Vaginal Delivery Is Best for Patients With Pelvic Girdle Pain

Patients with pelvic girdle pain during pregnancy who had a cesarean section were more likely to experience persistent pain 6 months after delivery than patients who delivered vaginally, according to a new follow-up study from the Norwegian Institute of Public Health.¹
   
Pelvic girdle syndrome is characterized by severe pain over the frontal part of the pelvis and on both sides of the rear part of the pelvis. Women with pelvic girdle pain may often request a cesarean delivery because they fear that a vaginal delivery will be too painful or difficult or might make their pelvic girdle pain worse after delivery, said Elisabeth K. Bjelland, lead author of the study and a postdoctoral researcher at the Institute’s Division of Mental Health.² However, there is no scientific evidence to substantiate this, she said.
   
To better understand how cesarean delivery affects the prognosis of pelvic girdle pain, researchers followed up with 10,400 women from the Norwegian Mother and Child Cohort Study who had singleton deliveries and who reported PGS in week 30 of their pregnancy. Participants were given 3 self-administered questionnaires, and data were linked to the Medical Birth Registry of Norway. Of these 10,400 women, 79.9% had unassisted vaginal deliveries, 6.7% had instrumental vaginal deliveries, 7.2% had emergency cesarean deliveries, and 6.2% had planned cesarean deliveries.
   
According to the study results, women who had a planned cesarean delivery had a 2- to 3-fold increased risk of severe PGS 6 months after delivery compared with women who had an unassisted vaginal delivery (adjusted odds ratio, 2.3; 95% confidence interval, 1.4 to 3.9). Severe pelvic girdle pain 6 months after delivery was also associated with both emergency and planned cesarean deliveries in women who required crutches during their pregnancy. In addition, instrumental delivery was associated with an increased risk of PGS 6 months after delivery.
   
“Our findings, which support previous assumptions, do not indicate that cesarean section represents a benefit for the process of recovery from pelvic girdle pain. If there are no medical reasons for a cesarean section, the findings suggest that vaginal delivery is the safest option for women presenting with severe pelvic girdle pain,” advises Bjelland.²

Pertinent Points:
- There is an increased risk of nonrecovery after cesarean delivery among women with severe pelvic girdle pain.
- Barring no other medical reasons for a cesarean section, vaginal delivery is the safest option for women with severe pelvic girdle pain.
 

References:

1. Bjelland EK, Stuge B, Vangen S, et al. Mode of delivery and persistence of pelvic girdle syndrome 6 months postpartum. Am J Obstet Gynecol. 2013. In press.
2. Norwegian Institute of Public Health. Vaginal delivery is the safest option for women with pelvic girdle pain. Press Release. Available at: http://www.fhi.no/eway/default.aspx?pid=238&trg=Area_5954&MainArea_5811=5895:0:15,4992:1:0:0:::0:0&MainLeft_5895=5954:0:15,4992:1:0:0:::0:0&Area_5954=5825:100908::1:5955:1:::0:0. Accessed January 28, 2013.