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PelvicPhysiotherapy - For continence control and relief of pelvic pain

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If you're prepared, and get good advice and support, PGP shouldn't cause you problems during labour.

It's unlikely your obstetrician or midwife will recommend an induction or a caesarean section purely because you have PGP. But much depends on your personal circumstances, so it's a good idea to discuss your birth preferences with your medical team in plenty of time.

The front part of your pelvis, called your pubic symphysis, naturally separates during labour. You probably won't have any problems as a result of this, but you can try these positions to stay comfortable in labour:

Kneel or stand, with support, to prevent strain on your pelvis. Lean on your partner, over a pile of pillows, a tilted bed end or a birthing ball.

Position yourself on all fours, so the weight is on your hands and knees. This may also help your labour to progress.

If you are tired, lie on your side, with your midwife or partner supporting your upper leg.

Hospitals and birth centres have a range of aids, such as birthing pools, birthing balls and beanbags. You can use these to help you get into the most comfortable position for you.

Using a birthing pool may ease your pain and help you to stay upright. The water supports the weight of your body, and its warmth acts as a pain-soother.

Your midwife will need to be sure that you can get in and out of the pool safely and quickly, if needed. Many pools have steps and rails, which can be hard to use if you have severe PGP.

Practise different positions and movements with your birth partner before labour starts. Then you'll know what works best for you when the time comes.

Write down how far apart you can comfortably move your legs, called your "pain-free gap", depending on what position you are in. Ask your midwife if she can arrange a practice session, and write the positions you prefer in your birth plan.

Ask if you can see a physiotherapist while you're in hospital, though bear in mind this may not be possible if you give birth over a weekend.

Your midwife and birth partner should make sure that you don't widen your legs any further than is comfortable. It's particularly important if you have an epidural, as you won't be able to feel your pelvic pain. This may cause you to irritate or over-stress your joints without realising it.

You won't need an epidural solely because of your PGP. But if you want one, having PGP won't stop you.

If you need continuous electronic fetal monitoring during labour, your doctor or midwife will work with you to find a comfortable position that allows them to monitor your baby's heartbeat.

Your maternity notes should mention that you have PGP. Midwives, obstetricians and ward staff need to be aware of the help you'll need if you have an assisted birth.

If your legs are lifted and placed in stirrups, it can put a strain on your pelvis, so you shouldn't spend long in these positions. Don't rest your legs on the midwife's hips, as it may make your PGP symptoms worse.

Bear in mind that labour is unpredictable. You may find that a different position from the one written in your birth plan turns out to be more comfortable.

It's very rare for the position you adopt in labour to be the cause of problems in the weeks following the birth, but ask to have a follow-up appointment post-birth with your physiotherapist, just in case.

Get advice on how to write your birth plan.

Last reviewed: January 2018

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How will having pelvic girdle pain (PGP) affect my labour?

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If you're prepared, and get good advice and support, PGP shouldn't cause you problems during labour. It's unlikely your obstetrician or midwife will recommend an induction or a caesarean section purely because you have PGP. But much depends on your personal circumstances, so it's a good idea to discuss your birth preferences with your medical team in plenty of time.

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Supporting you.

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We would like to build a better understanding of what information, treatment, and support are available to women with PGP in all areas of the UK. Our main aim is to ensure all women with PGP in the UK are offered the best practice for the treatment and management of their PGP symptoms. The results of this survey will help us to plan for future projects working to achieve this aim.

If you are a healthcare professional please share this survey with women with PGP you have treated or supported who may be interested in completing it.

It should not take more than 15 minutes to complete. Please do not hesitate to contact us if you have any questions.
> Complete our survey today

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We would like to build a better understanding of what information, treatment, and support are available to women with PGP in all areas of the UK. Our main aim is to ensure all women with PGP in the UK are offered the best practice for the treatment and management of their PGP symptoms. The results of this survey will help us to plan for future projects working to achieve this aim.

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Pelvic Obstetric and Gynaecological Physiotherapy

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Contact for support

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What is the pelvic floor?

The pelvic floor is a group of muscles which attaches at the front to your symphysis pubis and at the back to your sacrum. It acts like a hammock, holding all your pelvic organs, and keeps you continent of urine and faeces.

When do pelvic floor problems start?

Pelvic floor problems can start if the pelvic floor muscles, often on only one side, are too tight or 'overactive' (sometimes referred to as 'muscle spasm'). This can be due to holding your pelvic floor muscles too tightly, which can happen when this group of muscles is compensating for other joints and muscles in the pelvis that are working incorrectly (like in PGP). This overactivity can also be linked to previous pelvic floor trauma, for example, after a tear, forceps delivery or episiotomy during birth.
Symptoms:

Pelvic Girdle Pain (PGP) which is not getting completely better with manual therapy, or which keeps coming back even after good treatment.

A bulge in the vagina or a feeling of pressure in the vagina or rectum.

Lower back ache or pelvic pain and/or pain low down in your tummy.

Vaginal pain or discomfort during sexual intercourse.

Urinary tract infections (UTIs).

Constipation and/or evacuation problems.

Bladder emptying problems (urgency, frequency or incomplete emptying).

Incontinence - leakage of urine or faeces, or both.

Women can assume that if they have these symptoms the pelvic floor is weak, which is often not the case. However, as with any muscle, the pelvic floor muscles are likely to weaken the longer they are functioning incorrectly (the longer that they are in spasm) so addressing the cause of this is important.

What can I do about it?

As with PGP, pelvic floor problems often respond well to manual therapy treatment. The treatment for pelvic floor overactivity is physiotherapy which is done by internal examination through the vagina, finding tight 'trigger points' and releasing them using pressure from the therapist's fingers. This is usually followed by exercises to retrain your pelvic floor muscles to get them working normally and avoid them tightening up again.

The therapist will teach you to contract and relax the pelvic floor muscles, rather than just focussing on contraction which women can easily do if they are not taught to do these exercises correctly. Doing these exercises incorrectly is likely to increase pelvic floor tightness and pain. The therapist may use a biofeedback machine to show you how to do these exercises correctly if you are finding them difficult. However, biofeedback treatment alone is unlikely to address the muscle overactivity. Other exercises may include self-trigger point release and specific stretches or strengthening exercises of other muscles which can be affected by pelvic floor dysfunction (and PGP) such as abdominals, gluteals etc. Your therapist is also likely to discuss lifestyle changes to complement treatment including bladder and/or bowel re-training, relieving constipation, minimising heavy lifting and reducing weight, depending on your situation.

As with all manual therapy treatments, this treatment can be uncomfortable at the time, but the pain should get better soon after treatment. You should walk out feeling better after each treatment, and should see continued improvement between treatments as well.

During treatment for the pelvic floor, or soon after, you will need to have your pelvic joints checked by your manual therapist to ensure your joints are also functioning normally. Please see our 'Treatment' section for PGP for more information.

Who can provide this pelvic floor treatment?

This treatment can be carried out by a physiotherapist specialising in myofascial release and trigger point therapy for the pelvic floor, usually a women's health physiotherapist. Your pelvic joints may be checked and treated by the same therapist at the same time, or you may need to see a specialist manual therapist separately, depending on the experience of the therapist you are seeing.

It is possible to be referred on the NHS for women's health physiotherapy but it is important to be aware that not all women's health physiotherapists use this trigger point release treatment approach, so some women with pelvic floor overactivity choose to find a private women's health physiotherapist offering this treatment. Unfortunately, you would need to pay for any private treatment.

I have tried this treatment but I am still experiencing pain, what should I do next?

As with treatment for PGP, it can be difficult to find the right practitioner on the NHS or privately. The same applies to this treatment as to the manual therapy treatment of pelvic joints; if you are not feeling relief in pain and/or function (preferably both) after each treatment then it may be worth trying another practitioner.

Further information:

More information about pelvic floor dysfunction and treatment is available at www.pelvicphysiotherapy.com, which also includes a list of practitioners who have undertaken extra training in this type of treatment.

If you feel you have responded to a course of pelvic floor treatment but you still have pain and problems significantly affecting your day-to-day life, you may find the information in our 'PGP Following Pregnancy' section helpful.

There is also helpful information about pelvic floor dysfunction on the following websites:

Other pages in this section:
Content reviewed and updated in 2017.

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Pelvic Partnership: information about Pelvic Girdle Pain (PGP)

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What is the pelvic floor? The pelvic floor is a group of muscles which attaches at the front to your symphysis pubis and at the back to your sacrum. It acts like a hammock, holding all your pelvic organs, and keeps you continent of urine and faeces. When do pelvic floor problems start?

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Pelvic Girdle Pain Support group

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Log into Facebook to start sharing and connecting with your friends, family, and people you know.

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Facebook group

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Log into Facebook to start sharing and connecting with your friends, family, and people you know.

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Pelvic Partnership

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Pelvic Partnership: information about Pelvic Girdle Pain (PGP)

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PGP (formerly known as Symphysis Pubis Dysfunction) is treatable during & following pregnancy. Information for women with PGP & healthcare professionals

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Mixed Connective Tissue Diseases

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MCTDfoundation.org is a non-profit, online gathering place, for those living with the Mixed Connective Tissue Disease (MCTD), their friends, families, support systems and medical providers.

We strive to present the most current information available on the overlap autoimmune diseases that comprise MCTD, as well as available treatment options.

We sell MCTD awareness merchandise as a fundraising mechanism to ensure the future of the site, as well as providing educational materials.

We provide forums for those afflicted, as well as blog formatted personal stories of those who care to share their personal journey with the disease. Only when we can share symptoms and histories can we start to identify commonalities. As appropriate, photographs of symptoms will also be filed.

An important aspect to be covered on the website is the impact of the Autoimmune Protocol Paleo diet, one of the 'clean' eating plans that has helped modify the disease process for many patients.

Our goal is broad as the need is great. We know many patients feel utterly alone and are frequently treated as if they have psychological issues, rather than an identifiable disease process. This needs to be changed.
Contact us at mctdfoundation@gmail.com
MCTD Foundation is a tax-exempt, charitable organization and is eligible to receive tax deductible contributions under the IRS Code 501(c)(3). Our EIN is 81-2333671 We thank you for your consideration.
Help us continue the mission. Make donations using Paypal

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Mixed Connective Tissue Disease - MCTDfoundation.org

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MCTDfoundation.org is a non-profit, online gathering place, for those living with the Mixed Connective Tissue Disease (MCTD), their friends, families, support systems and medical providers. We strive to present the most current information available on the overlap autoimmune diseases that comprise MCTD, as well as available treatment options.

