Warning - unless you are pregnant and doing battle with a consultant, this is a very long and boring post!!!
Came across this article and wished I'd had it at my fingertips while pregnant. Perhaps it will come in handy for someone struggling with under-informed medical professionals!
The article is called 'Pregnancy-related pelvic girdle pain - an update' and was published by BMC Medicine in 2011. One of the contributing authors is head of pelvic trauma surgery at Leeds University. As well as outlining some safe birthing positions, the article may be helpful if you are trying to persuade your GP that paractemol is inadequate pain relief for Pelvic Girdle Pain. The article may also be helpful if you are weighing up whether to have a Caesarean section.
If you are very severely affected by PGP and want to have a Caesarean but are finding you have to fight for it, this article could be useful in a couple of ways. One, it points out that little research has been carried out to find out how labour impacts long-term recovery from PGP (so a doctor would have little medical basis for saying 'you'll be fine!'). Two, it points out that PGP can be a long-term problem for a minority of women - so while it's likely to go after birth, it's not guaranteed to go away at once, as many doctors suggest. Three, the article points out that a Caesearean section doesn't seem to make any difference in recovery for most women, but does indicate that for the minority who are severely affected, the situation may be different.
Here are the bits of the article I've been talking about. I wouldn't have been in any state to read it while suffering during pregnancy, so please excuse it all being a bit 'bite size!'.
VBAC/Caesarean section
'The labour of a pregnant woman with established PPGP syndrome appears to be the phase less investigated with regard to its relationship to the persistence of the symptoms postdelivery. However, there appears to be a consensus regarding minimal stress on the pelvic girdle, avoidance of abduction of the hips over the prespinal/epidural anaesthesia comfort arc of the particular patient and minimisation of the duration of the lithotomy position ("all-four" position or lateral positions should be used instead) [150-152]. Caesarean section does not appear to offer any particular advantages to women with established PPGP syndrome, except for those at the worst extreme, whereas the mere positioning for vaginal delivery is impossible [31,92,151]. Early induction of labour or elective caesarean section is advocated by a few of the authors [85,153] in the most severe cases, but these options are still supported by limited evidence.
Pain Relief
Pain relief drug therapies have been evaluated extensively in the literature. The reported consensus is that paracetamol, although safe for use in the pregnant population, is considered inadequate on its own for the PPGP levels of pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) have a better pain relief effect but are linked to foetal malformations or pregnancy complications [135]. Luckily, the severity of PPGP symptoms also peaks at the end stages of pregnancy, allowing for NSAID use then or mostly postpartum. Opioids are strictly restricted in the prepartum cases, as well as among lactating females [92]. In a few small series [23,136,137], the use of epidural analgesia has been reported with good results, delivered either in a single shot or in extended administration during periods of pain exacerbation. In all cases, it should be considered as a temporary method of pain relief until delivery.
(Pregnancy-related pelvic girdle pain: an update.Nikolaos K Kanakaris, Craig S Roberts and Peter V Giannoudis, BMC Medicine 2011, 9:15, 2011 www.biomedcentral.com/1741-7015/9/15).