Symphasis Pubis Dysfunction

[shish]

Has anyone had this during their pregnancy? I am expecting ds 2 and am suffering from this. Very uncomfoatable and quite painful and times.

Does it tend to resolve itself quite quickly after giving birth? Can it affect labour and birth?

Am so scared. I had such a horrible time with ds1. This is making me even more worried about labour, birth and recovery..

[Hawkmoth]

Won't affect Labour and birth, though you need to make sure you don't end up with legs akimbo as it can make it worse.

I had it and just waddled around in labour just the same. Plus when baby engaged it was like a new lease of life as the head wasn't pressing on the pelvic girdle anymore

If you have an epidural you need to be extra careful as you won't feel any warning pains from your pelvis.

Try to think that the loosening of your pelvis is a good thing - it's a bigger opening for the baby. I certainly had a relatively quick labour.

Before that, try to rest. Get a physio referral, buy a support. REST!

How far on are you?

It can resolve straight away after birth, or it can take longer.

My best tip for recovery is NOT to think "Oh, I feel a bit better now, time to do sit-ups". THAT set me back a good few months and was one of the MOST foolish things I have ever done!

There are lots of people with SPD and you'll get some great advice and support here.

Start resting now.

[YouKnowNothingoftheCrunch]

Got it at the moment and had it last time too. Birth last time was no problem at all and it disappeared afterwards. Although I did have a water birth and there is some evidence that labouring in a pool can take the pressure off the joint and relieve the pain - talk to your Midwife about it if you fancy it.

Try not to do too much on it. This is not the sort of thing that gets better if you just keep going through the pain - it'll get worse if pushed. So rest as much as you can and keep your legs together at all times

[YouKnowNothingoftheCrunch]

Also sleep with a pillow between your legs to keep your hips straight - I still wake up a hundred times a night, but without the pillow I wouldn't sleep at all.

[swissmiss]

I had SPD with all 3 dcs. Agree with the uncomfortable/painful. Have you been getting any treatment for it? I would never have got through without visiting the Obstectic Physio at the local hospital. Check with your midwife if your area has one. Ours was a self referral system and was seen whenever I needed too, on occasion more than 1x week! Also, if paracetamol isn't enough to help with the pain go to your GP for something stronger on prescription (but NOT ibuprofen or similar NSAIDs). Make sure you get a body tubigrip or even a fembrace as needed.

My biggest problem with labour and delivery was not being able to lie on my back or "drop" my knees open. This wasn't a problem in itself as I had understanding m/ws who were happy with me lying on my side for ds1 and dd1 births. With dd1 I had a hca supporting my top leg as I could not hold it up in the air, parallel with the one on the bed iyswim. With dd2 I had a water birth which was amazing for being able to move around/change position as the water took the weight off my pelvis completely. My personal choice I didn't want an epidural as I was worried I'd do my pelvis more damamge as I wouldn't be able to feel what range of movement was comfortable/not painful, so I managed with gas and air. Unfortunately I was proved right as I ended up in theatre with a spinal block after dd2 to remove a very stuck placenta and those 45mins on my back with legs up in stirrups did more damamge than being pg. First 2 times my SPD was gone immediatley after delivery, I just went back to physio for a check up but was fine. 3rd time I was in worse shape after than before delivery and needed more physio from 6 weeks onwards. 6mths later it has now gone apart from a very occasional twinge which the physio has taught my how to self treat.

Hope you are doing ok?

[ihavenewsockson]

Had SPd with both of mine.

Get one of these asap

keep your legs together- imagine you are walking with a mini skirt and no knickers- so knees together when you get out the car & into bed.

doesn't affect labour as long as you don't go too far akimbo. I had an epidural last time and i'm suffering a bit still as i stretched too far (but it was only 6days ago so should improve)

when i had both my babies i left my crutches in the delivery suite and with DS1 i didn't even get any twinges at all afterwards.

don't work thru the pain or try to 'walk it off' the best thing for it is to rest.

hope it doesn't cause you too much agro.

[shish]

Thank you for all the advice.

Howkmoth, I'm 36 weeks +2 gone and am 4/5 engaged.

Trying to rest but people keep telling me that I should be walking and exercising more as they don't quite get it when I tell them what I have.

