Pelvic girdle pain persists postpartum despite cesarean section

Women who experience pelvic girdle syndrome (PGS) during pregnancy and undergo cesarean section are still at an increased risk for PGS 6 months after childbirth, research shows.

Despite the fact that women who experience pelvic girdle pain during pregnancy are more likely to request a cesarean section than those who experience no pain, these current findings "do not suggest that caesarean section represents a benefit for the process of recovery from pelvic girdle pain," caution lead investigator Elisabeth Bjelland (Norwegian Institute for Public Health, Oslo) and co-authors.

They add: "When deciding the mode of delivery, clinicians should be aware of the increased, rather than decreased, risk of nonrecovery after caesarean section among women presenting with severe pelvic girdle pain."

The investigators obtained data from three self-administered questionnaires answered by women recruited into the Norwegian Mother and Child Cohort study between 1999 and 2008. The responses allowed the investigators to classify the degree and location of any pelvic girdle pain at pregnancy week 30 and at 6 months postpartum.

The current follow-up study, described in the American Journal of Obstetrics and Gynecology, included 10,400 women with singleton deliveries reporting PGS at pregnancy week 30.

At 6 months postpartum, 3.1% of women who underwent planned cesarean section reported severe PGS versus 1.1% of women who had unassisted vaginal delivery, representing a two-fold increased risk for severe PGS (adjusted odds ratio [OR]=2.3).

Neither planned nor emergency cesarean section were associated with increased prevalence of PGS, but there was an increased prevalence of severe PGS in women who underwent instrumental vaginal delivery or emergency cesarean section. However, neither increase was significant, say the researchers.

The researchers also observed an association between the use of crutches at pregnancy week 30 and the persistence of pain 6 months after delivery, and the association was more pronounced in women who underwent planned (8.7%) and emergency (5.7%) cesarean section than in women who had unassisted vaginal delivery (2.9%; adjusted ORs=3.3 and 2.0, respectively).

Although, according to the researchers, "no previous study of this magnititude has examined the association between mode of delivery and persistence of pelvic girdle pain after delivery," they do admit some limitations. The original cohort may not have been representative of the general population of Norway, and thus the occurrence of PGS in the current study may have been underestimated, they explain.

Nevertheless, they point out, it is unlikely that the direction of the associations is biased.

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  1. Bex Wilson Bex Wilson United Kingdom says:

    To whom this may concern.
    I am writing to you to make you aware of a product that could greatly benefit women suffering PGP.
    Through my journey of PGP I discovered that women in Scandinavia are using a 'maternity slide sheet'. This product is as commonly used and known off as a breast pump. It helps women with turning and movement both during and after pregnancy.

    The reason this product is of special interest to women suffering  PGP is that it can prevent much of the inflammation that is the root of the pain PGP suffers experience. Maternity slide sheet helps women glide from one side to the other whilst in bed;  Sitting up in bed;  Getting in and out of the bed; Getting up from the sofa;  Getting in and out of the car.

    A maternity slide sheet is used to aid all of these movements that are so difficult for PGP sufferers as well as women who have caesarean sections. It is of equal importance that the exercises recommended by yourselves and physiotherapists are used whilst turning and moving when using the maternity slide sheet. It is therefore not replacing anything but rather complementing and improving the services provided by yourselves and physiotherapists who specialised in PGP.

    The reason I have become so passionate about this product is because I felt cheated that women in other countries are recommended by physiotherapists at maternity wards and other PGP specialists  to use a maternity slide sheet as aid for movement but UK seems to be behind on this one. There is no argument that I have come across so far in not recommending this product to women with PGP.
    As a part of the NHS in Denmark and in Iceland a ‘maternity slide sheet’ is prescribed to women who are categorised as severe sufferers of PGP. I think it would be of benefit to your clients to be made aware of this product as NHS is not catching on it yet like other societies are.

    Many thanks for reading this email, I am looking forward to receiving your response to my suggestion.

    Best wishes,
    Bex Wilson

The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News-Medical.Net.
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