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Visit your GP or midwife to be referred for treatment

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The aim of manual therapy treatment is to assess the position and the symmetry of movement of your pelvic joints, especially the sacroiliac joints at the back of the pelvis. A thorough assessment will help your manual therapist to identify which joint/s is causing the problem, and then treat it. You should expect to feel an improvement or some relief of your symptoms after each treatment. Keep going until you are completely pain-free after you have had your baby. We get a lot of calls from women who only had a few niggles in their joints after one pregnancy but just put up with it because it was much better than it had been, then develop symptoms very early in their next pregnancy because the underlying problem has never been resolved. This can be prevented or at least minimised by making sure that you are pain-free through continuing with treatment after your baby is born.

Gentle hands-on techniques are used to treat PGP and these focus on making sure that the joints are moving symmetrically and normally, rather than focussing on treating pain. This treatment is offered by physiotherapists, chiropractors or osteopaths with training and experience in treating PGP. Treatment involves a combination of joint mobilisation and soft-tissue or muscle treatment including myofascial release, muscle energy techniques and trigger point release with or without the use of dry needling. Joints will need to be mobilised if they are stiff or 'stuck' and are not working symmetrically. Muscles supporting the pelvis are also likely to become tight or go into spasm if they are trying to compensate for the pain in one or more of your pelvic joints. This muscle tightness will often need to be released as part of the treatment to allow the joint/s to move normally and prevent the problem from occurring again.

There are varying approaches to treating PGP, but the main things you should expect from your therapist are:

The therapist will ask you about your PGP and how it affects you.

They will ask you to undress down to your underwear.

They will look at and feel how the joints at the back and front of your pelvis move when you move (e.g. standing on one leg, bending forwards etc).

They will feel how symmetrically the joints move when you are lying down on your back and your front (or your side if you are very pregnant).

They will discuss their findings and agree a plan of treatment with you, explaining what they are going to do.

Treatment is likely to include a combination of joint mobilisation and muscle release to restore normal movement to your pelvis. Some women find they need one or two treatments and others will need treatment throughout their pregnancy to keep your joints and muscles functioning normally.

You should leave each treatment session feeling better, with either improved function such as being able to walk without your crutches or stand on one leg, or reduced pain (or hopefully both).

You will be given gentle exercises to help your pelvic stability once the pain has reduced. Exercises on their own if you have a lot of pain are usually not effective as the pain stops the muscles from working properly.

As you recover, your exercise programme will be adapted to suit your individual needs until you get back to normal. For more information about exercise and PGP please click here.

Other pages in this section:
Content reviewed and updated in 2017.

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Pelvic Partnership: information about Pelvic Girdle Pain (PGP)

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The aim of manual therapy treatment is to assess the position and the symmetry of movement of your pelvic joints, especially the sacroiliac joints at the back of the pelvis. A thorough assessment will help your manual therapist to identify which joint/s is causing the problem, and then treat it.

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Pregnancy related pelvic girdle pain (PGP) in pregnancy

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Pelvic girdle pain (PGP) is the umbrella term for all pelvic pain, including pubic pain which was previously called symphysis pubis dysfunction (SPD). PGP includes pain anywhere from the lumbar spine/abdomen down to the thigh, either at the front or back. The pain may range from a mild ache to severe pain which limits your daily activities.

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Pelvic Partnership: information about Pelvic Girdle Pain (PGP)

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PGP (formerly known as Symphysis Pubis Dysfunction) is treatable during & following pregnancy. Information for women with PGP & healthcare professionals

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What is a Tens machine?

Handheld Tens Transcutaneous Electrical Nerve Stimulation or TENS is a device which sends pulses of electrical current through four sticky surface pads or electrodes which are placed on the skin. The electrodes are placed parallel to each other on either side of the spine at specific points. Maternity tens machines are usually a small handheld device for ease of use during labour and birth.

How might Tens help me during my labour and birth?

Tens is thought to stimulate the release of naturally occuring endorphins in the body; our body's own natural pain reliever. Tens is also thought to block pain signals from reaching the brain by using a pain gate control theory. Tens has assisted many women seeking a natural non-invasive form of pain relief to help them cope with contractions during their labour and birth.

I'm planning a waterbirth, can I use a Tens machine?

Tens cannot be used in the birth pool itself, however most birth centres and maternity units will not advise getting into the birth pool until the woman is in active labour. Active labour is classed as once the woman's cervix has dilated to 4cm or more. A tens machine can be helpful during early labour when contractions may be erratic. Tens can also help the woman to manage contractions until she is able to get into the birth pool.

What are the advantages of using a Tens machine?

The woman is in complete control of pain management during contractions. Tens is a non-invasive form of pain relief which may allow the woman to delay the use of stronger medical pain relief. Tens helps your body increase levels of endorphins during labour; endorphins are your body's own natural pain reliever. Allows the woman to remain mobile, upright and active during your labour; the use of upright positions during labour assists the woman's uterus to work most efficiently during contractions to help the baby be born. No known side effects for you or your baby.

Is Tens safe for every woman to use?

Tens machines are designed for use in labour; they should not be used before the 37th week of pregnancy without medical supervision. They are safe for the majority of women with a few exceptions, if you use a demand type pace maker you should not use a Tens machine. If you suffer with epilepsy, any other existing health condition or have any doubts whatsoever you should consult with a health professional to confirm whether Tens will be safe and appropriate for you to use.

How do I hire a Tens machine?

We do not hire Tens machine directly through our local branches. If you are interested in hiring a tens machine then please visit the NCT & Babycare Tens web site where you can find out more and arrange to hire or buy a Tens machine that will suit your needs. Babycare Tens will make a donation to the NCT charity if you order a Babycare Tens which will help us to support more expectant and new parents.

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Handheld Tens Transcutaneous Electrical Nerve Stimulation or TENS is a device which sends pulses of electrical current through four sticky surface pads or electrodes which are placed on the skin. The electrodes are placed parallel to each other on either side of the spine at specific points.

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Painkillers

It is important to discuss medication choices with your GP if you feel your pain is not well controlled. Pain relief is available to buy over the counter at your local pharmacy, but it is helpful to talk with your midwife or GP to make them aware that you have severe pain. It is often a case of trial and error to find the medication that suits you best, so do not be too downhearted if the first product you try does not help. Although PGP is a common condition, your GP may be relatively unfamiliar with its treatment and you may have to stress your need for pain relief if you have severe pain. Many women find that during pregnancy, GPs not used to managing PGP may be unwilling to prescribe anything stronger than paracetamol, in which case you can ask for a referral to a consultant (e.g. an obstetrician) who has more experience of pain management.

Be aware that taking painkillers regularly usually gives the best effect with chronic pain. However, if you take them regularly when you are not experiencing pain, your body may become accustomed to them, and they will become ineffective when you do experience pain.

More information about any of these drugs can be found in the British National Formulary (BNF). The side effects of all drugs can be found in the leaflets provided by the manufacturers, so do read them before starting to take any medication. It is usually best to take painkillers with food to reduce any potential irritant effects on the stomach.

Diclofenac (Voltarol®)

Diclofenac is a non-steroidal anti-inflammatory drug (NSAID). In single doses it is used for mild to moderate pain but it is also used regularly as an anti-inflammatory medication which is often particularly effective in PGP. Diclofenac usually starts to work after about an hour, with the duration of action depending on the preparation used. It is available as tablets, slow-release tablets and suppositories (which may sound unpleasant but are acceptable and very effective). It is not usually used in the last trimester of pregnancy owing to effects on the baby. Small amounts are passed into breast milk but it is commonly used on maternity wards after birth. Naproxen and ketoprofen are possible alternatives as they are both in the same class of drugs.

Codeine

Codeine is a mild opioid analgesic and is effective for mild to moderate pain. It may cause constipation and/or drowsiness. Codeine should not be taken in the first trimester of pregnancy as there is a possible association with respiratory and cardiac conditions in the baby. It can also lead to drug dependence in the baby which may include withdrawal symptoms after birth. Codeine passes into breast milk and so is regarded as unsafe to take during breastfeeding.

Tramadol

Tramadol is indicated for moderate to severe pain, but its use in pregnancy and breastfeeding is not advised although it is often prescribed by consultants during pregnancy.

Opiate patches are starting to be more commonly used, particularly through pain clinics, for example, buprenorphine (Transtec ®).

Nefopam

Nefopam is a non-opioid analgesic. It can be used to treat moderate pain. It is not recommended in pregnancy or when breastfeeding.

Nerve block

An injection may be used to temporarily block the nerve carrying the pain message, and it can also be used to help diagnose the causes of chronic pain. However, this is generally not very useful in PGP as it does not treat the cause of the problem, only the symptoms, and as it is an injection, it is invasive. If it is being offered, it is worth thinking again about whether you are really receiving the most effective manual therapy possible and whether a second opinion might give you a better result. Your manual therapist may recommend a nerve block if your symptoms are very irritable.

Neuropathic pain

Neuropathic pain is caused by damage to nerves and is often described as burning, sharp or shooting. Sensitivity to things which are not usually painful (e.g. light touch) and heightened pain sensation to things which are painful are both common.

The two main groups of drugs used to treat neuropathic pain are the medicines commonly used to treat depression and epilepsy;

Amitriptyline and Nortriptyline

Antidepressants are effective in treating neuropathic pain at much lower doses than those used to treat depression. They work in a different way to their effect on depression.

Traditionally, Amitriptyline and Nortriptyline are most often used (doses between 10 mg and 100 mg) but some of the newer antidepressants such as Venlafaxine have also proved to be effective.

Amitriptyline is not recommended in pregnancy but the amount passed into breast milk is thought to be too small to be harmful.

Gabapentin

Gabapentin is one of the antiepileptic drugs and has well-documented effectiveness in the treatment of neuropathic pain. Other antiepileptics are also used and all have different modes of action so that failure to respond to one does not mean that others will not work.

It is recommended that the dose should be monitored carefully during pregnancy and after birth. Gabapentin is present in breast milk, discuss the risks with your GP.

Often a combination of drugs works best, e.g. antidepressant and antiepileptic. These medications are often prescribed for chronic pain following pregnancy.

Other pages in this section:
Content reviewed and updated in 2017.

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Pelvic Partnership: information about Pelvic Girdle Pain (PGP)

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Painkillers It is important to discuss medication choices with your GP if you feel your pain is not well controlled. Pain relief is available to buy over the counter at your local pharmacy, but it is helpful to talk with your midwife or GP to make them aware that you have severe pain.

