Zwangerschapsgerelateerde bekkenpijn [richtlijn]

A.2.2 Probleemoriëntatie na de bevalling

Bij ZGBP na de bevalling spelen de beperkingen in activiteiten en participatieproblemen een veel grotere rol dan tijdens de zwangerschap. In een enkel geval ontstaat de pijn tijdens of in de eerste dagen na de bevalling, waarbij de klacht bestaat uit hevige pijn in het schaambeen. Omdraaien in bed, komen tot zit, opstaan, staan en lopen is tijdens het kraambed vrijwel onmogelijk. Al in het kraambed zijn er forse beperkingen in activiteiten en participatieproblemen. Bij een heel kleine groep vrouwen ontstaat ZGBP sluipenderwijs na de bevalling. De pijn wordt voornamelijk aangegeven in de bekkenregio en de lage rug.

Tijdens het kraambed vermindert de pijn vaak snel. Een heel kleine groep vrouwen krijgt dan pas problemen. Deze vrouwen klagen over pijn in het schaambeen, hebben moeite met omdraaien in bed, uit bed komen, opstaan uit een stoel of traplopen. Soms is de pijn zo erg dat ze nauwelijks in staat zijn om zelfstandig uit bed te komen. Bij vrouwen die na de bevalling pijn blijven houden, is de aard van de pijn niet wezenlijk verschillend van die tijdens de zwangerschap. Wat wel verschilt, zijn de functionele gevolgen en de bijbehorende problemen op het niveau van participatie. Er is vaak ook teleurstelling dat het einde van de zwangerschap niet tevens het einde van de pijn betekende. Dat er bepaalde activiteiten zijn die niet of onvoldoende kunnen worden uitgevoerd en dat dit consequenties heeft voor het gezinsleven en de verzorging van kind(eren) wordt als (zeer) hinderlijk en moeilijk ervaren. Daarnaast wordt na de bevalling niet zo vanzelfsprekend meer een beroep gedaan op de partner als tijdens de zwangerschap en maken veel vrouwen zich zorgen over de invulling van de snel naderende terugkeer naar (betaalde) arbeid. Men voelt zich vaker onzeker over het hervatten van activiteiten die tijdens de zwangerschap problemen opleverden en achterwege werden gelaten.

Een kleine groep vrouwen gaat ernstig gebukt onder de klachten en heeft veel pijn en problemen met zowel het uitvoeren van activiteiten als op het gebied van participatie.8

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