PGP and birthing positions

[Carolyn76]

Hi ladies,
I've researched this subject to death, as I'm suffering severe PGP and in chronic constant pain on crutches since wk 30 (now wk38). It seems birth options are pretty limited if we don't want to risk causing more permanent or long lasting damage during labour and birth. I value hard scientific evidence over pure conjecture, and studies point to C-sections and being on your back or semi-reclined as big risk factors for either a slow or never full recovery. Stirrups are a particular no-no. Question is, if you're ground down already by pain, exhausted by a long labour, or just got a baby in distress and you need that intervention or epidural for the baby's sake, how do they get her out without stirrups or back position?

It is apparently possible to perform ventouse when lying on your left, but my hospital have no experience of this method.

Anyone who's been through this got advice? Did you find a birth position (out of water) which was possible for assisted delivery yet still safe on your back? Or did you end up in stirrups/lithotomy and make a swift, speedy recovery all the same? Very grateful for advice.......

[Roseybee10]

I birthed on my back first time but never had stirrups. Don't think they're routunely used here tbh. What about birthing on your side with partner supporting your leg?

[Carolyn76]

Thanks Roseybee10, that is the plan if not in water by that point, but if I am too tired and need assistance they've said they'll need to turn me onto my back for forceps or ventouse, a position I absolutely cannot get into to prevent spinal damage.

How bad was your PGP both before and after?

[Roseybee10]

I had quite bad pain with Dd1 in the last 6 weeks and could barely walk by the end. I had no pain after though. I was never diagnosed with spd - just though the pain was normal. It was only afterwards that the mw said that's what it was.

With dd2 I had no pain before really and birthed in water in an upright position but it was very fast and my contractions vety powerful when pushing and I was in agony for about 2 weeks in my back, pelvis and lower abdomen. I feel fine now 5 weeks post baby though.

[Carolyn76]

That's really encouraging, thank you, although the 2 weeks of agony post baby doesn't sound great! I'm really glad to hear you've been back to normal for 3 weeks though. I really hope you stay that way.

Its such a misunderstood condition, particularly in the NHS, and the response is always the assumption it will just go away straight after birth. From a lot of research, that's not always the case and some poor women suffer on crutches for years if not decades. I'm also finding that there's very little real knowledge on how to prevent further injury through certain modes of delivery. Recent Norwegian and Indian studies point a big red cross over C-sections and anything involving being on your back. Hence my concern!

[JamesAndTheGiantBanana]

I know it's hard but try not to worry too much about the birth (although I did!) with my first baby spd/pgp started at just 11 weeks, by the end of the pregnancy I could barely walk, I should have had crutches definitely, my pelvis was just a huge crunching clunking mess, turning over in bed was impossible, the pain was like toothache in both hips and it felt like my hip was going to pop out of joint sometimes. I didn't have a very good birth but that was because they wanted me flat on my back in the bed throughout which was excruciating (labour pain wise) however, despite my worrying about the spd and not opening my knees beyond a certain point etc, spd did not bother me during the labour.

Afterward, well I felt like I'd been hit by a truck and my bones ached a lot (Plus I'd had a tear too so was generally very sore and achy) but it did get better after a few days. And sore and achy with a newborn feels SO much better than doubly sore and achy with a big bump pressing on your sore pelvis day and night trust me!

Second pregnancy spd didn't start til 20 weeks, and it didn't affect labour then either (obviously I wouldn't have squatted or anything, though) I stayed upright as long as possible then they got me to lay back on the bed at the last moment to push. I was achy again but not as bad as when I was lying down the whole time.

Last pregnancy spd started at 26weeks (getting better!) and I had a water birth, pushing on all fours leaning over the side of the pool which made a HUGE difference, both to mobility, ease of birth, and how I felt afterwards. I felt amazing, it didn't feel like I'd had a baby, there was no aching.

Spd carried on in a minor way each time until I stopped bf (the hormones keep it going) in my and my elder sisters experience it doesn't ever totally go away, 18 months on I still can't do things like walk on my knees as it will irritate my pelvis and start the aching off, I still clunk when I roll over in bed (but no pain) and certain bedroom positions aren't doable without pain/aching if not at the time then the next day.

Would definitely definitely recommend the pool. The warm water will help a lot with the pain, as will cuddles with your dh and Gas and air. You may not need an epidural (but it's there if you do)

[Carolyn76]

Thank you very much JamesAndTheGiantBanana (great name, btw!) - more encouragement. I think the pool is definitely my best bet and I'm really going to avoid being on my back.