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Painkillers

It is important to discuss medication choices with your GP if you feel your pain is not well controlled. Pain relief is available to buy over the counter at your local pharmacy, but it is helpful to talk with your midwife or GP to make them aware that you have severe pain. It is often a case of trial and error to find the medication that suits you best, so do not be too downhearted if the first product you try does not help. Although PGP is a common condition, your GP may be relatively unfamiliar with its treatment and you may have to stress your need for pain relief if you have severe pain. Many women find that during pregnancy, GPs not used to managing PGP may be unwilling to prescribe anything stronger than paracetamol, in which case you can ask for a referral to a consultant (e.g. an obstetrician) who has more experience of pain management.

Be aware that taking painkillers regularly usually gives the best effect with chronic pain. However, if you take them regularly when you are not experiencing pain, your body may become accustomed to them, and they will become ineffective when you do experience pain.

More information about any of these drugs can be found in the British National Formulary (BNF). The side effects of all drugs can be found in the leaflets provided by the manufacturers, so do read them before starting to take any medication. It is usually best to take painkillers with food to reduce any potential irritant effects on the stomach.

Paracetamol

A non-opioid analgesic. Effective for mild pain. Usually starts to work after 15-60 minutes and lasts for approximately six hours. Suitable for use during pregnancy. Suitable for use whilst breastfeeding. Does not cause drowsiness.

Aspirin

A non-opioid analgesic and anti-inflammatory. Effective for mild pain particularly joint and muscle pain. Not usually recommended in pregnancy, especially during the last few weeks, so discuss with your doctor. Aspirin passes into breast milk and may cause problems such as Reyes Syndrome, so should not be taken while breastfeeding.

Codeine including paracetamol or aspirin and codeine combinations

Codeine is a mild opioid analgesic and is effective for mild to moderate pain. It may cause constipation and/or drowsiness. Codeine should not be taken in the first trimester of pregnancy as there is a possible association with respiratory and cardiac conditions in the baby. It can also lead to drug dependence in the baby which may include withdrawal symptoms after birth. Codeine passes into breast milk and so is regarded as unsafe to take during breastfeeding.

Ibuprofen

Non-steroidal anti-inflammatory drug (NSAID). Effective for pain, inflammation, stiffness and soft tissue injury. Usually starts to work after 1-2 hours, with duration of action of 5-10 hours. Ibuprofen gives its best effects with PGP if taken regularly for at least two weeks.

Ibuprofen should not be used in pregnancy and is also not recommended when breastfeeding.

Other pages in this section:
Content reviewed and updated in 2017.

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Pelvic Partnership: information about Pelvic Girdle Pain (PGP)

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Painkillers It is important to discuss medication choices with your GP if you feel your pain is not well controlled. Pain relief is available to buy over the counter at your local pharmacy, but it is helpful to talk with your midwife or GP to make them aware that you have severe pain.

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Manual therapies such as physiotherapy, osteopathy and chiropractic treat the underlying mechanical joint problem with the aim of relieving pain and preventing deterioration. Other treatments can reduce the chance of pain becoming a chronic (long-term) problem which can happen when it is not controlled or treated in the early stages of a condition such as PGP.

This is by no means an exhaustive list of alternative and complementary methods of managing pain - you may find other alternatives. Do ask about any risks, benefits and side effects of these.

TENS pain relief

Transcutaneous electrical nerve stimulation (TENS) is a medication-free method of pain relief that has proved very popular in the treatment of many persistent conditions including PGP.

How does it work?
Adhesive electrode pads are placed around the area of pain and these are connected to a battery-powered unit that is small enough to be attached to a belt. Mild electrical impulses are then transmitted to stimulate the nerves in the affected area. This is usually felt as a slight tingling sensation, and it leads to the body's releasing natural painkillers called endorphins and reducing the pain messages reaching the brain. TENS can be used in conjunction with medication and is now used in both pregnancy and labour for pain relief.

Acupuncture and dry needling

Acupuncture is a therapeutic treatment using fine needles derived from ancient Chinese medicine which uses meridians within the body. Acupuncture is widely used as a form of pain relief for a variety of conditions. The fine needles stimulate sensory nerves under the skin and in the muscles of the body, resulting in the body producing natural substances, such as pain-relieving endorphins, that help to relax muscles and reduce pain. Acupuncture is safe in pregnancy and can be used in labour for pain relief.

The acupuncture used by most manual therapists, also known as dry needling, is slightly different. It can be very helpful during and following pregnancy to manage pain and to release tight muscles or painful 'trigger points' using acupuncture needles. It can be useful to allow manual therapy to become more effective if your muscles are not responding as you had hoped to manual therapy. You may find it helpful (and cost-effective) to find a physiotherapist who uses a combination of manual therapy and dry needling if your symptoms are not responding quickly to manual therapy alone.

Please see our 'Acupuncture and PGP' page for more information.

Meditation

There are many different types of meditation, including mindfulness, yoga nidra and raja yoga, each using different relaxation techniques which can help to relax muscles, calm tension and ease/help manage pain. Mindfulness is now widely available on the NHS to help people with long-term health conditions including chronic pain. Some women find that meditative techniques can be helpful to manage pain, allowing manual therapy treatment of their pelvic joints to become more effective.

Hypnosis

When you are under hypnosis you focus on relaxation and letting go of distracting thoughts. This temporarily tunes out the conscious part of your mind, opening your mind to the power of suggestion. At this point, your hypnotherapist can make suggestions to encourage pain relief.

Rather than convincing you that your pain doesn't exist, hypnosis for pain aims to manage any fear and anxiety you may be experiencing relating to your pain. It also helps to reduce stress and relax the nervous system to help it become less reactive to pain.

Please see the Hypnotherapy Directory for more information about hypnotherapy for pain relief and to find a registered hypnotherapist in your area.

Complementary therapies

Complementary therapies, for example, massage, homeopathy, reflexology, the Bowen technique, are used to help with a variety of health conditions, and women with PGP may find these therapies useful to help manage acute or chronic pain. However, most pain in PGP is as a result of a mechanical joint problem such as stiffness in one side of your pelvis, so the joint cannot move normally. The cause is unlikely to get better using alternative therapies alone, although they may temporarily relieve the pain. If you have to choose between spending money on manual therapy or on complementary therapy, we suggest that you are likely to get more long-lasting relief from manual therapy; if you can afford both, that is a bonus.

See our 'Links to other organisations' page under 'Alternatives to pain medication' for links to various complementary therapy websites.

Other pages in this section:
Content reviewed and updated in 2017.

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Pelvic Partnership: information about Pelvic Girdle Pain (PGP)

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Manual therapies such as physiotherapy, osteopathy and chiropractic treat the underlying mechanical joint problem with the aim of relieving pain and preventing deterioration. Other treatments can reduce the chance of pain becoming a chronic (long-term) problem which can happen when it is not controlled or treated in the early stages of a condition such as PGP.

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Find out how to cope with pelvic pain in pregnancy, including the condition symphysis pubis dysfunction (SPD), or pregnancy-related pelvic girdle pain (PPGP)

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What happens to my pelvis during pregnancy?

During pregnancy your body produces a hormone called relaxin. Relaxin softens your ligaments, the tough tissues that connect your joints.

This means that the joints in your pelvis can be more mobile during pregnancy. It happens for a good reason. Having lax ligaments helps your baby to pass through your pelvis during birth.

But having lax ligaments doesn't necessarily cause painful problems (Aldabe et al 2012, POGPH 2015, Vøllestad et al 2012). Usually, your nerves and muscles are able to adapt and compensate for the greater flexibility in your joints. This means your body should cope well with the changes to your posture as your baby grows (Vleeming et al 2008).

What causes pelvic pain?

Pelvic pain is likely to be caused by a combination of factors, including:

the joints in your pelvis moving unevenly

changes to the way your muscles work to support your pelvic girdle joints

one pelvic joint not working properly and causing knock-on pain in the other joints of your pelvis
(POGPH 2015)

Normally, when you lie down, stand up or walk, your pelvis is in a stable and even position. If you have pelvic pain, you're probably doing these activities with a less stable, uneven pelvis. The result is irritated joints.
These sorts of discomforts are a common feature of pregnancy. At least half of all mums-to-be are thought to have some sort of back pain or pelvic pain at some point (POGPH 2015). Although it's common, it's not considered normal to have pelvic pain (POGPH 2015), so it's not something that you should just put up with.

It's best to seek help early if you start to feel pain, because it can get worse (RCOG 2015). About one pregnant woman in five develops serious problems and about one in 12 has severe pain or disability resulting from it (POGPH 2015).

What causes pelvic pain?

What is pelvic girdle pain (PGP)?

Pelvic girdle pain (PGP) is the umbrella term that describes pain in the joints of the pelvis, including:

The joints that connect the triangular bone, or sacrum, that sits between your hip bones at the back of your pelvis. These joints are called the sacroiliac joints.

The joint that connects the two halves of the front of your pelvis, called the symphysis pubis joint. The term symphysis pubis dysfunction (SPD) is used to describe pain resulting from problems with the symphysis pubis joint.

What are the symptoms of PGP?

The levels and location of pain can vary from woman to woman (NHS Choices 2014, POGPH 2015). The pain may be one-sided or it may appear to jump from side to side. The pain may be a general ache or it may shoot into your buttocks or down the back of your legs (POGPH 2015).

Some GPs or practice nurses may confuse PGP with sciatica, as this also causes shooting pain down the back of the leg.

You may feel pain:

in your lower back

in your symphysis pubis joint

in your sacroiliac joints

in your groin

at the front and the back of your thigh

at the back of your lower leg

around your hips

in your pelvic floor and around the opening to your vagina and your anus (your perineum).
(POGPH 2015)

What makes pelvic pain worse?

The pain is often made worse by activities that you previously took for granted, such as lying on your back and turning over in bed. Having sex can be painful, depending on the positions you get into (RCOG 2015). Sitting or standing for long periods (POGPH 2015, RCOG 2015) can make the problem worse too.

PGP is often worse at night, particularly if you've been very active during the day. Moving your legs apart, especially when sitting or lying down, can hurt. So getting out of a car or turning over in bed can be painful (NHS Choices 2014).

At what stage in pregnancy does PGP happen?

PGP can begin as early as the first trimester or as late as the last few days before giving birth (Keriakos et al 2011).

If the pain comes on at the very end of your pregnancy, it may be because your baby's head is engaging, or moving down into your pelvis (POGPH 2015). You may even feel pelvic pain for the first time after giving birth (Keriakos et al 2011).

If you experience PGP in one pregnancy, you're likely to have it again next time you get pregnant (POGPH 2015, Vermani et al 2010). It may not be as bad next time if it is well managed from early on, so get help promptly (POGPH 2015, RCOG 2015, Vleeming et al 2008).

