A systematic exploration of a perinatal wellbeing framework through women's experiences of lumbo-pelvic pain

Women's wellbeing during the perinatal period has received increasing attention in research, policy and practice, but is often poorly defined and conceptualised. We have developed a framework of perinatal wellbeing (PWB) which we will refine further in this review, using the example of lumbo-pelvic pain (LPP). Perinatal LPP, which includes lower back pain (LBP) and pelvic girdle pain (PGP), is common and can significantly affect women's wellbeing.

The aims of this review are (1) to synthesise research into women's experiences of LPP and (2) to use these findings to contribute further to developing our framework of PWB.

A systematic search of online databases was conducted for qualitative studies exploring women's experiences of LPP linked to the perinatal period; 15 papers describing 11 studies were identified. A framework synthesis approach (Carroll et al., 2011; Carroll et al., 2013) was used to synthesise studies, using the PWB framework as the a priori framework.

The review highlights the impact of LPP on all areas of women's lives and their functioning at every level, as well as the impact of a range of factors on women's experiences. Only one study explored women's experiences of LBP, all others focused on PGP. Findings illustrate how multi-faceted women's wellbeing is in the context of LPP, particularly the importance of relationships and support, but also the role played by wider socio-cultural discourses of pregnancy and motherhood and by women's individual circumstances and characteristics. Findings underline the interconnectedness of physical, emotional and psychological experiences. The review largely confirmed, and further elaborated, the domains of the original framework, but also led to some changes, notably the inclusion of an 'individual factors' domain describing women's individual circumstances and characteristics. The limited discussion of LPP during labour and birth was notable.

Findings support the framework, but also provide evidence for some changes, thus further refining the framework. Women's wellbeing in the perinatal period (with regards to LPP, other issues, or generally) should not be considered in isolation, but needs to take account of women's life context. The perinatal period should be considered a continuum, rather than seeing each part in isolation. For clinical practice, the review underlines the importance of distinguishing between PGP and LBP and offering appropriate, individualised support.