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How will I get my baby out?

It is natural for any woman to feel excitement tinged with a certain amount of fear when it comes to the prospect of giving birth. It is only natural for you to feel some anxiety about how the birth will go and how much it will hurt. As many babies are weighing in at well over 9 lbs, it is not surprising that you may worry about how you will ever be able to stretch to accommodate a large baby, and even a small one seems an enormous challenge. With PGP these kinds of fears can increase as the pregnancy develops. You may already be finding that your mobility is limited, that you are already experiencing pain and that you cannot move your legs more than a few centimetres apart.

PGP does require careful management during childbirth but it need not limit your birth options. There is still a wide range of possibilities open to you and with an understanding of PGP and how the condition affects you, it is possible for you to make an informed choice about the kind of birth that you would like to have.

It may come as a considerable relief to learn that having PGP does not mean that your birth options are limited. It does not mean that you automatically need a caesarean section, or that you must give birth standing up, or avoid any kind of pain relief. Many women with PGP have had very positive birth experiences. However, having PGP does mean that you should think about and plan your birth carefully. You should also take time to discuss it with your partner, your midwife and any other medical professionals who may be caring for you, e.g. your consultant, physiotherapist, etc.

PGP is only one aspect of your pregnancy; others will also affect which birth option is appropriate for you. The ultimate goal is to have a healthy baby whilst avoiding anything that may cause undue stress on the pelvis.

We find that women who tell us that they have had a positive birth are those who have been supported in their choice of birth, whether this is choosing a home or hospital vaginal birth or deciding to choose a caesarean section. If they still have symptoms after the birth, they are satisfied that they made their own individual choice based on the best information available to them, and were supported in this choice. Women who are not supported in their choice who still have symptoms postnatally find that their recovery is affected by this lack of choice. We therefore believe that there is not a right or wrong option, but that you should think about all the choices open to you and choose what you think is the best option for you.

Vaginal birth

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. 

Avoid:

  • 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.

You should also consider what type of pain relief you would like to use. 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. 

You should be aware that research shows that an epidural can prolong labour and increase the chance of needing an assisted birth.

Home birth

PGP does not mean that you cannot have a home birth. In lots of ways it is an ideal choice – you can give birth in an environment where you are comfortable and at ease, you have already assessed and dealt with any mobility and access problems and you can have people you are close to at hand to help you with your care and the baby’s care after the birth. You can also choose to hire or buy a portable birthing pool for your home birth.

Water birth

A water birth can be a great option if you have PGP. The water is warm and comforting and provides natural pain relief. Many women report a sense of freedom of movement that they haven’t experienced for some time, and the water makes it very easy to change position. Most units ask that you are mobile enough to get in and out of the pool without their assistance (although your partner can help) and that you are able to get out relatively quickly should an emergency arise. However, lack of mobility should not be a reason for saying you cannot use a pool. There is always a plan to get an unconscious woman out of a birthing pool (though it almost never happens), so if necessary they will be able to get you out in an emergency. It is usually easy to get in and out if you perch on the edge of the pool (or on a stool at a similar height to the pool) with someone behind you and someone to help you to lift your legs in, then you can slide into the water.

Midwifery-led units or birth centres

Midwifery-led units (MLU) may be freestanding (i.e. not on a main hospital site) or alongside a main hospital unit, although they may be on a different floor from the main labour ward, also known as an obstetric unit (OU). They provide the same care for low-risk women as an OU in that a doctor will not be involved in your care, but the difference is that a doctor is not present in the MLU. The environment tends to be more homely in an MLU, and they have the facilities to deal with an emergency, but do not have access to epidurals, and should you need an emergency delivery with forceps, ventouse or by caesarean section, you would need to be transferred to an OU, usually by ambulance. For most women at low risk of complications in labour (which is around 45% of women), MLUs offer the best outcomes for you and your baby. It is recommended in the Intrapartum Care NICE guidelines that for women who have their baby outside of hospital, there is less chance of complications which would require intervention and this is therefore a better experience for women with PGP.

Caesarean section

For most women having PGP is not a reason to need a caesarean section, although there may be other factors that make it necessary, such as the position of the baby or if you have other medical problems. However, some women with PGP choose to have a caesarean section. There are valid reasons for doing so, particularly if you are very immobile, very worried about the birth, if the birth is likely to be problematic or if you have had a traumatic previous birth. Choosing to have a caesarean section can be quite a contentious issue and you should take time to discuss the matter fully with your midwife/consultant. A caesarean section is a major surgical procedure and, as such, there are risks involved. These are explained in recent NICE guidelines. These guidelines also support the fact that you should be supported in your choice if you decide that a caesarean section is the best option for you because of your PGP.

You should also be aware that you will have pain from the abdominal wound in addition to your PGP pain, that you will have to stay in hospital for several days and that your recovery time may be longer overall than a woman who has no symptoms of PGP. There is also a limit on how many caesarean sections you can have – so if you are planning to have lots of babies this may not be the right option for you. Despite these issues, many women who have chosen to have a caesarean section have told us that it was a very positive experience, one that was absolutely the right choice for them. 

As with a vaginal birth, you should make sure that everyone in the medical team knows that you have PGP and is aware of what you can and cannot do. The pain-free gap should not be exceeded and you should remain aware of the masking effects of pain relief both during and after surgery. 

For further information, visit our Elective caesarean section page.

Complications

Birth is unpredictable and complications can and do 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 with the Supervisor of Midwives (SoM) or consultant midwife, who will be able to discuss your options in more detail, and will 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, so everyone is clear about such a plan.

Birth plans:

Whilst birth plans are very useful in describing concerns and wishes for the birth, one of the most useful things you can do with a birth plan is clarify what you can and cannot do physically or functionally, and how you think this may affect you during labour and/or birth, and what may help in light of this. If your choices are outside what the unit normally offers, you may wish to meet with the SoM or consultant midwife (see above) to discuss this. For more information about creating a birth plan please click here.

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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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