly. This can also result in muscles becoming tight and painful as they try to compensate for these joints that are working incorrectly.

If you think you may have PGP, the most obvious symptoms are pain and inflammation in the pelvic joints, which in turn can mean that it is hard for you to move around easily. In fact, PGP can make it hard to do many of the everyday tasks that previously you've taken for granted - at work or at home. The causes of PGP are not always clear, and your symptoms may not be exactly the same as someone else's. Some women have very little pain or discomfort and can get around fairly easily while others may find they can barely take a step without feeling that stabbing or burning pain. Your pain may be at the front of the pelvis or it may be at the back; you may be less aware of it during the day but feel much more pain at night. In addition, with PGP your mobility can decrease so your ability to move around, walk or manage stairs is considerably compromised.

Treatment through manual therapy

If you see your GP or midwife during pregnancy, they can refer you to see a physiotherapist and preferably they will do this as soon as the symptoms first occur. It is safe to treat you at any time during pregnancy without harming your baby. Unfortunately, it's a myth that the symptoms usually go away once the baby is born, so many women still have PGP symptoms after having their babies. If you are post delivery (even by some years) but still have PGP symptoms, you can still benefit from having your GP refer you for physiotherapy.

manual therapy image press pageWhen you go for your appointment, the physio should discuss your medical history and carry out a thorough assessment with you in your underwear so that it is easy to see and feel how your joints are moving. They will be looking to see and feel whether your joints are working symmetrically and fluidly by asking you to do a range of movements, for example, standing on one leg, bending forwards and side to side. If your pelvis is functioning normally you will be able to do these movements with ease and without pain. If you are unable to do these movements or find them difficult, your physiotherapist should be able to identify which joint or joints in the pelvis are causing the problem. As a result, they will need to treat the cause of the problem by using hands-on treatment called manual therapy.

Manual therapy involves a range of techniques where the physio uses their hands to restore correct movement to the pelvis; this is often a combination of gentle joint mobilisation and muscle release. Once the pelvis is realigned and stiff and stuck joints and muscles work freely again, and the pain has settled, exercises are helpful to strengthen supporting muscles to keep the pelvis functioning efficiently. Your physiotherapist is likely to give you some exercises specific to you following effective hands-on treatment.

Some women respond quickly to manual therapy treatment within a few sessions, while for others it can take longer and the symptoms need ongoing management. However, you should notice an improvement after each treatment in either pain, function or preferably both.

In the past, women were told it was all down to their hormones which made the joints loose. The treatment offered at that time included crutches, support belts and exercises to 'strengthen the core muscles', but this tends not to be effective for most women as it does not address the underlying biomechanical problem of stuck, asymmetrical pelvic joints. The reason for this is because pain inhibits muscles and stops them from working normally, so most women report that it doesn’t matter how much they exercise, the pain doesn’t go away until their underlying joint problem is treated.

Struggling to get treatment for PGP? Then join us in taking action to get what you need!

If you are struggling to get treatment or you have seen a physio but in a large group of other women and you haven't been offered an individual assessment or treatment - then there is one answer: please firmly but politely complain! Ask for a prompt assessment with an experienced physiotherapist and if you find your appointment is with a physio who doesn't examine you at all, then ask to see one of the senior physiotherapists in their team. Be firm but polite and take a friend or family member if you are nervous of fighting your corner. You might also find that you see a couple of physiotherapists who try to give manual therapy but don't really seem to be making a difference for you so sometimes you need to try a few professionals until you find one that really seems to make the difference through their manual therapy skills and experience of treating PGP effectively. Often it is helpful to be referred to a sports physiotherapist as they usually have more experience of using manual therapy in their treatment approach.

If you do not feel you are being listened to then use some key publications to help you...

