As you prepare for the birth, you may be given advice to help get your baby into the best position for delivery by:

• walking (especially if you are overdue), 
• spending time on your hands and knees
• sitting in a forward leaning position.  

These activities can be difficult and painful for women with PGP.  It is important you explain the pain you are experiencing to your midwife and doctors so that they can adapt their advice accordingly.  

We would suggest avoiding activities that increase your pain. It is important that you feel rested and comfortable in the run-up to the birth. Download our free toolkit to help you explain how PGP affects you physically and emotionally.

The pain-free gap

A good way to look after your pelvis during labour and birth is to control the position of your legs. Your pain-free gap is the distance you were able to move your legs apart before labour without causing pain. Try not to go beyond this gap when you are having your baby. Before giving birth:  

• measure how far you can move your knees apart without pain and record this in your birth plan 
• make sure your birth partner and midwife know about your pain-free gap 
• know that the pain-free gap can change when you go into labour.

If you move your legs beyond your pain-free gap during labour (for example, if you have an epidural and can’t feel pain) you may over-stress your joints and cause more pain after the birth, slowing your recovery. 

Your birth plan

Your birth plan and/or personalised care plan (PCP) can be extremely helpful, both when you’re planning your labour and during the birth. These documents can be the best way for you to tell your partner, midwife and any other medical professional about your wishes and preferences. Ideally, your plan will give clear, specific information and won’t be too long. 

• Explain how PGP affects you and which movements cause you pain.  Include details of any aids you use (crutches, wheelchair).
• Describe your pain-free gap. 
• Make clear that you want to avoid positions and medical interventions that are likely to put stress on your pelvis.
• Write about what help you will need after the birth, see the tips about help on the ward following birth. 
• Check that a copy of your birth plan is included with your maternity notes. 
• Carry spare copies of your birth plan for anyone who needs to know about your PGP, including the midwife, and the senior midwife and doctors on duty. 

Please be aware that birth doesn’t always go to plan; some people prefer to see these as birth choices or preferences. 

Where you would like to have your baby is your decision. What is right for one woman is not necessarily right for another. 

Most likely, you will give birth in one of these four places: 

• home 
• a freestanding midwifery unit (sometimes called a birth centre) that is not next to a hospital 
• an alongside midwifery unit (within a hospital) 
• a hospital labour ward/obstetric unit.

You can find more information in the sections below as well as from the National Institute for Health and Care Excellence (NICE). 

Having a baby at home with PGP

Giving birth at home means you can be somewhere familiar, surrounded by the equipment and people you need during and after the birth. You can hire or buy a pool for a home-based water birth (and sit in it for pain relief in the days before labour).

Having a baby in a midwife-led unit or in hospital with PGP

Your local hospital and midwife-led unit are likely to have birthing pools, beanbags and birthing balls. These can make labour much easier if you have PGP, as using them will make you feel supported when you move and will help you manage your pain.  You could bring your own birthing ball so that you know it will be the right size for you.  

Midwife-led units offer a more home-like setting for giving birth. In midwife-led units, you will have the assistance of a team of midwives but no access to doctors, stronger pain medication such as epidurals, or continuous electronic monitoring. If you choose to have your baby at home or in a midwife-led unit and you need an epidural or other medical care you can be transferred to a hospital by ambulance. 

It is helpful to think about any equipment or special help you might need to help deal with your PGP during your labour, for example:

• Many hospitals offer virtual or online tours which can be helpful for your planning. 
• Think about any special equipment you might need, like a raised toilet seat or a monkey bar to help you to move in bed. 
• Find out the arrangements for your partner visiting. Many hospitals support partners to stay with you after the birth. 
• You could ask whether individual or private rooms are available. If you can afford a private room in hospital it may make it easier for your partner to stay with you after the birth and provide help.

Many women with PGP give birth vaginally. You may be concerned that this will not be possible for you because you are having difficulty moving your legs and changing positions.  With the right support, a vaginal birth can be a good option for women with PGP. 

When you first meet your midwife, explain how PGP affects you, and what you can and can’t do.  For instance, how wide is your pain-free gap? Can you lie comfortably on your back or side, stand with support, walk with or without crutches or remain in one position for some time? This will help you and your team to work out which positions will be comfortable in labour. Make sure PGP is added to your medical notes and include this information in your birth plan and personalised care plan. 

Download our free toolkit to help you explain your PGP.

