Pelvic Girdle Pain in Pregnancy: Causes and Relief

✓ This content has been medically reviewed by an obstetrician and gynaecologist
Written & medically reviewed by: Op. Dr. Ayşet Jane Özcan, Obstetrics & Gynaecology Specialist
Istanbul Faculty of Medicine · Medical Park Bahçelievler · TJOD and TSRM member
Last updated: 15 October 2026 · Last medical review: 15 October 2026

Pelvic girdle pain is one of the most common reasons women come to see me in the second half of pregnancy, and one of the most commonly dismissed. It is the pain you feel at the front of the pubic bone, across the back of the pelvis, or in both places at once. It is the pain that makes turning over in bed feel like a project, that makes the first few steps out of a car feel impossible, and that makes a flight of stairs something you plan for. Many women are told it is simply part of being pregnant and that they should wait it out. That is not good advice. Pelvic girdle pain is a recognised musculoskeletal condition, it can be assessed properly, and in most cases it responds to practical treatment.

This article explains what pelvic girdle pain is, why it happens, how it differs from round ligament pain and from sciatica, and what genuinely helps. It also covers the things that reliably make it worse, how pain relief is approached in pregnancy, what it means for labour and birth, and what to do if the pain is still there months after your baby arrives. Nothing here replaces an individual assessment, and nothing here is a treatment plan for you personally. It is the background I would want a patient to have before we sit down together and work out what to do.

What is pelvic girdle pain (PGP)?

Pelvic girdle pain is pain arising from the joints of the pelvic ring during pregnancy or after birth. The pelvic ring is made up of three joints: the two sacroiliac joints at the back, where the sacrum meets the pelvic bones on either side, and the pubic symphysis at the front, where the two pubic bones meet in the midline. Pelvic girdle pain is pain coming from one, two or all three of these joints, together with the ligaments and muscles that control them.

You may also hear the older term symphysis pubis dysfunction, or SPD. That term was used specifically for pain at the pubic joint at the front. It is now largely replaced by pelvic girdle pain, because in practice the front and the back of the pelvis almost always behave as one system, and most women with front pain also have some degree of sacroiliac involvement whether or not they notice it. If your notes say SPD and mine say PGP, we are describing the same problem.

It is common. Pregnancy-related pelvic girdle pain affects roughly one in five pregnant women to a degree that interferes with everyday activity, and milder discomfort is more common still. It most often starts in the second trimester, though it can appear in the first trimester, late in pregnancy, or for the first time after birth. The severity varies enormously between women: some notice a nagging ache after a long day, while others cannot walk to the end of their street without crutches.

What pelvic girdle pain is not

Pelvic girdle pain is not a sign that your pelvis is unstable in any dangerous sense, and it is not a sign that something is wrong with your baby. The pelvis does not come apart during pregnancy; a significant separation of the pubic joint is a rare birth injury rather than something that develops as a pregnancy progresses, and it is covered later in this article. It is also not a condition that you have to tolerate silently because you are pregnant, and it is not a reason to assume that your next pregnancy will be identical. Finally, it is not the same thing as ordinary pregnancy backache, although the two frequently overlap and many women have both.

Where it hurts and what it feels like

The short answer: pain over the pubic bone at the front, pain over one or both sacroiliac joints at the back just below the dimples above your buttocks, or both, often spreading into the groin, the inner thighs, the perineum or the back of the thigh. It is almost always made worse by movements that load one leg at a time or that part the legs.

Women describe it in fairly consistent ways. At the front it is often a deep, bruised ache directly over the pubic bone, sometimes sharp, sometimes burning, occasionally with an audible or palpable clicking or grinding when you change position. Pressing on the pubic bone is tender. At the back it is usually a dull, heavy, gnawing ache lower than you would expect back pain to be, often on one side more than the other, sometimes spreading across the buttock. Some women feel it mainly in the groin and assume it is a hernia or a hip problem.

The movements that provoke it

The pattern of provocation is more diagnostic than the location. Pelvic girdle pain characteristically flares with:

• Walking, especially longer distances, and particularly at the end of the day
• Climbing or descending stairs, often one side hurting more than the other
• Standing on one leg, so getting dressed while standing, or stepping into a bath
• Turning over in bed, which for many women is the single worst movement
• Getting in and out of a car, especially swinging one leg out at a time
• Parting the legs, including during an internal examination or sexual intercourse
• Standing still for long periods, or sitting still for long periods and then moving
• Lifting, pushing a trolley or pram, or carrying a toddler on one hip

Many women develop a characteristic waddling gait, taking shorter steps with the feet slightly apart, because that reduces the shearing movement at the pubic joint. Night pain is common and is one of the most exhausting features, because the pain wakes you when you turn, and interrupted sleep then lowers your tolerance for pain the next day.