You could consider giving yourself a bit of time from one pregnancy to the next. Losing excess weight, getting fit and waiting until your children can walk may help to reduce the symptoms of PGP next time (POGPH 2015).

How is PGP diagnosed?

Ask your midwife or GP to refer you to a physiotherapist with a qualification from the Association of Chartered Physiotherapists in Women's Health (RCOG 2015). You should be able to do this for free if you are referred within the NHS.

If you seek help yourself from a chiropractor or osteopath, make sure that they are experienced in treating pregnant women.

Your physiotherapist should examine your back and hips to see if the problem is coming from these joints. She'll take a detailed look at how the muscles of your tummy, back, pelvis and hip are working together.

How is PGP treated?

Working with your physiotherapist and making some lifestyle changes are the main tactics for treating PGP:

Be careful during everyday activities. Your physiotherapist can show you how to protect your pelvis during movements that are usually painful, such as walking or standing up (POGPH 2015).

Your physiotherapist may give you a pelvic support belt. A belt can give relief from pain, particularly when you're exercising (Pennick and Liddle 2013).

Exercises, especially for your tummy, pelvic girdle, hip and pelvic floor muscles, aim to improve the stability of your pelvis and back (POGPH 2015). Gym-type exercises in water can be helpful (POGPH 2015, Pennick and Liddle 2013).

Your physiotherapist can gently manipulate your hip, back or pelvis to loosen stiff areas (POGPH 2015).

Acupuncture may help to reduce the pain and is safe in pregnancy (Pennick and Liddle 2013, POGPH 2015). But make sure your practitioner is trained and experienced in treating pregnant women.

If pain is persisting despite physiotherapy treatments and exercises, there are other options to consider. You could try taking regular pain relief, such as paracetamol, or talking to your employer about changes to your work or working hours (RCOG 2015). Bear in mind that there's not a lot of evidence to suggest that paracetamol is an effective painkiller. Speak to your GP for advice on how much to take, and for how long (Moore et al 2015).

Will having PGP affect my labour?

Most women with PGP are able to have a normal labour and vaginal birth (NHS Choices 2014, POGPH 2015, RCOG 2015). With the right support, it's rare for PGP to cause problems, or to be a reason for having labour induced or a caesarean (POGPH 2015).

If possible, try not to lie on your back to give birth. Try not to get into positions that involve moving one leg only or moving your legs further apart than is comfortable for you (POGPH 2015, RCOG 2015).

You'll find upright or kneeling positions more comfortable, as they protect your pelvic joints. Or you could try lying on your left side (POGPH 2015). If you want to squat, it's best to be supported.

It's worth discussing with your midwife or doctor which positions would be best in case you need an assisted birth.

With an assisted birth, a doctor helps your baby to be born with forceps or ventouse. Your doctor will probably ask you to lie on your back with your legs in stirrups to make it easier to help your baby out.

However, a straightforward ventouse birth may be possible while you lie on your side (POGPH 2015). Read our expert question on SPD in labour for more information.

If you're in severe pain, and can't move much at all, you may be offered a caesarean section. This really would be a last resort (POGPH 2015, Vermani et al 2010), as having a caesarean doesn't help with PGP. It may slow down your recovery from PGP (RCOG 2015).

What can I do to help myself?

Be as active as you can, but don't push yourself so that you feel pain (POGPH 2015, RCOG 2015).

Stick to the pelvic floor and tummy exercises that your physiotherapist has recommended (POGPH 2015).

Ask for and accept offers of help with daily chores (POGPH 2015).

Plan ahead so that you reduce the activities that cause you problems. You could use a rucksack to carry things around, both indoors and out. This is particularly helpful if your symptoms are so severe you're having to use crutches (POGPH 2015).

Take care to part your legs no further than your pain-free range, particularly when getting in and out of the car, bed or bath (RCOG 2015).

If you are lying down, roll onto your side, squeeze your knees together, swing your legs off the bed and push yourself up to sitting.

If you are sitting, pivot round if necessary, keep your feet together, and stand up, using your arms to pull yourself up.

Avoid activities that make your pain worse or that put your pelvis in an uneven position, such as sitting cross-legged or carrying your toddler on your hip. If something hurts, stop doing it. If the pain is allowed to flare up, it can take a long time to settle down again. (POGPH 2015, RCOG 2015)

Try to sleep on your side with legs bent and a pillow between your knees (POGPH 2015). This position is also best for your baby - by the third trimester, sleeping on your side reduces the risk of stillbirth compared to sleeping on your back (Gordon et al 2015, Heazell et al 2017, McGowan et al 2017, Stacey et al 2011).

Rest regularly or sit down for activities you would normally do standing, such as ironing (POGPH 2015). If you have SPD, you could sit, leaning forwards slightly, on a birth ball to take the pressure off the symphysis pubis joint.

When you can, get down on your hands and knees to take the weight of your baby off your pelvis.

Try not to do heavy lifting or pushing. Pushing supermarket trolleys can often make your pain worse, so shop online or ask someone to shop for you (Pelvic Partnership nd, POGPH 2015).

Try not to go up and down stairs too often (RCOG 2015). When you have to climb the stairs, take one step at a time. Step up onto one step with your best leg and then bring your other leg to meet it. Repeat with each step (POGPH 2015).

Avoid standing on one leg. When getting dressed, sit down to pull on your knickers or trousers (POGPH 2015, RCOG 2015).

How soon will PGP go away?

PGP usually clears up within a few weeks or a few months of the birth (Vermani et al 2010). About one woman in 13 finds it lingers for longer (Vermani et al 2010, Vleeming et al 2008). It's more likely to persist if you had severe pelvic pain during pregnancy (Vermani et al 2010, Vleeming et al 2008).

Although you're unlikely to have pain that lingers, you may have a mild recurrence just before your period (POGPH 2015). Hormones released at this time can have a similar effect to pregnancy hormones.

If your pain does persist, you can help yourself to recover by carrying on with the exercises your physiotherapist gave you during pregnancy (POGPH 2015). Pilates or yoga are also great for building the type of core strength that keeps pelvic pain at bay.

Where can I find support?

You can get in touch with other women in your situation by contacting The Pelvic Partnership, a charity that offers support to women with pelvic girdle pain, including SPD.
More help and advice:

Visit our community

Chat to other women with PGP in our friendly BabyCentre community.

References

ACPWH. 2012. ACPWH guidance on the safe use of transcutaneous electrical nerve stimulation (TENS) for musculoskeletal pain during pregnancy. Association of Chartered Physiotherapists in Women's Health. www.csp.org.uk [Accessed May 2015]

Aldabe D, Ribeiro DC, Milosavljevic S, et al. 2012. Pregnancy-related pelvic girdle pain and its relationship with relaxin levels during pregnancy: a systematic review. Eur Spine J 21(9):1769-76

Gordon A, Raynes-Greenow C, Bond D, et al. 2015. Sleep position, fetal growth restriction, and late-pregnancy stillbirth. Obstet Gynecol 125(2):347-55

Heazell A, Li M, Budd J et al. 2017. Going-to-sleep supine is a modifiable risk factor for late stillbirth - findings from the Midlands and North of England Stillbirth Case-Control Study. BJOG online first: 20 Nov. onlinelibrary.wiley.com [Accessed November 2017]

Keriakos R, Bhatta SR, Morris F, et al. 2011. Pelvic girdle pain during pregnancy and puerperium. J Obstet Gynaecol 31(7): 572-80

McGowan LME, Thompson JMD, Cronin RS, et al. 2017. Going to sleep in the supine position is a modifiable risk factor for late pregnancy stillbirth; Findings from the New Zealand multicentre stillbirth case-control study. PloS ONE 12(6):e0179396. journals.plos.org [Accessed November 2017]

Moore RA, Derry S, Wiffen PJ, et al. 2015. Overview review: Comparative efficacy of oral ibuprofen and paracetamol (acetaminophen) across acute and chronic pain conditions. Eur J Pain 19(9):1213-23

NHS Choices. 2014. Pelvic pain in pregnancy. NHS Choices, Health A-Z. www.nhs.uk [Accessed May 2015]

Pennick V, Liddle SG. 2013. Interventions for preventing and treating pelvic and back pain in pregnancy. Cochrane Database of Systematic Reviews (8): CD001139. onlinelibrary.wiley.com [Accessed April 2015]

Pelvic Partnership. nd. Practicalsuggestions. www.pelvicpartnership.org.uk [Accessed July 2015]

POGPH. 2015. Pregnancy-related pelvic girdle pain. Pelvic Obstetric & Gynaecological Physiotherapy, Guidance for health professionals. www.csp.org.uk [Accessed May 2015]

RCOG.2015. Pelvic girdle pain and pregnancy: information for you. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk [Accessed July 2015]

Robinson HS, Mengshoel AM, Veierød MB, et al. 2010. Pelvic girdle pain: potential risk factors in pregnancy in relation to disability and pain intensity three months Postpartum. Manual Therapy 15(6): 522-8

Stacey T, Thompson JMD, Mitchell EA, et al. 2011. Association between maternal sleep practices and risk of late stillbirth: a case-control study. BMJ 342:d3403. www.bmj.com [Accessed November 2017]

Vermani E, Mittal R, Weeks A. 2010. Pelvic girdle pain and low back pain in pregnancy: a review. Pain Practice 10(1):60-71

Vleeming A, Albert HB, Östgaard HC, et al. 2008. European guidelines for the diagnosis and treatment of pelvic girdle pain. Eur Spine J www.ncbi.nlm.nih.gov [Accessed May 2015]

Vøllestad NK; Torjesen PA; Robinson HS. 2012. Association between the serum levels of relaxin and responses to the active straight leg raise test in pregnancy. Man Ther 17(3): 225-30

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association of chartered physiotherapists in women's health

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During pregnancy your body produces a hormone called relaxin. Relaxin softens your ligaments, the tough tissues that connect your joints. This means that the joints in your pelvis can be more mobile during pregnancy. It happens for a good reason. Having lax ligaments helps your baby to pass through your pelvis during birth.

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Information booklet

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If you are referred to an obstetric physiotherapist for SPD they are likely to advise you on exercises that strengthen your pelvis, stomach and back. You may also get a pelvic support belt to give more support in this area. If you're having pain, you should talk to your doctor or midwife about this as soon as possible.

Aside from physiotherapy exercises, you should still continue to stay active in any way that does not cause pain. Your level of activity is likely to depend on the severity of the condition. It can be very frustrating if you were previously active to find that you have to stop. If you are able to, try different exercises until you find one that works. Some women report that cycling causes no pain while walking is very painful, while others say that swimming or aquanatal exercises are fine.