Was going to go for an epidural again as last time was 19 hours long and had complications and ended up with a spinal block. I guess I will have to re-evaluate now. It's reassuring that you found the labour quicker - I am so scared

[Hawkmoth]

www.pelvicpartnership.org

They have a leaflet on there. Print off ten copies and post to all your family. Stick one to your fridge!

I'm now suffering in my second pg and my dad still thinks it's my hip and that I should walk it off!

Do you have a gym ball? My physio said I should sit on it, not bouncing, but sort of balancing on it to strengthen my core muscles.

Slight hijack - those of you that had a water birth - how did you get in and out of the pool? It takes me all my time face showering!

[BoffinMum]

Wikipedia entry

I wrote most of this myself while laid up with SPD and having read practically all of the current relevant medical papers and mainstream self-help advice on it. There is even a link to a Women's Hour feature at the bottom which you may find interesting to listen to.

Hope it's helpful - please feel free to edit it if you find out anything new.

[Qally]

Water birth - the pool was fine, just sat on edge and got DH to support as I swung legs over. It was bliss, as it supported all the ligaments.

My physio told me that SP women often have an easiertime in labour. SPD is when the ligaments are too soft, too early, but your pelvic bones being loose is extremely useful when a head has to get past - that's the reason for the hormonal surge in the first place. It was certainly true for me - I am a giant wimp and need paracetomol & ibuprofen just to get legs waxed, but I just needed water and gas and air for a 4 hour natural birth. I didn;t even really need to push, my body did it all. I had a filthy pregnancy - terrible morning sickness and SPD kicking in at 3 months - but a fantastic birth, and I am the least hippy, lentil-weavery person on earth, so had no real commitment to that sort of birth. It was genuinely fun! (I know that sounds quite mad, I privately snorted when a friend said hers had been.)

So the short answer is that SPD is hell, but an active labour controlled by you, preferably in water to support the joints, can be easy. I gave birth kneeling up against the edge of the water and was fine.

Be aware that some people are IDIOTS. I had an appointment with an obstetrician (with thrush) when 8 months, and she listened to me explain I had SPD then still insisted I straddle so she could do an internal. I could hardly walk afterwards for a week. Have it on your notes that you can't part your knees unless the baby's life literally depends on it and make sure your birthing partner is aware. My Mum and DH would have physically stopped anyone without a good reason. I had great midwives who let me birth uninterrupted except for gas and air when I asked for it, I never even needed an internal exam - there's no need in a straightforward labour, which most are, as a good midwife can tell your contractions from breathing patterns, and can monitor you and the baby with a waterproof doppler and thermometer. Just make sure your supporters are very knowledgable about what and why SPD precautions are required.

I still get a bit of a twinge as breast-feeding means hormones are still surging, but it's pain-free now, and I should be fine after I wean. And I did nothing when pregnant, no walking far, nothing, after even physio-led Pilates caused me pain. Ignore anyone who tries to tell you different, if that seems best to you. You know your own body.

[BoffinMum]

There's a lot of sense in these here posts. Picking up from what Kyte said, when I was in hospital with this recently, they explained a lot to me about pain management for SPD. The theory is that you have to train your 'pain gates' to be closed as much of the time as possible. In other words, with a condition like this the pain mechanisms get very trigger happy, and start to give out extra pain signals, but if you spend as much time out of pain as possible, then the less it hurts overall, and the quicker you recover. It sounded a bit counter-intuitive to me when they explained it, tbh, but they have been proved right in my case. If I take my medication like a good girl four times a day, and sit around practically all the time doing nothing, then I am better overall.

At the recommendation of the hospital consultant, I take quite high doses of codeine (60mg four times a day) and paracetemol at the same time to enhance the effect (500mg four times a day) with Oramorph for breakthrough pain, and use a TENS machine for a minimum of five hours a day as well. This is more extensive pain relief than GPs normally give (they tend to advise 30mg once a day at night), so I think it makes sense to try to get up to the hospital if things are very bad in your case (apart from anything else, taking opiates during pg needs to be carefully monitored). Bear in mind I normally have the pain threshold of an ox and rarely take tablets for anything, btw, so I have to be pretty convinced about something to pill pop like this as it goes against the grain.

Resting up a lot like Qally suggests and being very fussy with your pelvic care, and not being bullied into doing things that are bad for it, is very important as well.

They generally tell you to do lots of pelvic floor exercises and also specialist physio Pilates exercises to strengthen the area around the pelvis and promote stability. However from discussion on MN, a lot of us have found these exercises to be ineffective during pg. However they might help you get better quicker after the birth, IMO. If you work within your pain threshold, they certainly won't do you any harm.