When you should not wait

Some symptoms that women attribute to pelvic girdle pain are not musculoskeletal at all: pain that came on suddenly and severely rather than building up over weeks, any vaginal bleeding or leaking of fluid, fever or feeling generally unwell, a change in your baby's movements, and pain or swelling in one calf all mean you should contact your obstetrician's office the same day rather than assuming it is PGP. The full list, including the symptoms that are an emergency rather than a same-day problem, is at the end of this article. If you are unsure whether what you are feeling is pelvic girdle pain or something else, it is always reasonable to be checked; that is part of what routine pregnancy follow-up appointments are for.

Why pelvic girdle pain happens in pregnancy

Pelvic girdle pain is not caused by one single thing. It is the result of several changes acting at once: hormonal softening of the ligaments, a rapid increase in load, a shift in posture and centre of gravity, and a change in how the deep stabilising muscles coordinate. Previous injury or previous pelvic girdle pain makes all of this more likely to become symptomatic.

Relaxin and ligament laxity

The hormone relaxin, together with progesterone and oestrogen, increases the elasticity of ligaments and cartilage throughout pregnancy. This is purposeful: the pelvis needs to accommodate a baby. The pubic symphysis normally widens measurably during pregnancy, and the sacroiliac joints allow slightly more movement than they do outside pregnancy. This is physiological, not pathological.

What is worth knowing, because it is often misrepresented, is that relaxin levels do not neatly predict who gets pelvic girdle pain. Women with high levels may have no symptoms and women with modest levels may be severely affected. So relaxin is part of the explanation, but it is not the whole explanation, and this matters practically: it means the problem is not purely hormonal and therefore not something you simply have to endure until the hormones change.

Load and changing posture

Over the second and third trimesters the weight of the uterus, baby, placenta and fluid increases substantially, and it sits forward of the spine. The centre of gravity moves forward, the lower back tends to curve more, the pelvis tilts, and the abdominal wall stretches and lengthens. A lengthened abdominal wall transmits force less efficiently, which means the pelvic joints and the muscles around them take more of the work. Add a toddler to carry and a full working day on your feet, and the load rises further.

Muscle control, not just laxity

The pelvis is stabilised by a coordinated system: the deep abdominal muscles, the pelvic floor, the deep back muscles alongside the spine, the diaphragm and the gluteal muscles. In pregnancy this system is disrupted both mechanically and by the way pain itself changes muscle recruitment. When the timing of these muscles changes, the pelvic joints are loaded unevenly, particularly during single-leg activities. This is the part of the problem that treatment can genuinely change, which is why exercise-based physiotherapy sits at the centre of management rather than at the edge of it. The pelvic floor is part of this system, which is also why pelvic girdle pain and pelvic floor problems such as prolapse often appear in the same conversation.

Who is more likely to develop it

• Pelvic girdle pain in a previous pregnancy, which is the strongest single predictor
• Existing low back pain or pelvic pain before pregnancy
• Previous injury to the pelvis, such as a fall onto the tailbone, a road traffic accident or a pelvic fracture
• Generalised joint hypermobility
• Physically demanding work, especially with prolonged standing, lifting or twisting
• Higher body weight before pregnancy
• Having had several previous pregnancies
• Carrying twins or more, because load rises faster and earlier

None of these are things you did wrong. They describe risk, not fault, and most women with several of these factors still go through pregnancy without significant pelvic girdle pain.

Is it pelvic girdle pain, round ligament pain or sciatica?

These three are routinely confused, and the distinction matters because the treatment is different. In brief: pelvic girdle pain comes from the pelvic joints and is provoked by weight-bearing and single-leg movements; round ligament pain is a short, sharp abdominal catch triggered by sudden movement; sciatica is nerve pain that travels down the leg, usually below the knee, often with numbness or tingling.