Labour and birth positions with PGP

It’s helpful to try and stay upright and active in labour. Many women with PGP find it helpful to change position regularly, as this reduces stress on their pelvic joints. Not lying on your back can enable your baby to move through your pelvis with the help of gravity. Here are positions that many women with PGP find helpful: 

• in a birthing pool where you can move and change position easily
• standing or leaning forward 
• on your knees or on all fours 
• lying on your side with your top leg supported. 

Water birth

Birthing pools are popular with women with PGP. The support of the water allows you to move around with ease, and the warmth of the water provides pain relief. In a pool you’re also in control of the position of your legs, so you’re unlikely to move beyond your pain-free gap. 

Most hospitals and midwife-led centres have birthing pools. Ask your midwife if one is available. 

Don’t be discouraged from using a pool because you’re worried about getting in and out. There are ways you can slide into the water from the pool’s edge, such as using a high stool or a transfer turntable (which can be turned to give you the right angle to get in). You’ll probably need someone behind you to support your back and another person ready to lift your legs. It’s safe to go through your entire labour and to give birth in the water. There will always be an emergency plan to get you out of the pool if needed.

Labour and birth positions likely to make PGP worse

• Lying on your back with your feet in stirrups (the lithotomy position). This position puts the most strain on your pelvis and seems to cause more long-term problems for many women with PGP. The team caring for you may ask you to move into this position if you need stitching (suturing) after giving birth. You can ask for stitching to be done while you are lying on your side with your top leg supported. Inserting stitches while a woman is on her side can be challenging and your midwife might not have experience of this. If this is the case, ask for a senior midwife or a consultant to help. 
• Sometimes the ‘feet in stirrups’ position is unavoidable if your baby is in distress. If you find yourself in this situation, make sure both your legs are moved at the same time, keeping them symmetrical (identical on both sides), and that they are in the stirrups for the shortest time possible. 
• Lying on your back with your feet on your midwife’s hips or shoulders. If you are asked to push in this position, say no. It will put a lot of strain on your pelvic joints and could make your PGP worse.

Pain relief in labour

You may be worried that your PGP will get worse during labour. However, many women say the pain wasn’t as bad as they had expected. Some women tell us they did not notice their PGP once they were in labour, or that the contractions were never as painful as their PGP.  

You have many pain relief options, including TENS, gas-and-air, medication and epidurals. 

Read more about pain relief in labour on the NHS website

Epidurals and PGP

Epidurals numb the lower half of your body. They are given by an anaesthetist and are only available in hospital. The numbing medication is slipped into the space around your spinal cord through a very fine tube. If you’re given a low dose, you’ll be able to move around and change position during your labour.

If you have PGP and are having an epidural it’s important to know: 

• It can hide PGP during labour and birth. By numbing your lower body, an epidural can mask the symptoms of PGP. This means you’ll need to be extra careful about the position of your legs during your labour, as your body won’t tell you if something is hurting. It’s important not to go beyond your pain-free gap, and to keep all leg movements symmetrical (that is, identical on both sides). Get help to change position regularly so your joints don’t get stuck in one position. 
• It can also hide PGP after the birth. The effect of the epidural can last for several hours so you need to be careful after, as well as during, the birth.
• Having an epidural increases the chance of needing other interventions, such as forceps or ventouse. 

You may be advised that a caesarean birth is the best option for you, or you might choose a caesarean birth, either because of concerns about PGP or for other reasons.  

Here is what you need to know when deciding whether a caesarean birth is the best option for you:

• In most cases, having PGP doesn’t mean you can’t have a vaginal birth.  However, if you cannot get into any birthing position you may need to consider a caesarean birth. Some hospitals suggest caesarean births are the only option for women with PGP, but there is no research to support this.  
• Having a caesarean birth avoids the risk of interventions, such as forceps or ventouse, which could worsen your PGP.  However, there is no evidence that a caesarean birth has faster recovery times for women with PGP compared to vaginal birth according to the POGP.  
• During recovery you will have pain from the surgical wound.  This might be in addition to PGP, as for many women PGP does not go away straight after birth.  

Make sure your medical team knows about your PGP. It’s important they are aware of your pain-free gap and the positions you can and cannot manage comfortably. 

Don’t forget that the pain relief you are given for a caesarean will mask any pain from PGP.  Make sure you don’t do too much straight after birth as you may put strain on your pelvis without realising it.  

