How do women manage pregnancy-related low back and/or pelvic pain? Descriptive findings from an online survey

Background: Low back pain is typically experienced by over 60% of pregnant women and pelvic pain by almost 20% (Pennick and Liddle, 2013). The treatment offered for this condition is mostly physiotherapy, however this is not always effective, or evaluated positively by women. Midwives accept that low back pain and/or pelvic pain (LBPP) is common during pregnancy and that treatment is conservative, often including paracetamol, alongside a variety of physiotherapeutic interventions. However, there is growing concern over the use of medication by pregnant women with LBPP. Therefore, an online survey was undertaken to explore women’s experiences of LBPP, treatments used and their perceived satisfaction and effectiveness.
Aim: To determine the treatments women use to manage LBPP in pregnancy, how helpful they find these treatments and how satisfied they are with them.
Method: An online UK survey was designed to investigate the incidence of LBPP among women who have recently given birth within the UK. The survey was developed and distributed using Qualtrics online software and contained 92 items piloted with 10 women who had given birth within the previous two years. The Doctoral Midwifery Research Society website hosted the survey and the popular mother and baby websites Netmums and Bounty advertised the study. Ethical and research governance approval was granted by the University of Ulster. The survey collected data on demographics, birth outcomes, body mass index (BMI), pain, treatments for LBPP in pregnancy, and physical activity levels. Women were eligible to complete the survey if they had given birth in the last two years, could understood and read English and were willing to take part.
Findings: A total of 331 women accessed the survey, 140 were currently pregnant and screened out. The remaining 191 were eligible and 176 questionnaires were fully completed. The mean age was 30.46 (SD 7.60) and 95% of women were white. The sample response was heavily weighted towards England (75%), with smaller proportions of respondents from Scotland (11%), Northern Ireland (8%) and Wales (6%). The average BMI of survey respondents before their most recent pregnancy was 26.
Most women reported being physically active on two days each week, with walking the most popular activity (81%). Mean low back pain intensity was 6.43 on a 0 to 10 sliding scale, mean frequency of low back pain was 7.16, mean pelvic pain was 7.62, and mean pelvic pain frequency was 8. Most women gave birth vaginally (66%), followed by emergency CS (12%), planned CS (8%), forceps (8%), and vacuum (6.29%). Most women (78%) gave birth at 36 to 42 weeks’ gestation. A large number of women (110/157) had suffered LBPP before their pregnancy, with many using over-the- counter painkillers. Painkillers were used by 96 women to manage LBPP, and the most frequently used was paracetamol, followed by codeine/co-codamol and non-steroidal anti-inflammatory drugs (NSAID). In total, 46% of women received treatment other than painkillers for LBPP in pregnancy. Qualitative data has revealed a disturbing picture of women’s pain and its impact on the quality of daily life.
Implications: Recommendations include the development of evidence-informed guidelines for practitioners and raising awareness of medication safety with mothers.
Keywords: Low back pain in pregnancy, pelvic pain in pregnancy, medication in pregnancy, analgesia usage, online survey, evidence-based midwifery