Round ligament pain

The round ligaments run from the upper uterus down through the groin. As the uterus grows they stretch, and a sudden movement can make one of them spasm. The result is a sharp, stabbing or pulling pain low in the abdomen or groin, usually on one side, lasting seconds rather than minutes, typically triggered by coughing, sneezing, laughing, rolling over quickly or standing up suddenly. It is most common in the second trimester and it settles when you stop moving. It does not usually hurt to walk, it does not hurt at the pubic joint when you press on it, and it does not make stairs difficult. If what you are feeling is a brief catch in the lower abdomen rather than a persistent deep ache in the pelvic joints, read more about round ligament pain and how it is managed.

Sciatica

True sciatica means irritation or compression of the sciatic nerve or its roots, and it produces pain that follows the nerve: down the back of the buttock and thigh, usually past the knee into the calf or foot, often with pins and needles, numbness, or weakness in the foot. Despite how often the word is used in pregnancy, genuine sciatica is relatively uncommon. Most pregnant women who say they have sciatica have posterior pelvic girdle pain, which can refer into the back of the thigh but rarely goes below the knee and does not usually cause numbness or weakness.

The distinction is worth making because of one specific pattern. Leg pain accompanied by progressive weakness, numbness in the saddle area between the legs, difficulty passing urine, or any loss of bladder or bowel control is a medical emergency: these are the warning signs of pressure on the nerve roots at the base of the spine, and they need immediate hospital assessment rather than an appointment. That combination is rare, but it is the one situation in this whole article where hours matter.

Other things that can masquerade as pelvic girdle pain

• Urinary tract infection: suprapubic pain with stinging on passing urine, frequency, or cloudy urine. Easily tested, and important to treat in pregnancy.
• Contractions: rhythmic tightening that comes and goes at intervals, rather than pain tied to a movement. Before 37 weeks this needs assessing.
• Hip joint problems: pain felt deep in the groin with restricted hip rotation. Rare conditions such as transient osteoporosis of the hip can occur in pregnancy and are usually suspected when pain is severe, one-sided and disproportionate.
• Abdominal or gynaecological causes: ovarian cysts, appendicitis and other conditions can produce pelvic pain in pregnancy. The broader picture of what causes pelvic pain in women is worth knowing if your pain is not clearly mechanical.
• Blood clot in a leg vein: one-sided calf pain, swelling, warmth or redness. This is an emergency assessment, not a physiotherapy problem.

How pelvic girdle pain is diagnosed

Pelvic girdle pain is a clinical diagnosis. It is made from your history and a physical examination, and in the great majority of cases no imaging is required at all.

In the consultation I want to know where exactly the pain is, when it started, what makes it worse and better, what you can no longer do that you could do a month ago, how it affects your sleep, and whether you had anything similar in a previous pregnancy or before pregnancy. The functional detail matters more than a pain score. "I can walk about ten minutes before the front of my pelvis starts burning and then I limp" tells me far more than "it is a seven out of ten".

The examination involves watching you walk, stand, and move from sitting to standing, then a set of specific provocation tests. These include pressing gently over the pubic symphysis and over the sacroiliac ligaments, a posterior pelvic pain provocation test in which pressure is applied through the bent thigh with you lying on your back, a test of hip position and rotation, and an active straight leg raise, where you lift one leg a few centimetres and we see whether the pelvis loses control or whether manual compression of the pelvis makes it easier. We also measure how far you can comfortably part your legs without pain, because that single measurement becomes important later when we plan your birth.

When imaging is considered

Routine X-rays are avoided in pregnancy and are not needed to diagnose pelvic girdle pain. Ultrasound of the pelvis looks at the uterus and ovaries, not at the joints, so it does not confirm or exclude PGP, although it may be done for other reasons. MRI does not use radiation and is occasionally used after birth or in pregnancy when something does not fit: severe one-sided hip pain, suspected fracture, suspicion of infection, or neurological signs. Imaging is for excluding other diagnoses, not for confirming this one.

One practical point: there is no useful relationship between how far the pubic joint has widened on a scan and how much pain a woman has. Women with marked widening may be comfortable and women with modest widening may be severely limited. Treatment follows your symptoms and function, not a measurement.

What actually helps: physiotherapy, belts and equipment

The single most useful step is assessment by a physiotherapist with specific training in pelvic health or musculoskeletal obstetric care. Everything else, including belts, crutches and analgesia, works best as part of that plan rather than instead of it. Ask your obstetrician to direct you to a pelvic health physiotherapist early rather than waiting to see whether it settles, because the longer the altered movement patterns persist, the more work it takes to change them.

