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Pelvic Partnership Coronavirus (COVID-19) Guidance

This guidance has been specifically developed for women experiencing pregnancy-related pelvic girdle pain (PGP) and healthcare practitioners who provide care, support and/or treatment to women experiencing PGP.

For more general guidance related to pregnancy, being a pregnant healthcare worker or providing care, support and/or general treatment to pregnant and postnatal women, please see the relevant association below:

Royal College of Obstetricians & Gynaecologists (RCOG) and Royal College of Midwives (RCM) Coronavirus (COVID-19) infection and pregnancy

Chartered Society of Physiotherapy Information and guidance for CSP members about the coronavirus outbreak

General Osteopathic Council Coronavirus guidance

British Chiropractic Association Coronavirus guidance

 

Q&As for women experiencing PGP and their families during COVID-19

Are pregnant women more likely to become ill with COVID-19?

According to the Royal College of Obstetricians & Gynaecologists (RCOG), “pregnant women do not appear to be more likely to be severely unwell than other healthy adults if they develop the new coronavirus. It is expected the large majority of pregnant women will experience only mild or moderate cold/fly like symptoms”.

Along with the rest of the UK, pregnant women are being told to stay at home to limit the spread of COVID-19.

 Can I still go to my antenatal appointments?

As outlined in the RCOG guidance, “attending antenatal and postnatal care when you are pregnant and have a new baby is really important to ensure the wellbeing of you and your baby”. Before any appointments please contact your maternity team to check if it will still be held in person or by telephone or using videoconferencing.

Please keep in touch with your maternity team and ensure to continue to call and ask them any questions or discuss any concerns with them throughout your pregnancy and once your baby has been born.

How can I get manual therapy to treat my PGP during self-isolation?

Many manual therapists have been advised to stop providing in-person consultations by their regulatory bodies and/or professional associations. This is to ensure the safety of their patients, themselves and their families and limit the spread of COVID-19, in line with the Government recommendations.

For women experiencing PGP however, this news will mean that they can no longer get hands-on manual therapy to treat their PGP.

Many practitioners are still available to provide consultations by telephone or video conferencing if they are able. Please contact your own physiotherapist, osteopath or chiropractor to discuss your own treatment plan and identify next steps. Please do not attempt any exercises without consulting with your manual therapist. Although exercises may help in the short term by keeping you moving, they won’t sort out the underlying problem.

If you don’t have a manual therapist yet, please discuss with your midwife or head to our list of recommended practitioners to see if there are any practitioners near to you who may be providing alternative consultation options.

If you want to discuss this with one of our trained volunteers, please give our helpline a call on 01235 820921.

 

Q&As for healthcare practitioners who provide care, support and/or treatment to women experiencing PGP during COVID-19

Please note that the different regulatory bodies are giving different advice. Please visit your own professional association for more current information.

I am a physiotherapist, should I be providing face-to-face consultations?

The Chartered Society of Physiotherapy (CSP) has confirmed that face-to-face consultations must stop unless absolutely necessary.

NHS England has stipulated that patients should only be offered face to face consultations if:

  • They are in hospital and require physiotherapy.
  • You have a high suspicion of risk of serious deterioration from underlying pathology and you are unable to determine this remotely.
  • They have urgent rehabilitation needs, which if not met, will require care from General Practice, secondary care or social care agencies. This is particularly important if they are themselves a carer for someone else who is vulnerable.
  • They require rehabilitation to support their rapid discharge from secondary care.

The CSP has also confirmed that group classes must not be delivered face to face at this time.

I am an osteopath, should I be providing face-to-face consultations?

The General Osteopathic Council’s advice is for professionals to use their own “professional judgement in determining whether it is appropriate to see patients”, pointing to the different advice in different parts of the UK:

“Osteopaths are allied health professionals in England and may also work in a range of roles including within the NHS. However, many osteopaths have now closed their own practices to reduce the transmission of COVID-19 and protect the public. We note that the Scotland, Wales and Northern Ireland governments have identified that only essential, urgent or emergency services should be delivered and many routine NHS services are now suspended for public protection.”

Having said this, remote consultation options and stringent infection control procedures if in person consultations are held, are highly recommended.

I am a chiropractor, should I be providing face-to-face consultations?

The British Chiropractic Association (BCA) has advised members “to cease all face-to-face appointments in order to be compatible with strong government advice on staying home”.

The BCA strongly encourages patients to contact their own chiropractor to explore remote consultation options.

How can I provide care, support or treatment for women experiencing PGP during the COVID-19 outbreak?

As outlined above, while you are not allowed to continue face-to-face appointments outside of a hospital setting, consultations can still take place using alternative approaches, such as by telephone or by video conferencing.

I want to provide care by telephone or by video conferencing, what resources are available?

There are a range of digital resources available. Many organisations are using Facebook, Skype, Zoom or Webex to continue their businesses remotely.

How can I connect with other practitioners at this time?