If you are swimming, avoid the breast stroke as this is likely to cause more pain.

The key thing to remember is to stop any activity that causes pain.

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If you are referred to an obstetric physiotherapist for SPD they are likely to advise you on exercises that strengthen your pelvis, stomach and back. You may also get a pelvic support belt to give more support in this area. If you're having pain, you should talk to your doctor or midwife about this as soon as possible.

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Exercise generally works best once your pelvic joints have been assessed and treated by an experienced manual therapist and when you feel little pain. If you have a lot of pain, it generally does not matter how much exercise you do, your pain will inhibit your muscles from working properly and you may put in a great deal of effort for little or no reward. It is best to start with manual therapy to sort out the joint function, and then discuss with your manual therapist which type of exercise is most likely to be beneficial for you. See our 'PGP is treatable' and 'What to expect from treatment' pages for more information.

Each woman's experience of PGP differs slightly, so different exercises will suit different women. There is no one single exercise or exercise programme that will suit all women. The ultimate goal is for you to recover enough to be able to enjoy whichever sport/exercise you practised before you became pregnant and developed PGP. Our members have reported getting back to all of the following after receiving the correct treatment: marathon running, skiing, sailing, dancing, horse-riding, trampolining, hiking, jogging, kick boxing and ballet.

As a general rule, you should allow your pain to act as a guide to how much exercise you can do. It is helpful to keep as active as possible, within the limits of your pain.

Before you start any exercise, we suggest that you talk to your manual therapist who should be able to give you a bespoke exercise plan as part of the course of treatment, and will update the exercises you need to do at each appointment. Often there are only a couple of strengthening and/or stretching exercises for you to focus on after each session. If your pain is reducing, you will be able to move normally which is the best sort of exercise and means that you are effectively exercising every time you do anything. If you follow the specific exercises you are given and they are regularly updated and progressed, you will stand the best chance of making a full recovery.

Until you have recovered it may be best for you to avoid sports that involve a lot of asymmetric movement, for example, some aerobic exercises which require you to abduct your legs beyond the pain-free gap. Swimming breaststroke, some gym machines and yoga movements also do this.
Once your pelvis is moving normally and your pain has reduced you might like to try the following to ease back into exercise:

Walking: a paced or graded walking programme can be beneficial, gradually building up the distances to be walked.

Pilates: Pilates is a gentle, low-impact form of exercise. It can help to maintain and improve the condition of both abdominal and pelvic floor muscles, which in turn stabilises the joints of the pelvis. Many women who have PGP have found that Pilates can help to manage their pelvic instability and therefore keep 'the niggles' at bay. For more information and class locations, see www.pilates.co.uk.

Swimming: when your manual therapist suggests you are ready to return to exercising in water it can be helpful to follow a graded programme similar to walking, as the resistance of the water and the buoyancy can often mask how difficult the exercise is, so it is easy to overdo it. Front or back crawl are often less of a strain on the pelvic joints; breaststroke can be quite a strong stress across the pelvic joints, so take care when you go back to this style of swimming. Many women find hydrotherapy and aquanatal exercise helpful, click here for more information about which exercises can be helpful and what to avoid with PGP.
Here are some suggestions to consider whilst exercising which can help you to avoid stressing the pelvic joints as you recover:

Make sure your instructor knows that you have PGP so that they can tailor the activity to your ability.

Try not to lift or push anything too heavy.

Try not to over-exert yourself.

Be careful of any large movement that causes one side of the pelvis to move against the other, for example, standing on one leg. This results in a vertical or up and down stress across the symphysis pubis and sacroiliac joints.

Any large movement that causes each side of the pelvis to move in opposite directions is unwise, for example, moving the legs far apart. This results in a 'gapping' movement of the symphysis pubis joint.

There is no need to panic if you do overdo it! You won't be back to square one but if you find your symptoms are worse after doing a particular exercise, it will be worth seeking advice from your manual therapist who may suggest further 'hands on' treatment and modify the exercises you are doing.

Other pages in this section:

Content reviewed and updated in 2017.

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Exercise generally works best once your pelvic joints have been assessed and treated by an experienced manual therapist and when you feel little pain. If you have a lot of pain, it generally does not matter how much exercise you do, your pain will inhibit your muscles from working properly and you may put in a great deal of effort for little or no reward.

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Pelvic Partnership: information about Pelvic Girdle Pain (PGP)

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PGP (formerly known as Symphysis Pubis Dysfunction) is treatable during & following pregnancy. Information for women with PGP & healthcare professionals

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Pelvic Partnership: information about Pelvic Girdle Pain (PGP)

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Birth plans are very useful, both in the planning stage, when you are thinking about what sort of birth you would like and what information you need to give to the people caring for you, and while you are in labour, to give information to the team caring for you.

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Pelvic Partnership: information about Pelvic Girdle Pain (PGP)

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PGP (formerly known as Symphysis Pubis Dysfunction) is treatable during & following pregnancy. Information for women with PGP & healthcare professionals

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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. Some women with PGP wish to opt for one based on their pain levels, mobility and previous birth experiences, to name but a few issues. It is important to gather as much information as you can before making any decisions.

You will have pain from the abdominal wound in addition to your PGP pain, and 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. There are also acknowledged risks associated with a caesarean section and NICE guidelines clarify these. As with vaginal birth, make sure your consultant knows you have PGP and is aware of your pain-free gap and the positions you can and cannot manage. You also have to remain aware of the masking effects of pain relief during and after surgery.

Some hospitals promote caesarean section as the only option with PGP, but the experience of our members indicates that this is not necessarily the case. There is no research evidence to show that it is the best option, so doctors rely on their experiences and individual circumstances when helping you to make a decision. If you wish to talk to one of our members with personal experience of either caesarean or vaginal birth, please contact us.

Tips from women with PGP who have had a caesarean section:
Food and drink

When in hospital (before or after birth) make friends with the housekeeping staff. They were really helpful once they realised I couldn't walk and delivered all my meals!
Equipment

Ask to have a cot that is bolted on to the side of the bed - you can lift the baby out to feed etc without getting out of bed. You may also need a normal mobile cot to move your baby around and change nappies, or

Ask for a hydraulic (electric) cot that moves up and down to a comfortable level for you at the touch of a button. These tend to be in short supply, so tell staff that you will need one as early as possible (preferably antenatally).
En-suite facilities

Ask for an en-suite room so that you can rest as much as possible after the birth. If this is not possible, ask to be taken to the toilet in a wheelchair.
Pain relief

As with vaginal birth, it is recommended that you have bed rest until the acute pain subsides. Beware of the masking effect of painkillers at this stage and don't over-do things. This helps your joints to start to recover.

Ask for your epidural top-ups in the recovery ward in plenty of time - don't wait, like me, until the tube has fallen out!

A caesarean is a major operation, and you may find you feel strange as a result of the pain relief etc. However, keep the pain under control and always ask when you need some more, don't wait for it to be offered.

There is an element of control - you hope not to cause further damage.

It can be very helpful to know the planned birth date - you know exactly how much longer you have to cope.
Breastfeeding

Breastfeeding can sometimes be slower to get going after a caesarean. Don't get down or frustrated with yourself - keep asking for help and guidance, and the milk will flow eventually.
"The atmosphere in the theatre was lovely and it was a very special time. Even my husband, who is very squeamish and quite concerned about how he would cope, said it was just amazing. He even stood up to see our son lifted out of me. It was, for us, a once in a lifetime moment and the theatre team around us was excellent. The baby was laid on my chest whilst the surgeons worked on the other side of the screen and he was given to my husband when they needed to move me."
Other pages in this section:
Content reviewed and updated in 2017.

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Pelvic Partnership: information about Pelvic Girdle Pain (PGP)

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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. Some women with PGP wish to opt for one based on their pain levels, mobility and previous birth experiences, to name but a few issues.

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Pelvic Partnership: information about Pelvic Girdle Pain (PGP)

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PGP (formerly known as Symphysis Pubis Dysfunction) is treatable during & following pregnancy. Information for women with PGP & healthcare professionals

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Pelvic Partnership: information about Pelvic Girdle Pain (PGP)

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PGP (formerly known as Symphysis Pubis Dysfunction) is treatable during & following pregnancy. Information for women with PGP & healthcare professionals

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PGP can continue after giving birth; some women will find that symptoms will disappear postnatally but many find that they do not. You can and should seek treatment as soon as you feel able to - women have reported that they have seen their manual therapist within a few days after the birth. The treatment is the same for PGP during and following pregnancy. Please read our 'Treatment' section for more information.

Claire's experience of PGP: "For me, PGP started at 28 weeks of my first pregnancy but my pain became worse following the birth of Sammy. My midwife was lovely but I think in helping to get Sammy out, my pelvis was pushed about and my legs opened beyond my comfortable range. So during the first week following Sammy's birth, I was hobbling about with much worse symptoms of PGP than I had experienced in the later weeks of pregnancy.
My GP put in an urgent referral to a musculoskeletal physio and I was seen within a few weeks. My physio saw that one of my sacroiliac joints was very stiff during her assessment and she gave me some manual therapy treatment to ease this and realigned my slightly wonky pelvis. I had three sessions in total; the first one seemed to free my pelvis so it was much less stiff and painful and by the third session I could walk normally and my pain disappeared. Sammy is just over 13 months now and I haven't had any further symptoms of PGP. If any twinges return, I would go back to my GP because the physio said it was important to get treatment as soon as possible."
There are some women who have PGP symptoms for a number of years following the birth of their baby and particularly if the symptoms were not recognised, diagnosed or treated promptly or successfully at the time. If you are in this situation, seek treatment from an experienced manual therapist. It can take time to find the right manual therapist for you. Please read our 'Treatment' section for more information.
Jenny had PGP symptoms for six years. It started in her first pregnancy and got worse with each pregnancy. In her third pregnancy she was on crutches from eight weeks, used a wheelchair from 28 weeks, then bed bound from 34 weeks. She eventually found the Pelvic Partnership helpline and was encouraged to seek manual therapy treatment for her symptoms. She went on to receive treatment from an osteopath who has changed her life: "I can't thank you enough, I spoke to someone from the Pelvic Partnership on the phone and they told me if I don't see a manual therapist I'll likely have this pain for the rest of my life. I was scared to see someone who was going to click around my bones and take off my clothes but after talking on the phone I knew I had to see someone. I found an osteopath and CANNOT BELIEVE that I'm pain free. It is an absolute miracle. I've had the pain so long now I just accepted it into my life. Thank you so much. I'm going to start to be normal again now."
It is important to remember that you should notice a reduction in your pain and/or an improvement in function after each treatment session. If this progress is not happening, it is worth asking yourself these questions:

Important note: The Pelvic Partnership was formed to help women with pregnancy-related PGP and we are strong in our conviction that PGP caused by a biomechanical joint dysfunction can resolve with treatment. However, there are many other causes of pelvic pain, so you may need to access further information and support from other charities/organisations.