What physiotherapy involves

A pelvic health physiotherapist will assess how your pelvis, hips and spine move, how your deep abdominal and pelvic floor muscles are working, and which specific daily activities are driving your symptoms. Treatment usually combines several elements:

• Targeted exercise for the deep abdominal muscles, pelvic floor, gluteal muscles and deep spinal muscles, progressed gradually and tailored to what your pelvis tolerates
• Manual therapy to the pelvis, hips and lower back, used to reduce pain and improve movement, not to "put anything back into place"
• Advice on activity modification that is specific to your job, your home and your other children, which is usually the part that produces the fastest change
• Water-based exercise or hydrotherapy, which allows movement with much of the body weight taken off the pelvis
• Acupuncture, offered by some appropriately trained practitioners as an adjunct for pain
• Advice on walking aids and equipment where the pain is limiting your mobility

Treatment is individual. Two women with identical pain maps can need almost opposite exercise programmes, because one has a pelvis that moves too freely and the other is holding everything rigid. This is exactly why generic exercise videos found online are an unreliable substitute for assessment.

Pelvic support belts

A pelvic support belt is a firm, narrow band worn around the bony part of the pelvis. Many women find it helpful, particularly for walking and for standing work. Two details decide whether it helps or not. First, position: it goes low, around the widest bony part of the hips at the level of the hip joints, under the bump, not around the waist and not over the abdomen. Second, duration: it is a tool for specific activities rather than something to wear all day, because the muscles still need to do their job. A physiotherapist can fit one and check that you are positioning it correctly, which is worth doing, as an incorrectly worn belt usually does nothing and occasionally makes things worse.

Crutches, walking aids and home equipment

If walking is genuinely limited, elbow crutches or a walking frame are not a defeat; they offload the pelvis and let you keep moving rather than becoming housebound. A wheelchair for longer distances is occasionally appropriate for a short period. At home, small changes reduce the number of painful movements each day: a raised toilet seat, a chair in the shower, a bed lever or a strap to help you turn, a stool in the kitchen so you can sit to prepare food, and a smooth sheet or a silk-like underlayer that lets you slide rather than heave yourself over in bed. Occupational advice matters too; many women need their working hours, duties or standing time adjusted, and that conversation often needs a letter.

How to judge whether treatment is working

Progress in pelvic girdle pain is measured in function, not in pain scores alone. The markers that mean something are how far you can walk before the pain starts to build, how many times the pain wakes you at night, whether you can get out of the car without having to plan the movement, and whether a busy day still costs you two bad days afterwards. Write those four things down before you start, because improvement is usually gradual enough that you lose track of where you began and conclude nothing has changed.

If none of them has shifted after a few weeks of consistent work, that is the signal to go back and have the programme reviewed rather than to decide that physiotherapy does not help. In practice the reasons are fairly predictable: an exercise programme that is too advanced for what the pelvis currently tolerates, a belt sitting too high, a daily activity that is quietly undoing the work between appointments, or pain and broken sleep that have reached the point where some additional pain relief is needed before exercise can be done properly at all.

Movement modification: changing how you do ordinary things

Most of the relief available in pelvic girdle pain comes from changing how you perform a handful of everyday movements. The underlying rule is simple: keep your knees together when you can, avoid loading one leg at a time, and spread activity through the day rather than doing everything in one burst.

The core adjustments

• Turning in bed: squeeze your knees together, tighten your deep abdominal muscles gently, and roll as one unit rather than letting the top leg swing across first.
• Getting out of bed: roll onto your side with knees together, then lower both legs off the edge while pushing your upper body up with your arms.
• Getting in and out of a car: sit down sideways onto the seat first with both feet still outside, then swivel both legs in together. Reverse it to get out. A plastic bag on the seat makes the swivel easier.
• Dressing: sit down to put on underwear, trousers, socks and shoes. Standing on one leg to dress is one of the most common daily triggers.
• Stairs: take them one step at a time, leading with the less painful leg going up and the more painful leg going down, holding the rail. Going up sideways helps some women.
• Carrying: use a rucksack rather than a shoulder bag, split shopping into two light bags rather than one heavy one, and avoid carrying a child on one hip. Sit down to lift a toddler onto your lap rather than lifting from standing.
• Standing and walking: break long periods of standing with short sits, and shorten your walking distance to the point where pain does not build up, rather than pushing through and paying for it that evening.
• Getting out of a chair: move to the edge, keep your feet level and hip-width apart, and push up with both legs equally.