Our Facebook Closed Group for Healthcare Practitioners who provide care, support and treatment to women experiencing PGP launched recently and is a forum for all practitioners to share ideas and advice, to promote best practice in the treatment of PGP. Given that face-to-face consultations have ceased in the majority, this group could offer an avenue for practitioners to work together and find creative solutions to help women with PGP during the COVID-19 outbreak.

 

Thank you

To discuss any of these issues in more detail, please email our co-ordinator on contact@pelvicpartnership.org.uk or call our volunteer helpline on 01235 820921.

This information is updated regularly but please advise if there are any broken links or information that is now out of date.

PGP with a newborn

Guest post by Claire, one of our volunteers

I had severe PGP during my first pregnancy, but I managed to stay quite positive. Everyone was telling me that the PGP would stop once the baby was born.  So this was just a short term problem I had to put up with, right?

Unfortunately, they were wrong.  For some women PGP does stop at birth, but for many, if not most, it continues.  Sometimes just for a short time, but for some women it lasts months or years without proper treatment.

Coping with a newborn first time round is a big shock and a real challenge for anyone, but when you have PGP it is even more difficult. 

I was kept in hospital for a number of days following my son’s birth. Some of the staff were unsupportive regarding my PGP, telling me “there is nothing wrong with your legs”.  In my notes they wrote “says she cannot walk”.  They stopped bringing food to my bed, presumably thinking that if I got hungry enough I would get up and walk.  I didn’t.  I felt too vulnerable to confront the staff, so survived on biscuits when my husband wasn’t there to help.

The hospital referred me straight to physio, but I was told they could do nothing until 6 weeks after the birth.

Once home I faced new challenges as I could not get up the stairs.  We had to live downstairs and sleep on the sofa bed.  My husband filled the watering can with hot water to give me a shower.

By the time my husband went back to work, I was able to get up and down the stairs with help.  In the morning, my husband would help me down the stairs and set up everything I needed for the day, leaving my lunch in the fridge.   I was then at home on my own all day, caring for the baby and unable to go out.   A very kind community midwife used to clear up my kitchen and make me a cup of tea every time she visited.  At this stage I was still being told that my PGP was just going to clear up, so we never planned ahead, we were just focussed on surviving each day as it came. 

My PGP was improving slowly.  There was no chance of managing our big off-road buggy, so we looked on Which? and found the lightest buggy suitable for a newborn.   I was soon able to walk round the block or to the cornershop, but I was still very isolated, with no friends of family living nearby.  Luckily, I had my NCT group, some of whom lived nearby, and we started going to a baby group at a church within hobbling distance of my house.  That was a real sanity saver.  But I felt very anxious about going out because I worried about how I would change my baby’s nappy. I couldn’t do it on the floor like others did.  Once I found a few places with easily accessible baby changing units, it got easier.

I went back to physio at around six weeks, but was not offered any hands on treatment.  It was just practical advice and core strengthening exercises.  Just getting to and from the hospital was very difficult. I couldn’t drive so had to walk there. Luckily it was quite close by, but with PGP it was a big struggle. 

Eight weeks in, my husband had unavoidable work commitments which meant he would be away for much of the next two weeks.  This forced us to make the decision to get a doula, and we wished we had done it sooner.  The doula came 2 or 3 times a week for a few months.  She would help with laundry, making lunch and looking after the baby while I slept or did my physio exercises.  My husband started working from home twice a week, which was such a help.

Around 3 months in, my PGP stopped improving.  Other people seemed to be getting back to normal, but I was still really struggling, and sleep deprivation was taking its toll. 

One of the lowest points was when I joined a mum and baby yoga group, as I had been advised this could help. It was so demoralising. I started the same week as another new mum.  The yoga teacher told the class how brilliantly this lady had done, having a totally natural birth with no pain relief, and how she had got straight back to yoga.  Nothing was said about my birth experience – a crash caesarean under general anaesthetic – I wasn’t the image of childbirth that the yoga teacher wanted to promote.  I felt like a failure for being in such bad shape physically and for not being able to do half the exercises.  But I kept on going, hoping it would fix my PGP and bad back.  Looking back, I wish I had just walked out that first time.   

Eventually I did recover from PGP, once I had proper manual therapy.  Unfortunately this wasn’t until my son was 15 months old.

It’s understandable that medical staff try to reassure women with PGP by telling them it will soon go away, but by not being open about the fact that PGP can continue after birth, they are denying women the chance to prepare for what can be a really tricky time both physically and emotionally.

I hope this blog will help other people struggling with PGP post-birth to realise it is not just them, and that there are ways to cope.  The most important thing is to get manual therapy. PGP is treatable!

Charity Registered in England: 1100373 

The Pelvic Partnership consists of volunteers who have had Pelvic Girdle Pain (PGP) and wish to support other women. We aim to pass on information based on both research and the experience of other women with PGP. We are not medical professionals and cannot offer medical advice and the information we provide should not take the place of advice and guidance from your own health-care providers. Material on this site is provided for information and support purposes only.

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