Induction is a medical treatment to start labour. It is rare for induction to be offered due to PGP alone.  This is because giving birth early involves a level of risk. Your doctor will take into account your medical history and will balance up the risks to you and the baby in making a decision on whether to offer you an induction. 

Here is what you need to know about induction: 

• Induction will not necessarily solve or improve your PGP.  Some women find that their PGP stops as soon as they give birth but, for others, it eases off gradually in the weeks after birth.  Most women find they need manual therapy treatment to resolve their PGP.  
• There are different types of induction offered. Some types may lead to stronger contractions than you would experience in non-induced labour. 
• After being induced, you may need to be monitored more frequently. In many hospitals this may mean you won’t be able to use a birthing pool (though special waterproof monitors to connect you to monitoring equipment are becoming more available). 
• NICE guidance reports that induction may lead to further medical interventions, such as an assisted birth (forceps/ventouse) or a caesarean birth.

We are often asked questions about induction, and the feedback we hear from women is varied.  We have gathered feedback from women with PGP who have experienced induction here.  You may find it helpful to read these experiences if you are making a decision about induction.  

The right decision for you will depend on your personal situation and your preferences.  It may be helpful to talk it through with your midwife or contact our helpline.

If your baby gets stuck or becomes distressed during labour, you may need an assisted birth using forceps or ventouse. 

Guidelines from POGP state that ventouse, rather than forceps, is the preferred option for women with PGP. Many women with PGP who have experienced an assisted birth say the experience put a lot of strain on their pelvis and made their recovery slower. 

If you expect your labour may be long or that an assisted birth is likely, you may want to consider a planned caesarean birth to avoid the need for forceps or ventouse.  Once you are in labour and experiencing difficulties, it may be no longer possible to ask for a caesarean birth instead of forceps or ventouse.  There are greater risks in having a caesarean if the baby has started moving further down the birth canal.

For an assisted birth you will usually be asked to lie on your back with your legs supported in stirrups.  This position can make PGP pain worse following birth, so it may be possible to have an assisted birth while you lie on your side.  However, this might not be possible if the people treating you are not experienced in this technique or if it is urgent to birth your baby quickly.

If you cannot avoid lying with your feet in stirrups, the following can reduce the risk of making your PGP worse:

• moving both legs into stirrups at the same time and keeping them symmetrical
• staying in stirrups for the shortest time possible.

A birth doula works alongside doctors and midwives but is not medically trained. The job of a doula is to give you emotional and practical support during pregnancy and birth, no matter where you choose to have your baby. 

This needs to be arranged before the birth. You will meet and get to know your chosen doula during the pregnancy so that they can understand your needs and wishes. They may also support you in the initial days and weeks after the birth. Find more about this private service at Doula UK.

If you have given birth in hospital, you are likely to spend some time on the ward before going home.  For a small number of women PGP will disappear straight away, but for most it will not.  Your mobility may also be affected if you have had a caesarean birth or a difficult birth.  The following tips may help:

• Make sure staff are aware that you have PGP.  Let them know if you need help collecting meals or caring for your baby, or if you need aids such as a wheelchair or raised toilet seat.  
• You may need to move around the hospital to get tests for yourself or your baby, or to attend support sessions.  You may want to ask to be taken in a wheelchair.   
• Ask whether a bedside cot is available.  This will keep your baby at the right height to be lifted out easily for feeding and comforting.
• Ask for a single room with en-suite facilities.  These rooms are often allocated to women based on their medical needs, such as PGP, but in many hospitals you can also pay for a private room if one is available.  Some hospitals will allow your partner to stay outside normal visiting hours, which will give you more support on hand.  If you do not have an en-suite room, you can ask to be taken to the toilet in a wheelchair.
• If you plan to breastfeed, ask for a suitable chair that will provide adequate support to be placed close to your bed.  Sitting up in bed to breastfeed is likely to strain your pelvic joints.   You can breastfeed lying on your side in bed, but you may find this difficult at first, especially with PGP.  
• Ask to see the physiotherapist while you are in hospital, so that they can assess your pelvis, refer you for further treatment and also raise awareness of your needs with ward staff.  It may also be possible to see an occupational therapist (OT) if you need specialist equipment at home or on the ward.  

Midwives on the ward encourage women to get up and walk to help recovery and help circulation.  Remember that if you have PGP you will be less mobile than other women. You should not be afraid to ask for more help if you need it.