Sleeping positions and getting through the night

Side-lying is the position most women find tolerable, and from 28 weeks onwards going to sleep on your side is recommended anyway. Place one firm pillow between your knees and, if the pain is at the front, a second pillow or a folded towel between your ankles as well, so that the whole upper leg is supported in line rather than dropping forward and twisting the pelvis. A pillow or wedge under the bump takes the drag off the lower back, and a pillow behind your back stops you rolling backwards in your sleep.

Two small practical points make a disproportionate difference. Satin or silk pyjamas, or a smooth sheet, reduce the friction you have to overcome to turn. And deciding in advance which side of the bed you will get out of, so the less painful leg leads, saves you one painful movement every night.

Work, driving and longer journeys

Work is where most women lose ground with pelvic girdle pain, because the shape of the day is not under their control. The adjustments that help most are a stool or chair so that standing work can be broken up, a change of duties that removes repeated lifting, twisting and stair climbing, shorter or more flexible hours so that the commute does not fall at the worst time of day, and permission to move rather than hold one position for hours at a time. If you need these, say so early and in writing; adjustments made at 24 weeks are far easier to arrange than adjustments requested in a crisis at 34 weeks.

Driving is often painful because the pedals load one leg at a time and the seat holds the pelvis in a slightly twisted position. A wedge cushion, a seat raised a little higher, and stopping every forty minutes or so on a long journey to stand and take a few steps all help. On a plane or a long coach journey, ask for an aisle seat so that you can stand up without climbing over anyone.

Exercise during pregnancy with PGP

Staying active is part of the treatment, not a risk to be avoided, but the type matters. Swimming is often comfortable, with one caveat: the breaststroke leg kick parts the legs forcefully and frequently aggravates pubic pain, so front crawl with a gentler kick, or back crawl, is usually better tolerated. Stationary cycling is comfortable for some women and painful for others. Walking is useful within your pain limit. Avoid activities that load one leg hard or that involve wide leg positions, including lunges, deep squats, step-ups and most yoga poses that part the legs widely. If an exercise causes pain that lasts after you stop, it is not the right exercise for you at the moment.

What commonly makes pelvic girdle pain worse

Knowing what to stop doing is often more valuable than knowing what to start. The movements below are the ones that most reliably aggravate pelvic girdle pain, and most of them are easy to avoid once you are aware of them.

• Standing on one leg for any reason, including dressing, stepping into the bath, or reaching up to a high shelf with one foot lifted
• Parting the legs widely, including straddling a chair or a bath edge, wide squats and sitting cross-legged on the floor
• Twisting while lifting, for example turning to lift a child out of a cot or a car seat
• Pushing heavy objects, especially supermarket trolleys and heavy prams over rough ground
• Vacuuming and mopping, which combine a twisting push with asymmetrical standing
• Sitting cross-legged or with one leg tucked under you, which holds the pelvis asymmetrically for long periods
• Prolonged sitting on a soft, low sofa, which makes standing up far harder
• Doing a week's worth of activity on a good day, which is the most common cause of a flare I hear about
• Wearing unsupportive or high-heeled footwear, which alters pelvic alignment with every step
• Pushing through pain in the belief that it will strengthen the area, which in this condition usually prolongs the problem

Sexual intercourse can be painful, particularly in positions that part the legs widely or load the pelvis unevenly. This is common, it is not harmful, and it is worth raising rather than enduring. Side-lying positions, or positions where your knees stay close together, are usually more comfortable, and your physiotherapist can discuss this with you specifically.

There is also a pacing principle worth naming. Pelvic girdle pain tends to follow a boom-and-bust pattern: a good day leads to catching up on everything, which leads to two bad days. Planning activity at a level you can repeat tomorrow, rather than at the level today allows, is one of the most useful habits to build alongside treatment.

Pain relief options in pregnancy, by class not brand

Pain relief in pregnancy is chosen by drug class, at the lowest effective dose, for the shortest period that is useful, and always alongside physical treatment rather than instead of it. What follows describes the classes and how the decision is made. It is not a prescription, and the right choice for you depends on your gestation, your medical history and what else you are taking. Do not start, stop or combine medication in pregnancy without speaking to your obstetrician or a pharmacist.

Non-drug measures first

For many women, non-drug measures carry a good part of the load: a warm (not hot) pack over the sore joint, a warm bath or shower, a supportive belt for specific activities, rest positions that take weight off the pelvis, and the movement modifications described above. Transcutaneous electrical nerve stimulation, or TENS, is used by some women for pelvic and back pain; placement and timing in pregnancy should be discussed with your doctor or physiotherapist first.