Here are some items to use to support your case:

  • Our Stickmum leaflet - this concise and clear publication outlines what you can expect a physiotherapist to offer in assessing and diagnosing your condition ahead of providing a treatment plan which should involve manual therapy. Use the leaflet to discuss with the manual therapist what you are expecting from them.
  • National guidance about pregnancy-related Pelvic Girdle Pain which is produced for healthcare professionals. You can download and print out the leaflet which outlines the expected best practice for diagnosing and treating PGP. It is produced by POGP (the associated of Pelvic Obstetric and Gynaecological Physiotherapists). It is written and aimed at multidisciplinary group including obstetricians, physiotherapists, midwives and women and their families. So every healthcare professional should be aware of it - www.pelvicpartnership.org.uk/images/pogp-healthcare_professionals_version.pdf There is also a version you might want to print out and keep which is designed for mothers-to-be and new mothers - www.pelvicpartnership.org.uk/images/pogp_patients_version.pdf
  • If you still find it difficult to access your right to treatment for PGP on the NHS, then there are various ways you can complain, through a number of channels.

Why is constructive feedback and making a complaint important?

For the NHS to improve its care and services to women, staff must be aware that there is a problem with how your PGP is being treated. If you keep returning to you GP or midwife with pain and difficulties, you are not being helped and the NHS is not making best use of its funding. It is perfectly reasonable to give clear, constructive feedback by complaining, to help yourself and other women in a similar position! You can ask to see the manager of a physio department, the consultant midwife or head of midwifery in a hospital if you are pregnant or you can see the practice manager at the GP practice if your GP is slow to refer you to a physio. If you speak to someone and they do not appear to be listening or understanding, follow it up with a letter to the surgery, physio team, etc covering the same points. Ideally, make your complaint as soon as you can where you received the treatment. Many issues can be resolved there and then.

How to go about providing feedback or making a complaint

If you are unhappy with the care you receive from the NHS, there are procedures to help you complain. There may be different approaches in different areas eg NHS England may differ from other parts of the UK.

Some people find it helpful to talk to someone who understands the complaints process first and get some guidance and support. You will find a Patient Advice and Liaison Service (PALS) in most hospitals.

You can speak with a PALS member, who will try to help you resolve issues informally with the hospital before you need to make a complaint. PALS can be particularly helpful if your issue is urgent and you need action immediately, such as a problem you have with the treatment or care you receive while in hospital as an inpatient or outpatient.

If you want support or help making a complaint, you can also contact the independent NHS Complaints Advocacy service. An advocate will also be able to attend meetings with you and review any information you are given during the complaints process. You can seek advice from an NHS complaints advocate at any stage of the process. If you decide you need some support, it is never too late to ask for help but aim to complain as soon as possible and within 12 months. Your local council will be able to tell you who the advocacy provider is in your area. Find details for your local council on the GOV.UK website.

Your local Healthwatch can also provide information about making a complaint.

Now you have seen this plea, please don't do anything else before clicking here to order those 10 free leaflets, thank you...

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This week: have your rights been undermined about choosing how you want to give birth and who supports you?

Posted by Madeleine Speed, the Pelvic Partnership, January 2017

In November 2016, NHS England published the next steps in its strategy to enhance maternity care and safety, recognising that women should have greater choice about how and where to have their babies. Linking good policy into practice in this way is a move that both women and healthcare professionals approve. So it's regrettable that the Nursing and Midwifery Council (NMC) took steps this week which appear to undermine women's access in the UK to a group of independent midwives. Concern has been raised by two campaigning organisations, who have asked charities and organisations supporting pregnant women, to raise awareness of the issue, and we share these concerns that women’s choice and access to safe care are being undermined by this action, which is why we have written this blog.

What has the NMC announced?

The NMC is the regulator for nurses and midwives and exists to protect the public by setting standards of practice for nurses and midwives. The NMC announced on 13th January 2017 that the indemnity scheme used by some independent midwives is inappropriate and inadequate. This scheme is provided for midwife members of the organisation: Independent Midwives UK (IMUK).