Poor you - from what I've studied, forcing you onto your back was not a very responsible thing to do to you. I'm glad your experiences got better each time. It seems this damn thing is so unpredictable. A lot of people experience it worse each time, some like you it eases back, and some never get it again with subsequent pregnancies. Its just the luck of the draw, I guess.

I'm still on that quest for how an assisted delivery could work without being on your back as I have a feeling I'm going to want an epidural, in which case its out the pool and I really want to find someone who can tell me they ended up needing ventouse/forceps but it was done where they had their bum perched on the end of the bed and consultant kneeling on the floor doing the yanking (that's be a change, hey!) rather than the more convention on-back-legs-up position.

[JamesAndTheGiantBanana]

Sorry for the late response, just saw this. Do you think you might need an assisted delivery, or is this just "worse case scenario" thinking?

If your baby is in distress, they are going to prioritise getting the baby out quickly and safely over your pgp so I doubt they'd get you in any other position than in stirrups on the bed so they can effectively use forceps or ventouse.

However, it's worth remembering that while pgp is painful and unpleasant for you, it will not stop your baby from coming out because it's the muscles of the uterus doing the hard work. spd simply makes your pelvic outlet more stretchy and easily opened, so it really shouldn't hinder you too much, you may just have to think more about good positions for labour so you don't do yourself any damage, no squatting for example, or supporting your own legs.

It could be argued that the biggest risk you stand of needing such interventions is if you have an epidural as you will be lying on your back so gravity can't help you (don't believe them when they mention walking epidurals, the majority of women on here have ended up on the bed because they'll also say you need a stomach monitor, or a fetal scalp monitor and a bp cuff, possibly a "just in case" IV line etc - you can't feasibly walk round with all those wires even if you can feel your legs)

and also because it places time constraints on you, so at some point if your midwives decide you haven't progressed fast enough (BECAUSE you're on your back and gravity can't help the baby's descent) then they might start suggesting ventouse etc

[Carolyn76]

Hi there, Not at all - I'm sure you are a busy mummy and I didn't expect a response.

Yes, its really a "worst case" scenario that I'm trying to think around. Nobody actively opts for an intervention, I'm just mindful that if she happens to get stuck and has to be pulled out, I'm trying to find whatever way possible of protecting my future mobility as I know that the condition is not well understood and they're only interested in getting the baby out safely. To hell with whether I'm permanently disabled as a result! I've rammed it home that as the sole earner in my partnership, I have to be able to get back to work and earn a living or we'll all be out on the street, but this is so far falling on deaf ears. The medical team are not even trying to find creative solutions.

Really useful information on the mobile epidural - thank you. Its been recommended that I have one - mainly because the PGP is exhausting me and they think I'll need the extra help being utterly ground down by pain already and getting on average 3-4hrs sleep a night. But I'm aware that once you start down that route, intervention is more likely to follow and its interesting to hear from you that "mobile" doesn't necessarily meant what it says! Thanks very much for the tip. I'm aiming for the pool and hoping and praying that your thoughts are correct in that hopefully everything has loosened and widened up enough to make this a smoother process than if otherwise.

Having spoken to the consultant, they have said they're not insured to carry out ventouse/forceps in anything other than on back in stirrups, which I'm sure is true but is also a very useful reason to close the subject down. I know there are other techniques out there - just frustrating that the industry is sufficiently ignorant about the potentially devastating effects on the recovery from PGP if not properly addressed during the delivery process.

As a first timer, the birth process is terrifying enough without the additional worry of being disregarded in an emergency moment and the fear of continued incapacitation. Hardly surprising they think I'm too stressed to go into labour naturally! ;-)

[JamesAndTheGiantBanana]

There's no need to dread it, I can see you're scared and I understand why. On one hand it's good to read up and educate yourself on your options, on the other hand there's a lot of scaremongering and sharing of bad birth stories.

I went with an independent midwife on my third baby because I wasn't happy with having another highly medicalised birth when there's nothing wrong with me (bar the crunchy pelvis!) it wasn't cheap, and we aren't rich, but it was money well spent to ensure a lovely calm, well supported birth. They know all the techniques to keep you calm, and because you're calm and feeling safe, you don't tense up so the pain is way less (also much reduced because they keep you upright) I didn't even use gas n air last time and I'm no tough guy, (I'm currently shitting myself about an impending root canal I need doing) But I'd give birth with my independent midwife again tomorrow. It's totally different to doing it on a bed surrounded by people under a strip light.

Just saying it's something to consider if financially possible, they really can give you that wonderful natural birth you see on the YouTube videos (unless there's some unforeseen unavoidable reason for hospital transfer like cord prolapse - but that's rare) and they would support you during the birth with your pgp worries 100%.