Other pages in this section:

Future pregnancies and periods
I've responded to treatment but I'm not 100%
Understanding chronic pain
If it's not PGP, then what could it be?
Surgery
Content added in 2017.

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PGP can continue after giving birth; some women will find that symptoms will disappear postnatally but many find that they do not. You can and should seek treatment as soon as you feel able to - women have reported that they have seen their manual therapist within a few days after the birth.

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Nappy changing

This can present problems, particularly if you try to bend down.

Here are some suggestions for avoiding difficulties:

Have everything within reach before you start.

Make sure you use a surface at the correct height, e.g. waist height.

Changing mats are available which clip on to the top of your cot for an accessible surface at a good height.

Have a routine so your baby knows what you are going to do, when you need to do it.

You can do it on your lap using your elbow to pin your baby down.

If you have a family member or friend visiting, ask them to do it for you.

If you are comfortable kneeling, you can use a table at kneeling level or use a low table with a changing mat. This will reduce the number of times you pick up your baby.

Keep a supply of nappies etc both upstairs and downstairs, and remember to refill it when planning your daily trips.

Dressing

It is easiest to sit down to get dressed and undressed so as to avoid standing on one leg.

Put pants, trousers and socks over your feet and then you only have to stand up once to pull them all up at the same time.

Use a 'helping hand' (provided by an occupational therapist (OT)) to help put clothes over your feet.

Socks and tights aids (provided by an OT) can be used to help put on socks and tights if you cannot bend.

Slip-on shoes and using a long-handled shoe horn (provided by an OT) can help to avoid you having to bend.

Other pages in this section:
Content reviewed and updated in 2016.

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Pelvic Partnership: information about Pelvic Girdle Pain (PGP)

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Nappy changing This can present problems, particularly if you try to bend down. Here are some suggestions for avoiding difficulties: Have everything within reach before you start. Make sure you use a surface at the correct height, e.g. waist height.

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If your mobility is limited it can be difficult to go outside with your child. However, there are many things to do together inside.

Here are a few suggestions:

It helps to have a small table near to where you sit, or you could use a lap-tray (a tray attached to a beanbag). You can use this to play different age-appropriate board games, e.g. lotto and dominoes, or to do jigsaws, Lego and all sorts of craft activities. You could get a book from the library for some craft ideas. You could also use a nursery rhyme video with some instruments to have singing sessions.

It is lovely to spend time cuddling your child. It can be difficult to carry a baby or toddler, so use the pushchair while outside. Inside, teach the child to climb onto your knee rather than lifting them up.

If your baby wants to explore and you are unable to carry him/her from room to room, there are several options to consider. With all of these suggestions you do need to be able to lift your baby in and out, which may be a problem. When lifting your baby generally, keep the baby close to your body. It may be easier to lift while you are sitting or kneeling, or wait until they can crawl, roll or bottom-shuffle to where you need them to be. Alternatively, stair gates or a playpen will confine your baby to one safe area, for example, if you are cooking.

Options to help your baby explore which also recognise your limited mobility include:

A toy which your baby sits in which has a handle for you to push your baby without having to bend down.

A baby bouncer on a doorway between rooms so that your baby can see you whilst having fun bouncing around.

A good-sized playpen will keep your mobile baby safe so you don't have to keep moving him/her away from potential hazards. It is a very good idea to put the baby in this before they can actually move so they become used to it and it does not frustrate them.

Get your child to do small tasks for you, such as fetching something, by turning it into a game. For example, say, "I'm going to close my eyes and when I've counted to five I'm going to see if it's in my hands."

A good way to get your child to come to you if you cannot chase them is to get them to understand they have to come to you by the time you've counted to three. They also learn that you are not going to play a chasing game, so tend not to run away.

Stairs: as long as you don't have a 'kamikaze' toddler, teach them to use the stairs on their tummy as early as possible, even before crawling or walking (backwards, feet first going down).

Other pages in this section:
Content reviewed and updated in 2016.

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Pelvic Partnership: information about Pelvic Girdle Pain (PGP)

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If your mobility is limited it can be difficult to go outside with your child. However, there are many things to do together inside. Here are a few suggestions: It helps to have a small table near to where you sit, or you could use a lap-tray (a tray attached to a beanbag).

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It is up to you which method you choose to feed your baby. Each option presents different issues to consider when you have PGP.

Breastfeeding

There is no evidence to support the suggestion that breastfeeding will slow down recovery with PGP. Many women have been advised to stop and found it made no difference to the symptoms, and normally women make a full recovery while breastfeeding. Some midwives and doctors believe stopping breastfeeding will help recovery, but they are those who still believe that it is a hormonal problem. Having spoken with many women with PGP who have breastfed, often for extended periods, there appears to be no link between giving up breastfeeding and recovery. New research from a large study in Norway (2014) found that women who breastfed recovered faster than those who did not. Women can enjoy breastfeeding for as long as they wish ( the World Health Organization recommends at least two years' breastfeeding to give you and your baby the most benefit from breast milk) and make a full recovery.

As we have said elsewhere in the website, PGP is a mechanical problem, so the main reason that breastfeeding impacts on pain is if you are not sitting or lying comfortably to feed your baby, so make sure that you find a supported position to feed right from the beginning.

Breastfeeding is one of the things you can do for your baby even if your mobility is very restricted, and many mothers find this is a really important time to bond with their baby and enjoy spending time with them. Breast milk is also the best food for your baby and provides all the nutrients that are needed as well as helping to build immunity to a large number of childhood illnesses. It also protects you against osteoporosis (important in a condition like PGP) as well as some breast and gynaecological cancers (see the UNICEF website for more details of the benefits of breastfeeding).

However, as for all mothers, positioning is important and feeding is not always straightforward at first. It takes time for both of you to learn. In addition, it is important that your pelvis is comfortable while you are feeding. It is better for your pelvis to avoid sitting in bed with your legs straight out, so it is usually preferable to sit in a chair. A crescent-shaped, bean-filled pillow can be a great help with breastfeeding and take the new baby's weight, while cushioning your symphysis pubis so that you can hold your baby more easily in the early days.

There are many local sources of support for breastfeeding so make the most of them: local breastfeeding clinics, NCT breastfeeding counsellors who will visit at home, baby cafés in various areas, breastfeeding peer supporters, midwives and health visitors.

Further information

For more information, advice and tips on breastfeeding visit:

Formula-feeding

If you are formula-feeding remember to plan ahead, i.e. make up batch bottles of boiled water to store in the fridge. However, do not store prepared bottles of made-up formula (because it is not sterile).

Night feeds can mean extra trips up and down stairs. You could invest in a night and day feeding system that enables you to store bottles in a cooling box and heat up the bottles in a steam heater after adding formula powder just before use. Alternatively, use a travel kettle and jug to heat bottles. Sterilised bottles of ready-prepared feeds (as provided in hospitals) can be obtained from some manufacturers. Teats for these bottles are available direct from the manufacturers or from Boots. The milk can be ordered through a pharmacy; it is expensive but can be very useful.

Other pages in this section:
Content reviewed and updated in 2016.

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Pelvic Partnership: information about Pelvic Girdle Pain (PGP)

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It is up to you which method you choose to feed your baby. Each option presents different issues to consider when you have PGP. Breastfeeding There is no evidence to support the suggestion that breastfeeding will slow down recovery with PGP.

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Pelvic Partnership: information about Pelvic Girdle Pain (PGP)

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PGP (formerly known as Symphysis Pubis Dysfunction) is treatable during & following pregnancy. Information for women with PGP & healthcare professionals

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Email us

If you can't find the information you need, please email us using the form below. The more information you provide the quicker we will be able to assist.

If you have a complaint or other comments about NCT or our services please email enquiries@nct.org.uk

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We provide practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers.

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Sex and Chronic Pain Persistent pain can affect lots of areas of life such as work, exercise, socialising, and mood. This leaflet is for people who find sexual activity difficult or have given up because of pain.

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We were founded in November 2011. Since then, our membership base has grown rapidly and we now support charities dealing with all manner of painful conditions, from head to toe. You can see more about...

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Bowen Technique Therapy Therapists Treatment UK

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Bowen Technique Bowen Therapy Bowen Therapists Bowen Treatment UK

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An induced labour is one that's started artificially. Every year, 1 in 5 labours are induced in the UK.

Sometimes labour can be induced if your baby is overdue or there's any risk to you or your baby's health.

This risk could be if you have a health condition such as high blood pressure, for example, or your baby is not growing.

Induction will usually be planned in advance. You'll be able to discuss the advantages and disadvantages with your doctor and midwife, and find out why they think your labour should be induced.

It's your choice whether to have your labour induced or not.

If your pregnancy lasts longer than 42 weeks and you decide not to have your labour induced, you should be offered increased monitoring to check your baby's wellbeing.

Why you might be induced

if you're overdue

if your waters have broken

if you or your baby have a health problem

If you're overdue

Induction will be offered if you do not go into labour naturally by 42 weeks, as there will be a higher risk of stillbirth or problems for the baby.

If your waters break early

If your waters break more than 24 hours before labour starts, there's an increased risk of infection to you and your baby.

If your waters break after 34 weeks, you'll have the choice of induction or expectant management.

Expectant management is when your healthcare professionals monitor your condition and your baby's wellbeing, and your pregnancy can progress naturally as long as it's safe for both of you.

Your midwife or doctor should discuss your options with you before you make a decision.

They should also let you know about the newborn (neonatal) special care hospital facilities in your area.

If your baby is born earlier than 37 weeks, they may be vulnerable to problems related to being premature.

If your waters break before 34 weeks, you'll only be offered induction if there are other factors that suggest it's the best thing for you and your baby.

If you have a health condition or your baby is not thriving

You may be offered an induction if you have a condition that means it'll be safer to have your baby sooner, such as diabetes, high blood pressure or intrahepatic cholestasis of pregnancy.

If this is the case, your doctor and midwife will explain your options to you so you can decide whether or not to have your labour induced.

Membrane sweep

Before inducing labour, you'll be offered a membrane sweep, also known as a cervical sweep, to bring on labour.

