PGP from a midwifery perspective
This is a summary of the talk that third year midwifery student, Helen Bloomfield, gave to us at the AGM on Thursday 12th June 2014 at the South Didcot Children’s Centre. Helen talked to us about her dissertation which looks at research findings about PGP and how a better understanding of women’s needs with PGP by midwives could greatly improve current care.
Helen explained that she is completing her third year of midwifery training and her dissertation has been about pregnancy-related pelvic girdle pain from a midwifery perspective. Helen confessed that when Sarah first asked her to speak at the meeting, she felt that her audience would know much more about PGP than she would. However, Sarah recognised that Helen’s literature research and approach to PGP from a midwifery viewpoint would be of great interest to the Pelvic Partnership on a number of levels and not least because it may help show us how we can engage with midwives to support woman-centred care for expectant mums with PGP symptoms.
Helen explained her background has been in psychology, and later she trained in using massage techniques, including body work and deep tissue massage. She has a particular interest in using massage in pregnancy and this led to her decision to train to be a midwife. Helen said that she came across PGP when treating women with discomfort during pregnancy but didn’t know a lot about it. Helen decided to focus on PGP for her dissertation as long as she could find a fundamental connection with the work of a midwife. Ironically, Helen said that in all her three years of training to be a midwife, PGP was mentioned only once and then it was linked with the outdated view that it is caused by hormones, whereas current thinking recognises that PGP has a biomechanical cause.
When she started doing her literature review about PGP and papers relevant to PGP, she found it was a complicated business because existing findings appeared to be patchy, disparate and unlinked. Helen explained that sometimes it was difficult to identify and gather relevant research papers with a PGP thread common to all. This was because pelvic girdle pain was referred to in many different ways using a range of different terms. It was very hard to see that these papers were all looking at the same problem and not comparing apples and pears when it was important to consider only apples!
Helen gave various examples concerning the difficulties of finding relevant re-search papers. She mentioned that the most recent was the Cochrane Review. This had some interesting and useful insights but in terms of providing practical outcomes for women with PGP, there was limited value. The Review simply suggested that pillows might help and acupuncture might help reduce pain. Helen found similar limitations with the European guidelines for the diagnosis and treatment of PGP which seemed to point to the need for further research.
Helen felt that the best thing would be to look at women’s experiences of PGP and to see how a midwifery approach could help to ease symptoms and work effectively within professionals from other disciplines (like physios) to overcome the pain and discomfort. Again, there doesn’t seem to be a lot of relevant re-search – three pieces have been done in England by the same researchers us-ing the same sample of just 28 women. Then there are three Swedish-based papers and one Australian. Helen found that all these papers seemed to look at extremes of pain and immobility and involved women who were self reporting – the incidence was meant to be just 20% of self reported pain when actually self reported pain seemed to be 50% or even 60% so the discrepancy there was worrying.
Helen felt that the majority of women who present with PGP and had pain and immobility were probably those with more mild forms rather than the more extreme examples. So she felt there were three key themes she wanted to look at where:
- daily life changed because of PGP
- relationships with partners and children changed because of PGP and
- the ability to work (or function as a home provider and mum) altered because of PGP
Helen’s literature research did lead her to the conclusion that even with limited studies into PGP, there was a still a great deal of information to help the midwifery profession do more to help women in childbirth with PGP. If midwives had a greater understanding of PGP they could actively enhance the service provided.
Helen looked at ways the role of midwife could be developed at each stage of the pregnancy (i.e. early presentation, each trimester, labour and delivery and on the ward). Helen found that without extending the current boundaries of the midwife’s role, there were many ways for them to provide greater support, information and referral to physios which in turn would facilitate ease of pain and immobility so the woman could best focus on her baby rather than her challenging symptoms.
Thanks very much for your presentation Helen. It does offer ways that mid-wives can promote better maternity experiences for women with PGP. We also hope that it can help us as a charity to find the most suitable ways to engage with midwives to encourage greater support and help for women with PGP symptoms. At the meeting, members of the committee mentioned that the Pelvic Partnership currently has much more contact with physios, chiroprators and osteos than it does with representatives from the midwifery profession. Sarah thanked Helen for her talk and expressed interest in including more of Helen’s work and dissertation in future issues of the newsletter.