Planning for birth with PGP involves considering many aspects. You may have concerns about how you will give birth, and we find that women find it very helpful to have a clear plan of what they would like to do before they go into labour.
The ideal is a straightforward birth which does not last too long, avoids intervention such as induction, epidural and assistance with the birth, and controls the position of your legs, avoiding being on your back with legs in stirrups (the lithotomy position). The most helpful positions are ‘active birth’ positions, using gravity to help the baby to move through the cervix, which include labour and birth on all fours, lying on one side or in water in a birthing pool.
- Home water birth, midwifery-led unit, hospital birth, caesarean section and epidural are all possible choices when taken with a supportive team caring for women as individuals. This means taking into consideration your range of joint movement (pain-free gap) and ability to turn yourself over and change position.
- Labour and birth in water can be ideal with PGP as it allows you to move easily to turn over and change position. You also have the normal benefits of pain relief through the warmth and support of the water.
- Induction of labour may increase your need for pain relief as the contractions are usually stronger than a labour which starts on its own. This can lead to the ‘cascade of intervention’ which means that because of the strong contractions you need more pain relief such as an epidural. This, in turn, makes you less mobile, which slows down your labour and increases the chance that your baby may become distressed and need to be born quickly with the help of forceps, ventouse or caesarean section. Most women find that it is best to avoid starting this route if you already have a painful pelvis. Therefore, it is important to discuss with your team what you will do in the event of needing more intervention (see NICE guidance on induction of labour).
- The ideal birth for someone with PGP is a straightforward labour where they can move around and change position, using normal active birth movements but avoiding over-stretching any painful joints. This often means that squatting can be uncomfortable, but birth balls, birthing stools or birthing pools may be very helpful. Using these, your labour should progress straightforwardly and reasonably quickly, and your baby should be in a good position for birth.
- Anything that indicates that it is going to be a long labour or that intervention is likely may make you wish to consider an elective caesarean section at an earlier stage than it might otherwise be done, to avoid the need for forceps or ventouse.
- We receive a large number of calls from women who have had a forceps birth in a previous birth and have experienced an increase in symptoms as a result. Experts therefore suggest avoiding the use of forceps unless absolutely necessary.
- Vaginal examinations, stitching and even ventouse and forceps can all be done by an experienced midwife or doctor with you lying on your side – again, it is worth exploring what your options might be should you need any of these.
- We have found that the women who have the best outcomes, both physically and emotionally, are the ones who have made an informed choice to have either a vaginal or a caesarean birth.
- Women seem to cope better, even when they still have symptoms afterwards, if they feel they made their own choice that was best for them in the circumstances and that they were supported in this choice.
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