A lot of people report huge improvements after osteopathy or chiropractic. I have seen a chiro a lot during the pg, and while in my case there was no magic cure, it does help with the pain (I really feel it if I have missed or delayed a session, for example), and also the baby happens to be positioned really well for the birth which may have something to do with the constant pelvic realignment she does for me - at this stage his brother was breech.

If you want to throw a bit of money at the problem, apart from shelling out for chiro/osteo, you might want to look at memory foam mattresses, Genii pg pillows, and satin pyjamas, all of which have been commented on favourably by MNetters with SPD. I happened to be signed up for a hypnobirthing course anyway, and I found this helped me panic about the SPD less as well, oddly enough.

The NHS can give you elbow crutches or a wheelchair if you need them (you might need to nag the Rehabilitation Department), and you can claim Disability Allowance for care and/or mobility if you get very bad. You can also apply for a Blue Disabled Parking Badge if necessary. But it may not come to that.

Birth wise they say you are likely to have an easy birth because they pelvis will probably expand nicely. Water birth is recommended because it supports all the joints - I wanted one of these anyway, but my consultant has also been encouraging it because she has seen good results with this in SPD cases. Flat on your back and forceps/ventouse ought to be avoided at all costs, apparently.

[Bumpsadaisie]

Just out of interest - when does SPD usually kick in? Is it always towards the end of pregnancy or can it start before?

Many thanks
Bumps x

[IwishIwasmoreorganised]

Bumps - mine started at 12 weeks .

9 months down the line and I am still struggling and having physio, though it did improve a lot immediately after having ds2

Lots of really great tips on here.

I'd like to add that ds2 was delivered with me in high kneeling, leaning over the head end of the bed and that was a great position - it didn't aggravate my pelvis at all and used gravity to good effect too!

[Hawkmoth]

Bumpsadaisie - mine started at around 6 months first time (I actually slipped on a mossy path). This time at about 8 weeks. Been off work for I think five weeks now doing nothing, and it's only gradually getting worse at 16 weeks.

[shish]

MIne only really kicked in a couple of weeks ago so I guess Ive been lucky. Some days aren't too bad like today and other days (although) not too many can be really bad.

I had some refexology this morning wich I had in my last preganancy so I'm hoping this might help with some pain relief or at least help me to relax. I am seeing my obstetrician for my antenatel check next week and I think I should disuss my birthing options with her as she will be delivering my baby.

Thank you so much for all the tips and advice. It is so helpful and ecnouraging.

[Gemzooks]

shish, I had it very badly from 30 weeks, am now 36 weeks and it's much better.. only because I stopped commuting to work, NEVER pick up my son (2.5), and have adjusted my lifestyle, for example he gets in to the bath himself using a stool with me just supporting. The only things that really helped me were:

-never picking up my son

• really cutting down on walking, the worst possible thing for it in my case. gentle stretches only, though recently I've been able to go on cross trainers or exercise bikes as my feet are fixed in position.
• never picking up anything from the floor or pulling on anything, like unfolding buggy, pulling washing out of washing machine etc.
• a good nap at lunchtime, no matter what.
• chair in the hall for getting shoes, coats on etc.
• did gentle pregnancy pilates which helped, from dvd.
• really being careful how I moved, keeping things aligned, legs together, tucking bottom under.

You have to rest, however inconvenient, and you have to prioritise yourself, I know how hard it is but you mustn't do any damage now which could be lifelong. I'm planning home water birth after very long and medicalised 1st birth, as I really do trust in it probably being quicker and easier, if more painful (as had epidural first time).

good luck, and please rest!

[BoffinMum]

I got it at 21 weeks.
I've had three previous babies with no problems.

[shish]

Mine only kicked a couple of weeks ago. Some days, like today really aren't too bad, and other days can be really bad.

I'm due to see my obstetrician next week for and antenatel check so I will have to discuss birthing options with as she delivered ds1 and will be delivering this baby too. I know I need to be on drugs during the labour and birth as I have a high chance of heamorrhaging again so I don't know how it will all work.

I had a session of reflexology this morning which I had during my last pregnancy in the last few weeks. I'm hoping this might help with some pain relief or at least help to relax.

Thank you all for all the tips and advice. It is really helpful and I am definatley following it