Simple analgesia

Paracetamol is the usual first-line simple painkiller in pregnancy. The standard advice is to use the lowest dose that helps, for the shortest time needed, rather than taking it continuously by default throughout the third trimester. If it is not helping, the answer is to review the plan rather than simply to keep taking it.

Anti-inflammatory drugs

Non-steroidal anti-inflammatory drugs, the class that includes ibuprofen, diclofenac and naproxen, are generally avoided in pregnancy. From around 20 weeks they are associated with effects on the baby's kidney function and the volume of amniotic fluid, and in the last weeks of pregnancy they can affect an important fetal blood vessel, the ductus arteriosus, which must stay open until birth. They are therefore not recommended in later pregnancy at all, and earlier in pregnancy they are only used when a doctor judges there is a specific reason. This includes gels and creams containing the same drugs, which are absorbed through the skin, and it includes anything bought over the counter without advice.

Stronger painkillers

Opioid-type painkillers such as codeine are occasionally used for short periods when pain is severe and other measures have not been enough, and that decision is made with an obstetrician. They cause constipation, which is already common in pregnancy, and if used regularly close to delivery they can affect the baby's breathing at birth and cause withdrawal symptoms in the newborn. They are not a long-term strategy for pelvic girdle pain.

What to ask at your appointment

• Which class of painkiller is appropriate for me at this gestation?
• What is the maximum I should take in a day, and for how many days before I come back?
• Is there anything in my history that changes the usual advice?
• Should any of this change as I approach my due date or if I go into labour?
• Can you direct me to a pelvic health physiotherapist, and how soon can I be seen?

Does pelvic girdle pain affect labour and birth?

For most women, pelvic girdle pain does not prevent a vaginal birth, and the condition by itself is not a reason for a caesarean section. What it does mean is that your birth needs a small amount of planning, and that the people caring for you in labour need to know about it in advance.

The pain-free gap: the single most useful thing to record

Before labour, ideally in the third trimester, you or your physiotherapist should measure how far you can part your legs without pain. This is done lying on your back, slowly moving your knees apart until you first feel discomfort, then measuring the distance between your knees. That measurement should be written in your notes and in your birth plan. During labour, and especially with an epidural, your legs should not be moved beyond that range. This matters because an epidural removes the warning signal: without it, legs can be positioned far wider than the joints tolerate, and that is the main way a painful pelvis becomes a much more painful pelvis after birth.

Positions that tend to work well

• Side-lying, with the upper leg supported on pillows or by a birth partner so it is not simply left hanging open. This is often the most comfortable position for both labour and pushing.
• Kneeling or all fours, which keeps the legs close together and takes weight off the pelvis
• Supported standing or leaning forward over a bed or birth ball, with weight shared evenly between both feet
• Water immersion, where buoyancy reduces the load on the pelvic joints and allows easier position changes

Positions to avoid, or to use with care, are those that part the legs widely or asymmetrically: the classic semi-reclined position with knees pulled far back, and lithotomy stirrups. If stirrups become necessary for an assisted birth or for stitching, both legs should be lifted into them and taken out of them at the same time, never one at a time.

Epidural, induction and caesarean

An epidural is not ruled out by pelvic girdle pain and may be welcome, provided the abduction limit is respected. Pelvic girdle pain on its own is not an indication to induce labour early, although in severe cases the timing of birth sometimes forms part of a wider discussion. A caesarean does not reliably prevent or cure pelvic girdle pain, and it brings its own recovery, so it is chosen for obstetric reasons rather than as a treatment for the pain.

Put it in writing

Write the key points into your birth plan and discuss them at an antenatal appointment: your measured pain-free gap, the positions you want to use, a request that both legs be moved together, and a note that you may need help with mobility after birth.

Plan the practical side as well, because a painful pelvis makes the first hours of labour much harder to manage alone. Agree in advance who is driving you, keep your crutches or walking aids by the door rather than upstairs, and ask whether a wheelchair can meet you at the hospital entrance if the walk from the car is beyond what your pelvis tolerates. Knowing how to tell whether your waters have broken and what to do next is part of that planning, because for many women that is the moment when all of these arrangements suddenly have to happen quickly.

Does it go away after birth, and what if it does not?