To carry out a membrane sweep, your midwife or doctor sweeps their finger around your cervix during an internal examination.

This action should separate the membranes of the amniotic sac surrounding your baby from your cervix. This separation releases hormones (prostaglandins), which may start your labour.

Having a membrane sweep does not hurt, but expect some discomfort or slight bleeding afterwards.

If labour does not start after a membrane sweep, you'll be offered induction of labour.

Induction is always carried out in a hospital maternity unit. You'll be looked after by midwives and doctors will be available if you need their help.

How labour is induced

If you're being induced, you'll go into the hospital maternity unit.

Contractions can be started by inserting a tablet (pessary) or gel into your vagina.

Induction of labour may take a while, particularly if the cervix (the neck of the uterus) needs to be softened with pessaries or gels.

You will usually stay in the hospital maternity unit while you wait for it to work.

If you've had no contractions after 6 hours, you may be offered another tablet or gel.

If you have a controlled-release pessary inserted into your vagina, it can take 24 hours to work. If you are not having contractions after 24 hours, you may be offered another dose.

Sometimes a hormone drip is needed to speed up the labour. Once labour starts, it should proceed normally, but it can sometimes take 24 to 48 hours to get you into labour.

What induced labour feels like

Induced labour is usually more painful than labour that starts on its own, and you may want to ask for an epidural.

Your pain relief options during labour are not restricted by being induced. You should have access to all the pain relief options usually available in the maternity unit.

If you are induced you'll be more likely to have an assisted delivery, where forceps or ventouse suction are used to help the baby out.

If induction of labour does not work

Induction is not always successful, and labour may not start.

Your obstetrician and midwife will assess your condition and your baby's wellbeing, and you may be offered another induction or a caesarean section.

Your midwife and doctor will discuss all your options with you.

Natural ways to start labour

There are no proven ways of starting your labour yourself at home.

You may have heard that certain things can trigger labour, such as herbal supplements and having sex, but there's no evidence that these work.

Other methods that are not supported by scientific evidence include acupuncture, homeopathy, hot baths, castor oil and enemas.

Having sex will not cause harm, but you should avoid having sex if your waters have broken as there's an increased risk of infection.

For more information on induction, you can read the NICE information for the public on induction of labour.

Community content from HealthUnlocked

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An induced labour is one that's started artificially. Every year, 1 in 5 labours are induced in the UK. Sometimes labour can be induced if your baby is overdue or there's any risk to you or your baby's health.

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"Manteado" is a gentle sifting, like a rhythmic jiggle. This way of using of The Rebozo aims to:

Relax tight uterine ligaments and abdominal muscles

Help a baby rotate in pregnancy or labor more easily

Help a birthing woman relax into her labor

The Rebozo is a very long, woven scarf created by women for women. The beautiful traditions of using the Rebozo are handed down from mother to daughter and midwife to midwife. The many uses of the Rebozo include carrying a baby, relaxing and repositioning mothers in childbirth, carrying groceries, and most especially, ceremonies for important passages of women's lives.

"Manteada" is the Spanish name of the technique used by Mexican Midwives with the Rebozo. Manteada is done for pregnancy, birth, postpartum... even for fertility by Mexican Midwives. This description was shared with Spinning Babies by Midwife Ximena Rojas García.

Muscle relaxants and narcotics are common pharmaceuticals offered at the hospital when a birthing person is tense or in pain or in a prolonged labor. Such drugs may have unwanted side effects on baby and birth giver.

The Rebozo technique from Mexico helps relax mothers with no drugs at all. Try Rebozo sifting in pregnancy for comfort. Use the two techniques below during early or active labor for comfort, and to enhance techniques that may then be used to "make space for the baby" to get into their best position for labor.

Watch this video of a couple using the Rebozo in a labor induced with Pitocin (labor made to begin by an artificial hormone in an intravenous drip or IV). This is a couple for whom I was their doula. We see her in early labor at 42 weeks and 2 days. Choosing no pain-reducing drugs, she coped well by releasing tension with Rebozo sifting, freedom of movement, the use of light massage on her arms, soft talk and dim lighting for comfort. Her baby was born healthy and bright. All nine pounds of her!

Gentle Rebozo Sifting in early labor

Before using the Rebozo

The helper breaths deeply to slow themselves down. Get calm and "tune into" the mother. Be in the calm mood desired to help the mother take in the calm given by this rhythmic technique.

Ask the mother if she is having frequent round ligament pain, in the abdomen above the pubic bone off to the sides, either side. Right where the midwife or doctor reaches to check for a head in a head-down baby. If she hasn't had pain or "zinging" there in the last two weeks, she is not currently having round ligament pain.

Listen to a YouTube on why it is important to buy a Mexican Rebozo.

Keeping the wrists straight helps the helper avoid wrist strain. Its a variation. The thighs engage to help lift the belly. Tanya Villano Photography

How to do Rebozo sifting in pregnancy or early labor

1. The helper helps you wrap the Rebozo around your abdomen like a hammock around the baby.

2. Kneel in front of a chair, couch, or birth ball. Use pillows as needed under knees and chest for comfort. Drape your arms over the ball, chair or couch rather than resting your weight on your hands. Relax the upper body without collapsing the back. Now the mother is in position to start. Here's what the helper does:

3. Have a trusted friend stand behind you and hold the ends of the material like reigns of a horse (sorry, just trying to help you picture this). They lift the weight of your belly off your back, snug but not uncomfortable. Mothers sigh in relief at this point.

4. The helper lifts the belly enough to lift the weight of the womb from the mother's back. Short movements are made slowly at first, and then with increasing speed. Not larger or wilder movements, just faster.

5. Helpful tip: The helper's slightly bent (soft) knees and shoe-less feet help the helper perceive the connection between the Rebozo and the mother's body more sensitively than if the helper's knees are straight, (Soft knees help proprio-perception. -Carol Phillips, Liz Koch, from class trainings)

6. With a gradual increase in speed (but not vigor), your belly is being vibrated. Breathe freely, slowly and let your belly hang into it. It's enjoyable. If it's not enjoyable, tell the helper to adjust the speed or pressure of the Rebozo. This is absolute relaxation!

7. Give your friend feedback so that they are not too broad with their movements or too mild, don't lift too high or too little. The cloth doesn't rub the tummy, it takes the tummy with it.

8. After 2-5 minutes your friend's arms may be tired and they should slow down gradually for several seconds before stopping. Then the weight of the belly is released.

In Active labor, the Rebozo is used to release the pelvic diaphragm (pelvic floor and fascia).
Shake the Apple Tree

1. The Mother is on hands and knees, sitting, or if in a serious case of obstructed labor, in Forward-leaning Inversion (know the limits of this way of positioning a birthing person before trying this!).

2. The Rebozo is wrapped over the buttocks and the ends are gathered tightly on each side of the hips.

3. The helper shakes the hips so the entire buttocks vibrates and shakes. "Shaking the Apple Tree" can be somewhat vigorous but should give a relaxing feeling. They are not shaken off their knees! We always tune in and be respectful and mindful when using our techniques.

Midwife and Spinning Babies Approved Trainer, Nicole Morales shakes Gail's hips with her in a Forward-leaning Inversion. We use Forward-leaning Inversion ONLY when the baby's head is mis-engaged and can't rotate or descend, as proven by the labor stall and an exam by the nurse, midwife or doctor. Bringing baby back up out of the pelvis only 1 cm is enough to allow the regular contractions to rotate the baby while keeping baby head down by the downward action of the contraction. This combo of techniques is a nuance best done with the supervision of an experienced birth care provider.

When to do the Rebozo Sifting:

Weekly

During each prenatal or pregnancy appointment with your helper, doula, bodyworker, friend, or midwife.

In early labor, between contractions

Why so often? Modern pregnant parents experience stress on a scale that effects society as a whole. The gentle sifting of the Rebozo helps activate the parasympathetic nervous system where calm and trust abide. The overall effect of a successful Rebozo session is more peace and love. Hey! That's a great hormonal environment to grow a baby in!
Fetal malposition?

Begin any series of Spinning Babies recommended techniques with Rebozo sifting for 2-5 minutes (til your arms are tired, longer is fine).

When NOT to do the Rebozo

Avoid sifting with the Rebozo when there is a threat of miscarriage, such as signs of bleeding or low cramping in early pregnancy, history of multiple mid to late pregnancy miscarriages or losses in past pregnancies. Use a myofascial diaphragmatic release instead.

When the round ligaments are tight or cramping in mid or late pregnancy, the Rebozo wouldn't be dangerous to the baby, but could make the mother's round ligament spasm. So, do only a lift and very gentle and slight rocking. Otherwise you might "set off" a round ligament spasm which hurts. If the mother isn't getting these spasms, you are not likely to set them off with the Rebozo.

Do not perform vigorous or even moderate sifting with the Rebozo or a Rebozo substitute (bed sheet, etc.) against an anterior placenta. I believe Rebozo use would be ok if done gently without jerking the cloth. I want to be careful and mindful with an anterior placenta.

A sensible caution for new users:
My preference is not to use the Rebozo for repositioning the baby through force, jerking one end or flipping the abdomen in the direction you want baby to go. Typically this may not be harmful, but occasionally baby's head and body are at 180 degree difference and this jerking of the Rebozo may jerk the baby the wrong direction. I trust the traditional Yucatan midwives who do this final jerk of the cloth because their skilled hands have felt literally hundreds or even thousands of fetuses and know well how the fetal back and head are lining up. Mexican midwives with traditional knowledge do Maya Abdominal Massage first before Rebozo sifting. This ability is far beyond the modern birth professional's training in assessing fetal position. As a midwife and fetus-whisperer, I respectfully note my limitations next to the skills of my midwife sister-neighbors in Mexico.

Done with these considerations, there is no danger in gently sifting with the Rebozo

Just for fun, here is a short clip of women practicing the sifting technique with Rebozo scarves at a birth doula workshop. They each have a different rhythm.

After the Rebozo

A pregnant or birthing person can do a series of balancing exercises or simply rest, depending on their goal.

Spinning Babies and the Rebozo

In The Three Sisters of Balance, the Rebozo Sifting on all fours position begins the trio. Forward-leaning Inversion comes next and is followed by Sidelying Release. These three techniques complement one another and cover a lot of area. The Fantastic Four adds Standing Release.

For active labor, we recommend " Shaking the Apples" with the birthing person in any of a variety of positions. See above. This is a particularly good technique for a stall at -2 Station when the birthing person is in Forward-leaning Inversion. See reasons why or why not to invert and shake the hips before trying it.