This action by the NMC prevents independent midwives from practising if they are using this IMUK indemnity scheme. Following an investigation, the NMC believes that IMUK has inadequate funds to settle any significant claims that might arise if a woman or her baby came to harm during childbirth attended by an IMUK member. However, the NMC has not been able to confirm what it does consider to be adequate insurance, which leaves these midwives in a very difficult situation.

While the NMC is right to uphold the importance of suitable indemnity insurance, the way it has gone about this seems unhelpful and heavy handed. The Government brought in the change to legal requirements only in 2014 for all health professionals including midwives to have an indemnity arrangement in place, for very good reasons. The IMUK has met this legal requirement and set up an indemnity scheme. What seems to be at issue here is that the NMC is stating that the IMUK scheme is insufficient while not providing an explanation about what would be acceptable. The Association for Improvements in the Maternity Services (AIMS) says that "this apparent level of obfuscation is unacceptable and we urge the NMC to immediately clarify the position on insurance requirements". Birthrights, the organisation protecting human rights in childbirth, has written to the NMC expressing its criticism of the NMC’s action, and the full information about this can be found here.

Why is this situation undermining women's access to midwives?

Induction

The NMC outlines in its press release on 13th January 2017, that there are only a small number of midwives in the UK who work on an independent basis and of these, most independent midwives have adequate indemnity insurance. The NMC states that therefore its decision applies to around 80 members who use the IMUK indemnity scheme. However, these midwives often provide care to women who have experienced traumatic pregnancies or births and choose an alternative, supportive package of care from highly skilled independent midwives. Some of our members come into this category.

Meeting specific, individual needs

Independent midwives can be invaluable through their care for women from all backgrounds with specific needs, who may fall outside the usual scope of an NHS setting. For example, for mothers who have experienced traumatic births or who wish to birth breech babies or twins, triplets, etc vaginally. These women's needs may not be supported within the NHS where hospital guidelines and protocols are aimed at best practice for a majority and not the specific needs of the individual. It may be a small minority of midwives who have been stopped from practising because their insurance is not thought of as adequate by the NMC, but for the women they were supporting during pregnancy and hoped to have been attending at the birth, this news is potentially undermining their choice about ongoing care with someone trusted and chosen to support them.

There is a wider concern here that the important role of midwives is being undermined and undervalued and the role of independent midwives in particular is very vulnerable. In 2014, a report by the Public Accounts Committee outlined that although there was an overall increase in the number of practising midwives, there was still a shortage of 2,300 required to meet current birth rates at that time. The report noted that the mechanisms used to record the amount of midwives needed, was inadequate and it is still the case that the numbers of midwives are insufficient in many parts of the country.

To support women’s choice and offer flexibility to meet individual care needs, we need the number of midwives both within the NHS and outside to grow. How do we generate more independent midwives and encourage their training and support and how do we ensure maternity care is truly women-centred? It is detrimental to women in the UK, that the Department of Health and any regulatory bodies, take steps that can undermine and discourage maternity services and particularly those provided by the independent midwife whose role extends and supplement the care provided by the NHS. If we do not safeguard and grow midwifery services both within the NHS and independently, then there is a real danger that actions like these from the NMC will undermine the scope of maternity services. The Pelvic Partnership adds its voice to AIMS and Birthrights in encouraging a quick and helpful resolution from the NMC to solve the problems they see with the IMUK indemnity scheme.

Next steps if this directly affects your maternity care

The Pelvic Partnership supports AIMS in highlighting the issues that are raised for women who have engaged an independent midwife who is now stopped from practising because that midwife is a member of IMUK and IMUK indemnity scheme. AIMS has also issued advice to help women in this situation here.

AIMS is gathering the voices of women and families who are affected by the independent midwifery crisis. Please complete this questionnaire if this is affecting you and share this survey so that they can hear from as many people as possible. 

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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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