[MabelSideswipe]

Since epidural doubles the risk of instrumental delivery you might want to do all you can you avoid that. Water is good. Mobility is good. Using deep relaxation practice before birth would be helpful for pain management and also because you sound very anxious. Anxiety is doing you no good at all and will hinder in labour. Natal Hypnotherapy is really good and you can use their downloads or CDs. If you really prepare yourself for this the chances of needing an instrumental birth or c-section are reduced. Also investigate peanut shaped birth balls which can be used in the event if an epidual to help women into more upright positions thus reducing side effects of the lack of gravity.

[Carolyn76]

Thank you so much, ladies, for your valuable tips and advice - I will be looking into the peanut birth ball (sounds intriguing!) and I know that probably my biggest challenge to the whole thing is a mental one - staying calm! At the moment, I'd happily swap your root canal for what I think I'm facing - would also throw in a broken leg or two at the same time ;-)

[JamesAndTheGiantBanana]

It's really, really not as bad as you're worrying it will be. It's like period pain which gets stronger and stronger but you have the gaps inbetween where the pain truly goes and you can talk. Your body is made to do this, have faith!

[Carolyn76]

Thank you! I could truly hug you for saying that! :-)

And I really hope your root canal goes equally cope-ably (if that's a word!) I had a lot of extensive work done on my teeth and honestly, its a miracle what they can do now with anaesthetics - I was in a chair for 2 sessions of 90 mins - each time they used a numbing gel before the injection - literally didn't feel a thing :-)

[LittleBairn]

I also have PGP and have been wondering about this especially since the hospital want constant monitoring whilst I'm in labour and I know that may increase the rusk of further intervention.

For what it's worth I was in stirrups for on Monday for 15 minutes there was no way to prevent this, whilst I have found an increase in PGP pain it hasn't been debilitating.

[Carolyn76]

Hi LittleBairn,

I "literally" feel your pain! You've probably looked into this extensively too, but to share what I've discovered, the main objective to have the best chance of quick recovery afterwards is to avoid being on your back and particularly in stirrups if at all possible.

There is a recent (2013 - I think) Norwegian research study I found where 10,400 women with severe PGP (i.e. on crutches/wheelchair in pregnancy) were studied pre and post partum. Those who had assisted deliveries on backs in stirrups were significantly more likely to still be on crutches or wheelchair users 6 months postpartum than those who managed an unassisted vaginal delivery. Those who had a Caesarean - both planned or emergency were twice as likely to still be suffering 6 months later, and an Indian study found the likelihood 3x more.

Now obviously, we're all doing positive thinking and aiming to not end up on our backs, but events may transpire otherwise, thus the need to educate ourselves and fight, if necessary, for our future well-being, if there truly is a choice if we have to be put in that situation.

It seems that there just aren't precious few obstetricians out there who have the relevant experience to perform the technique of an assisted delivery on left lateral, rather than the traditional method of us on our backs (which lets face it, is far easier for them!) It is definitely possible - I have read midwives accounts of obstetricians confirming they can do this, but its sadly not the norm and women's future health is really being jeopardised as a result. There really ought to be greater awareness in training - if I get out of this in one piece, I'm thinking of campaigning as my entire family's income will fall apart if I cannot work afterwards due to still being incapacitated.

I think everyone's pains are so different too though, so the risk factors will vary from one individual to another. I can open my knees really wide but lying on my back in any form makes me literally scream in pain, whereas for other sufferers, the pain is in the front pubic bone and opening knees more than a few centimetres is agony!

I hope you manage to get some answers and perhaps a little less of the constant monitoring to enable you to at least remain upright as long as possible. Really hope you're one of the lucky ones too to recover fast from this afterwards - it really is miserable, isn't it!?

[JamesAndTheGiantBanana]

May I ask op, are you seeing the consultant only because of your pgp? Because (unless you have some serious medical condition) in some cases (such as bmi over 35, or if you're a bit older than 35 or whatever) you don't have to be under consultant led care, it's your choice and you can argue it and ask to be put back under midwife led care. It's not as if the consultant can do anything about the pgp anyway other than maybe get you a support band. Obviously if you do have a medical condition then that's different!

I say this because if you're under consultant led care it will pretty much ensure a medicalised birth in a hospital bed. That's not to say it will be awful or anything like that, but from experience if they consider you high risk they tend to rule out the birth pool and birth centre.

They did this with me purely because I'm overweight (I don't have any health conditions) which is why I hired the independent midwife to support me in a home water birth, because I knew they'd never let me have one at hospital. And it was another perfectly normal pregnancy/baby/birth, no issues. But according to them it would all go horribly wrong, despite no evidence to the contrary, all scans and tests saying everything was perfect.

