Pelvic Girdle Pain After Birth

Where it hurts

POGP describes the territory precisely: "If you are feeling pain in your pubic bone, groin, hips, buttocks and/ or tail bone it may be that this is due to pregnancy related pelvic girdle pain/ pelvic girdle pain (PRGP/PGP). PRGP also used to be called symphysis pubis dysfunction or SPD."

The activities that provoke it are specific enough to be diagnostic. POGP lists walking; standing on one leg, for example getting dressed or using the stairs; moving your legs apart, such as getting in and out of bed or a car; lying in some positions; and sexual intercourse.

If turning over in bed is the worst moment of your day, and getting out of the car requires you to swing both legs together, that is the pattern.

Why it did not stop when the baby arrived

The expectation that PGP resolves at delivery is widespread and not always true. POGP is careful with the numbers: pelvic girdle pain "happens for approximately 20% of pregnant women and can happen at any stage of pregnancy. It can also continue or develop for a small number of women after having a baby."

Note "or develop." Some people get it for the first time after the birth.

POGP names the reasons, and they are unglamorous: "For women who have just had a baby, sitting in one position for a long-time feeding, lifting and carrying your baby and baby equipment can put a large amount of strain on your back and pelvis and cause pain."

It also lists the underlying mechanics: uneven movement of the joints of the lower back or pelvis; weakening of the tummy, buttock, inner thigh and pelvic floor muscles, which "puts more stress and strain on the joints of the lower back and pelvis"; a previous injury; and, for a small number of women, hormonal changes.

Two risk factors carry over from pregnancy: having a physical job, and having had PGP or low back pain in a previous pregnancy.

The red flags

POGP says to call your GP straight away or go to your nearest A&E department if you experience: pain going down both legs at the same time; numbness in both legs at the same time; difficulty passing urine; leakage of stool from the bowel that you could not control; or numbness around the vagina or back passage.

These are not PGP. They are the symptoms of a compressed spinal nerve bundle, and the timing matters, which is why the instruction is A&E rather than an appointment.

Separately, the HSE lists "severe muscle and joint pain" as a possible sign of sepsis after birth, and tummy pain that is severe or getting worse as a possible sign of infection. Pain that is escalating rather than mechanical, especially with a temperature, is a different phone call.

What actually helps

POGP's own self-help list, adapted for someone with a newborn:

• Pace yourself. "Try not to get all of your daily jobs done in one go. Break up the activities and have a rest in between."
• Do not push through. POGP says explicitly: "Try not to push through activities that make your pain worse." Postnatal PGP gets worse with the "just get on with it" approach.
• Supportive footwear, shorter and slower walks. POGP names all three.
• A pillow between your knees for sleeping, and keeping your knees together when you turn in bed — and the same technique getting in and out of the car.
• Fix your feeding position. POGP notes that "if you are breastfeeding using a feeding pillow can be more comfortable," and warns against sitting with legs crossed or tucked underneath. You will spend hundreds of hours in that chair; it is worth setting it up properly.
• Lift properly. POGP's instruction: keep your back straight, bend your knees, keep the load close, squeeze your pelvic floor and pull your tummy muscles in as you lift, and avoid holding your breath.

The car seat is the single biggest offender. Carrying it on one arm loads exactly the joints that hurt. Use the pram chassis, or carry it with two hands close to your body.

Getting referred

POGP is direct about the route: "Speak with your midwife/ GP in the first instance. They should advise you to see a specialist pelvic health physiotherapist who is trained to treat PGP and lower back pain in pregnancy. You can also contact the POGP who may be able to help find a specialist physiotherapist where you live."

NICE NG194 supports this. It says the GP at the 6 to 8 week check should "respond to any concerns, which may include referral to specialist services in either secondary care or other healthcare services such as physiotherapy." Physiotherapy is named in the guideline; you are asking for something the system is supposed to provide.

POGP also says when to escalate: ask for help "if it does not improve with the advice given here or if you are struggling with sleep and daily activities."

What treatment involves

A specialist pelvic health physiotherapist will assess how your pelvis, hips and lower back are moving, look at your pelvic floor and abdominal muscles, and give you a specific programme rather than generic exercises. Pelvic support belts, manual therapy and graded strengthening are all in the toolkit. NICE NG210 on pelvic floor dysfunction sits behind the pelvic floor part of that work.

On timescales, POGP's broader musculoskeletal guidance is honest about the principle rather than the clock: these problems "are not normal and should not be 'put up with' in silence" and "can be improved with the right advice." No credible source publishes a number for how long postnatal PGP takes to settle, because it depends on what is driving it and how quickly it is treated.