For most women, pelvic girdle pain improves markedly in the weeks after birth as hormone levels fall, the load on the pelvis drops and normal movement patterns return. A good proportion are substantially better within the first few weeks, and most of the remainder continue to improve over the following months. A minority have pain that persists, and that group should be treated actively rather than told to wait.

The early weeks

Immediately after birth, keep using the movement strategies that helped in pregnancy: knees together when turning, no standing on one leg to dress, sitting to feed and to lift the baby, and no heavy lifting. Caring for a newborn involves a lot of bending, twisting and carrying, which is precisely the load the pelvis is least ready for, so set up changing and feeding stations at a height that does not require stooping, and accept help with anything heavy. Gentle walking within your pain limit, and the deep abdominal and pelvic floor work your physiotherapist gave you, can usually restart early. This is also the period when you are managing normal postpartum bleeding and lochia, so judge activity by both.

When pain persists

If pelvic girdle pain is still limiting what you can do around three months after birth, that is the point to ask your obstetrician to direct you back to a pelvic health physiotherapist rather than waiting any longer. Persistent pelvic girdle pain is treatable, but the approach shifts: the hormonal contribution has gone, so the focus moves firmly to strength, motor control, graded return to loading, and sometimes to the way persistent pain itself changes how the nervous system responds. Pelvic floor assessment is part of this, because pelvic floor weakness and pelvic girdle pain commonly travel together after birth.

Symptoms that need prompt assessment after birth

• Severe pubic pain immediately after birth with inability to stand or walk, which can indicate a significant separation of the pubic joint and needs assessment that day
• Fever, redness or a hot swollen area over the pelvis or a leg
• New numbness in the saddle area, new weakness in a leg, or loss of bladder or bowel control, which should be assessed immediately at a hospital rather than at your postnatal check
• Pain that is getting worse rather than better week by week
• One-sided calf pain or swelling

What about the next pregnancy?

Having had pelvic girdle pain once makes it more likely in a future pregnancy, and it often starts earlier the second time. That is not a reason to avoid another pregnancy; it is a reason to prepare. Strengthening work before conceiving, a plan agreed in advance, and arranging physiotherapy in early pregnancy rather than when you can no longer walk all change how the pregnancy goes. If you are planning another pregnancy, mention your previous pelvic girdle pain at your first appointment and ask that physiotherapy be organised early.

When to contact your doctor

Pelvic girdle pain itself is not an emergency, but several conditions that can feel similar are. Contact your obstetrician's office without delay if any of the following apply, and go straight to a hospital emergency department if you cannot reach anyone quickly.

• Vaginal bleeding, or any leaking of fluid from the vagina
• Regular tightenings, cramping or low back pain that comes and goes rhythmically before 37 weeks
• A change or reduction in your baby's movements
• Fever, chills, or feeling generally unwell
• Pain or burning on passing urine, needing to pass urine very frequently, or blood in the urine
• Sudden severe pelvic or abdominal pain, rather than pain that has built up gradually
• Pain, swelling, warmth or redness in one calf or thigh
• Severe headache, visual disturbance, or sudden swelling of the face and hands, which can indicate a blood pressure problem
• Numbness in the saddle area (between the legs), difficulty passing urine or loss of bladder or bowel control, or weakness in both legs is a medical emergency — go to the hospital where you are booked for delivery, or the nearest emergency department, immediately. Do not wait for an appointment and do not wait to see whether it settles overnight.

It is worth being clear about the difference between those two levels of urgency, because it changes what you actually do. Emergency means leaving now and being seen in a hospital: numbness between the legs, being unable to pass urine, losing control of your bladder or bowel, or weakness in both legs can mean pressure on the nerve roots at the base of the spine, and the window in which treatment protects bladder and bowel function is measured in hours rather than days. Same-day means telephoning the office, describing clearly what has changed, and being seen that day rather than waiting for your next scheduled appointment. If you genuinely cannot tell which category you are in, treat it as the more urgent of the two. Nobody will think less of you for being checked and sent home.

Beyond the urgent list, there is a lower threshold worth naming too. Ask for help, and specifically to be pointed towards a pelvic health physiotherapist, as soon as the pain is changing what you can do: when you are avoiding stairs, when you dread turning over at night, when you cannot manage your usual walk or your usual working day. Waiting rarely improves pelvic girdle pain and usually makes the eventual treatment longer. You are not being a difficult patient by asking; you are asking for the standard management of a recognised condition.