Consultants are very keen on everything being very controlled, because they think everyone is out to sue them hence the constant monitoring, which is only possible if you're lying down still throughout, which is bad for any pregnant woman, pgp or not, because the weight of the baby is pressing on a major vein, limiting blood flow for mother and baby. And as I said earlier, you're not benefiting from gravity, effectively you're pushing the baby uphill (and the pelvic outlet is reduced by up to 2cm because your bottom is on the bed)

So you can see that despite all evidence about keeping upright being best for women, water being great for pgp etc, in most hospitals currently they still don't bother because it's easier for them to confine you to a bed where they can see what's going on (because their ease and comfort is the priority here of course!)

If you do want a water birth I'd recommend doing what I did and speaking to the supervisor of midwives, telling them how you feel, and asking what they recommend for women with severe pgp who want to avoid lying on the bed in stirrups. The bed should not be the only option. And if it is, ask about birthing centres, or home birth. They can't make you do anything, it's up to you. Once you start saying "I'll just have to have a homebirth then" it's surprising how quickly they start saying "Er, well, ok we'll let you labour at the birth centre/pool!"

[Carolyn76]

Hi again,

Your post has made me think! I've basically been offered whatever I want as apart from the severity of my PGP - the entire pregnancy has been a breeze and totally normal. I'm under birth-centre/midwife care and down for a water birth which is very much supported, although when I've raised queries about C-sections or interventions, the Supervisor and my own midwife have said they'd be more than happy to refer me to whatever I want - whether that's a C-section or homebirth.

The only concern my midwife has is my tiredness - brought about by lack of sleep from the PGP pain - and she's concerned that I simply won't have the energy to labour without an epidural as pain is draining me before I even start on labour!

I totally get that one intervention very often leads to another and will try everything in my power not to get induced, or leave the pool for an epidural. I think I just needed your reminder to hang in there for as long as I possibly can to avoid it.....

[stargirl1701]

I had PGP/SPD with DD2 and was on crutches for the second & third trimesters. Once in labour, I was fine. The endorphins took over. I used my ball and a TENS at home. Once in the midwife unit, I had planned to go into the pool but it took too long to fill. I delivered DD2 on all fours over a birth ball.

Recovery was tough. The first week was very painful. After that, back to normal.

[NotCitrus]

I had bad PGP both times (wheelchair for months as hands too buffered for crutches). For birth, MrNC was instructed to get some string to loop round my knees before coming to hospital, so no-one could forget and move them too far apart. They didn't. I knelt leaning down on large cushions, then in water pool, then ended up with epidural - with the help of 3 people I was got into all fours to push, but then had a ventouse (just after prepping for vs). Was on my back for that, no problem - the bed was tilted sideways and 3 blokes assigned to ensure I didn't slide off.

Second time was v similar only tiny midwife and MrNC couldn't get me onto all fours as that epidural had made me floppier, and for the ventouse they had a new invention called birth boots which were like tall ski boots that I think were used to keep knees a set distance apart, no more, no less.

Making sure I got fed postnatally was key (bring bag of food and keep with you, and despite being told not to, second time I brought my own codeine for after, as first time it took over 36 hours for my prescription to get to me - telling them my vagina was fine but my hips were the problem finally got action!). Second time round, postnatal care was excellent.

On the plus side, being so floppy meant I recovered from the birth very quickly, and then walkinng 30 min a day is a good thingto do with a baby anyway. Postnatal physio is highly recommended. Watch out when baby gets heavier so you don't strain hip joints again, and do all the pelvic floor exercises!

[NotCitrus]

I had 8 hours in the pool which was wonderful except for no labour progression. They did ask MrNC to help me out as they did have a hoist but weren't confident with it. Actually getting in and out was easier than a car, so he just stood by. The epidural was only for the PGP which got worse in labour - that's very rare though.

Can you get decent pain relief (say 60mg codeine up to 4x daily) to assist with sleep and do nothing else for the next couple weeks? I remember MrNC learning about nesting and hoping that would be useful toget DIY done. I told him not to get his hopes up, and indeed nested in bed for about 3 weeks!

[SolomanDaisy]

I was on crutches with PGP and laboured in a pool. I got out to go to the toilet and lay down on the floor so they could do a quick check of how dilated I was. The head was there and I ended up giving birth on a wooden floor on my back! Total opposite of what I had planned and what the physio had advised, but the baby was ready and had his hand on his head, so I couldn't get back in the pool. It only took about fifteen minutes though. I was well enough to be off crutches straight away, although I still had mild pain for about two years. DS is three now and I can ride a bike, hill walk etc..

[Carolyn76]

Thank you Ladies - really interesting and reassuring to read about your experiences. Lots of good stuff to take on board....... x