The Rebozo is not simply a scarf. It is a cultural emblem of women's ceremony and daily life. We wrap the mother in birth, and then the baby to the mother. The symbol of the Rebozo is as encompassing as the many ways to wrap the Rebozo.

Gail Tully was taught to use the Rebozo for comfort in pregnancy and birth by Mexican birth experts, Elena Carillo, Guadalupe Trueba, and Angelina Martinez Miranda. A valuable discussion with midwife and Rebozo ceremony facilitator, Bianca Tema Quinonez directed me to examine how Spinning Babies uses the Rebozo on the website here, and in our Spinning Babies Workshop. I was able to follow up by discussing our use with Midwife and Rebozo teacher, Naoli Vinaver. These topics were: Isolating the Rebozo techniques outside of the full cultural context of Rebozo history; frequency; choosing a particular hand position; circular movement for sifting; and the hands and knees position for one of the two techniques Gail has chosen to share in the workshop.

The Mexican Midwives Association sent word through Ximena Rojas Garcia that they are in support of Spinning Babies and our teaching some simple uses while we promote respect for the origins, history, and greater teaching of this valuable tradition. I receive the news with great honor and humble gratitude. We look forward with hope for more opportunities of cooperation to preserve Mexican midwifery culture and wisdom.

Gail and her trainers uphold the value in sharing our respect for the Rebozo through the Spinning Babies Workshop and website. We particularly hope to direct attention to communities who weave the Rebozo and uphold the wisdom of the Rebozo. It is very important to note that we are not teaching a Rebozo workshop. Rather, this wisdom comes from the Mexican Midwives whose lives are woven with the same cultural and historical context of the Rebozo itself. See where you can respectfully purchase this World Treasure, the Rebozo, to support the keepers of this wisdom.

Would you like additional ways of balancing the relaxation of the broad ligament? Some options may be:

Forward-leaning Inversion

Diaphragmatic Release

Standing Release

Sidelying Release

Maya Abdominal Massage

More myofascial releases in general - I prefer gentle versions of myofascial release

Craniosacral therapy

Therapeutic Massage of the abdomen and broad ligament

References:

Cohen, Susanna R., and Celeste R. Thomas. "Rebozo Technique for Fetal Malposition in Labor." Journal of Midwifery & Women's Health 60.4 (2015): 445-451.

Davis, V. (1988). The Mexican Jaspe (Ikat) Rebozo: Comments On Its History, Significance And Prevalence.

Iversen, Mette Langeland, et al. "Danish women's experiences of the rebozo technique during labour: A qualitative explorative study." Sexual & Reproductive Healthcare 11 (2017): 79-85.

Jordan, Brigitte. Birth in four cultures: A crosscultural investigation of childbirth in Yucatan, Holland, Sweden, and the United States. Waveland Press, 1992.

Paul, Julie A., et al. "Use of an early labor lounge to promote admission in active labor." Journal of Midwifery & Women's Health 62.2 (2017): 204-209.

Pitrou, Perig, et al. "Life, Awakened and Untangled: A Birth Ritual among the Mixe of Oaxaca, Mexico." Current Anthropology 58.3 (2017): 000-000.

Rodríguez, D. E. (2017). El rebozo tradicional indígena. Un estudio etnográfico de la rebocería de telar de cintura de Guanajuato y Chiapas.

Trueba, G. (2001). Comfort Measures for Childbirth: The Rebozo Way (DVD). Available from: Guadelupe Trueba (email: gtrueba@ prodigy. net. mx).

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'Manteado' is a gentle sifting, like a rhythmic jiggle. This way of using of The Rebozo aims to: Relax tight uterine ligaments and abdominal muscles Help a baby rotate in pregnancy or labor more easily Help a birthing woman relax into her labor The Rebozo is a very long, woven scarf created by women for women.

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Giving birth is exciting, but not always straightforward. Your partner needs you there to help if decisions have to be made. Read on for some tips on how to make the right ones.

Will we be able to stick to our birth plan?

Labour and birth often don't go as expected. Try not to worry if you can't follow your birth plan exactly.

Perhaps the birth pool your partner has set her heart on is in use. Or maybe she ends up having an epidural when she thought she could manage with gas and air. Ultimately, what counts is that she and the new baby are happy and healthy.

Sometimes complications do arise and your medical team will have suggestions about how to proceed (NCCWCH 2007). It can be difficult to keep a level head when the pressure is on, especially when the wellbeing of your partner and baby are at stake.

Some people worry about being assertive or involving themselves in decision making. It's fine to make your views known, and helpful for your medical team.

Different healthcare professionals have different approaches. You and your partner have knowledge that they lack. After all, you know your partner best, and she knows better than anyone how she feels!

Usually, everyone wants the same result, but may have different ways of getting there. There are rarely absolute rights and wrongs.

What say do I have if there is an emergency?

When making a decision it is important that you have been given the information you need. You'll need time to take in the information and be sure that you understand it. Your medical team should involve and support you in making decisions (NCCWCH 2007), but sometimes it seems as if there is no time for discussion.

In this situation it can be helpful to ask: "Is this an emergency or do we have time to talk?" Another way to find out if the situation is urgent is to ask: "Is my partner OK? Is the baby OK?"

This will help you find out if the concerns are directly about your partner and baby or about something else, such as hospital policy or guidelines.

Decision making should be a team effort, although you and your partner have the final say (NCCWCH 2007). If this feels like a lot of responsibility, do tell your medical team. It is fine to acknowledge that you are upset or frightened. Being honest will help them support you and your partner.

How do I get the information I need?

There is a simple, easy-to-remember tool to help you make sound, informed decisions in even the most complicated situations. It is called Brain, which stands for:

Following the five Brain steps will help you get the right information, weigh up the pros and cons, and, finally, lead you to a decision you can be satisfied with.

Benefits: what are the benefits of this procedure?

First, make sure you understand what your medical team is proposing and why. Perhaps your partner is a week overdue and they are considering artificially starting labour?

Your midwife should explain that inducing labour reduces the tiny but slightly increased risk that you may lose your baby as the days tick by (NCCWCH 2008a, b). Your partner may also be fed up with pregnancy and welcome the chance to get on with having her baby (NCCWCH 2008b).

Risks: what are the risks of this procedure?

Most medical procedures have risks as well as benefits and you need to know what they are. For example, some methods of inducing labour (such as a membrane sweep) are uncomfortable (NCCWCH 2008b). Other methods, such as using synthetic hormones, may make contractions more severe and painful (NCCWCH 2007, NCCWCH 2008b).

There is also no guarantee these methods will work first time. They may have to be repeated. Also, despite being induced, your partner may still give birth to your baby by caesarean section.

You may also need to weigh up the pros and cons of an assisted birth. If your partner is becoming exhausted, your medical team may suggest using instruments such as forceps or ventouse to help your baby be born.

Both increase the likelihood of your partner suffering soreness and bruising afterwards (RCOG 2011). Your baby too may also have slight bruising on his face (RCOG 2011). However, bruises fade and serious injury to babies from forceps or ventouse is rare (RCOG 2011).

Alternatives: is there a choice of obstetric procedures?

Like everyone, midwives have their favourite ways of doing things, but these are rarely the only ways. If your baby is overdue, ask about the various methods of inducing labour, from a membrane sweep to synthetic hormones.

You may want to try an old-fashioned spicy curry followed by some gentle sex. But be warned. There's not much evidence of either of these working (Schaffir 2006, Tan et al 2006, 2007).

Similarly, when considering a caesarean section your partner may be offered the chance to try an assisted birth with a ventouse and an episiotomy first. If the assisted delivery doesn't work you have the back-up of a caesarean section. Although going through both could leave your partner feeling battered and bruised.

Instinct: what does your instinct tell you?

Pay attention to what your instincts are telling you. After all, you know your partner better than anyone else in the room. If you feel she is, for example, able to cope with the pushing stage for longer, then you should support her if she turns down an assisted birth.

But if you feel she is refusing forceps or ventouse simply because she always imagined having a totally natural birth then you should say so - tactfully!

Nothing: what happens if we do nothing?

Doing nothing can sometimes be justified. For example, if your baby is overdue, you and your partner may decide to wait a few days to see if nature will eventually take its course. The risk to your baby does rise, but only slightly. At 37 weeks of pregnancy, one in 3,000 babies is stillborn. This rises to four in 3,000 at 42 weeks (NCCWCH 2008a,b)

Doing nothing is rarely an option in a medical emergency. However, it is still worth asking your medical team "what happens if we do nothing?" as the answer may help to clarify your thoughts.

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How do you support your partner when making decisions during labour? Find out using our decision-making guide.

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It can be very helpful to share your feelings about, and experiences of, PGP with a professional counsellor.

What to expect from counselling:

Counselling provides a safe and confidential space for you to talk and think about your situation with a trained counsellor, who will listen empathically and help you to express your feelings and find creative ways to move forward.

You may wish to seek counselling with your partner to talk about the effect PGP has had on your relationship.

It may take a few sessions before counselling starts to make a difference. Counselling sessions are usually 50-60 minutes long and the frequency varies, depending on your needs and resources.

How to find a Counsellor:
NHS:

Speak to your GP or Health Visitor for a referral to a counsellor.

Some hospitals offer a Birth Afterthoughts service where you can talk through your experiences in detail with a Midwife. Speak to your Midwife or Health Visitor for more information.

Private healthcare:
Other pages in this section:
Content reviewed and updated in 2016.

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Pelvic Partnership: information about Pelvic Girdle Pain (PGP)

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It can be very helpful to share your feelings about, and experiences of, PGP with a professional counsellor. What to expect from counselling: Counselling provides a safe and confidential space for you to talk and think about your situation with a trained counsellor, who will listen empathically and help you to express your feelings and find creative ways to move forward.

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Pelvic Partnership: information about Pelvic Girdle Pain (PGP)

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Antenatal and postnatal depression Antenatal depression is a type of depression linked to pregnancy. Women often describe feelings of anxiety and despair associated with their pregnancy rather than feeling joyful and excited. Postnatal depression (PND) is a type of depression some women experience after having a baby.

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Pelvic Partnership: information about Pelvic Girdle Pain (PGP)

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What is prolotherapy? Prolotherapy is a stabilising injection treatment which may be helpful for women with the chronic pain and instability associated with PGP. It seems to work well for women whose pelvis can be realigned and made pain-free during a manual therapy session, but as soon as they return to the normal activities of life, the pain and instability returns.

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Shared Decision Making If you are asked to make a choice, you may have lots of questions that you want to ask. You may also want to talk over your options with your family or friends. It can help to write a list of the questions you want answered and take it to your appointment.