“ Condition most commonly associated with pregnancy and childbirth. „
So you are nearing your due date, you feel like you're the size of a house and no clothes fit you anymore. You're uncomfortable, feeling huge, feeling impatient and you just want the baby out NOW. Then...you get this horrible pain between your legs, and you think oh great...just one more thing to add to my list of woes.
Symphis Pubis Dysfunction...you probably think it sounds like a deadly disease when you are told this is what you have, I know I did...I thought my was going to lose my baby when I was told I had it at first, and it didn't help that my doctor didn't actually explain what the hell it was, just said I had it, and there was nothing they could do for it, but that in most cases after birth it goes away- it took me hours of looking online (scaring myself basically!) to actually find out what SPD was, and to find that it is one of the most common things for pregnant women to get, that although excrutiatingly painful...it isn't in the slightest bit harmful to the baby- and yes in most cases once you give birth the pain will go away.
So what IS SPD?
The Symphis Publis is located the the bottom of your pelvis, and it is this which needs to open to allow the baby to pass through during childbirth, the pain comes when this part of the pelvis moves more than it should do and before labour, which can cause horrible pain in your groin area, in many women it makes even walking impossible- but in other women they may simply have a slight pain for a couple of weeks. SPD affects up to 1 in 4 pregnant women, so it is not at all rare. As I mentioned, it isn't harmful to you or the baby in any way- but it can be very painful, and a trip to the doctor is advised if you think you may have this- SPD may also be called "Girdle Pain". Usually diagnosis of SPD is simply done through your symptoms (i.e. there is no test done to diagnose it!), but if you continue to have the pain after pregnancy, you may be offered scans to diagnose SPD, and to rule out other problems- another reason you should see your doctor early on in suspecting you may have SPD is to rule out other problems which may need immediate attention, so any pain in the groin, abdomen or lower back really should mean you seek medical help- even if you just mention it to your midwife!
At the moment, there is no "cure" for SPD, and in 93% of cases it goes away on its own once you have given birth, in some cases (usually when SPD occurs early on in pregnancy) a girdle support will be given to try and keep the pelvis aligned and stop the pain from happening- I was not given one of these with my SPD as it was diagnosed in the last 2 weeks of my pregnancy so I am afraid I cannot really comment on this girdle support. The only other treatment is prescribed pain killers- as SPD occurs mainly in pregnancy of course the range of drugs you can take is limited- usually Co-codamol (a mix of paracetamol and codeine) will be prescribed which can make you drowsy and makes some people feel sick- though I myself have never experienced either of these side affects. If the pain is extremely severe and deemed you cannot live with it, you may be sent to a pain clinic who will asses the pain, and give you tips on pain management, and things to do in your lifestyle which will reduce the pain- you may be put on bedrest which would mean time taken out of work if you had not yet finished for maternity leave- you may be given a sick note and told to simply rest which is what I was told in my own case, and not walking too much did help- for me walking up the stairs brought the pain on, so you may want to try and stay downstairs as much as you can!
In very rare cases surgery may be required after you have given birth to realign the pelvis, but this is as I say very rare, and in the most part, the pain spontaneously goes once you have given birth!
Lifestyle changes which can help with SPD
There are certain things which can be done to help your condition in your life rather than taking medication (which a lot of women do not want to do during pregnancy for all the obvious reasons!).
Don't stand for long periods: so avoid things like vacuuming/sweeping and waiting in long queues. If you can, sit down for most things which would mean a long standing period, this could be whilst sorting the dinner.
When in bed, placing a pillow between the legs is thought to be good for easing the pain- and whilst turning, keep the legs together (this for me was the most painful part of SPD, turning in bed, but keeping the legs together does help!).
Avoid carrying things and having to lift heavy objects (of course this is advised during pregnancy anyway!).
Avoid walking long distances- a pain when you are trying to bring on labour...!!!
You may need help around the house when you have SPD, with things like the vacuuming, sweeping, lifting and carrying, and you may be told to rest as much as you can, which is a pain when you get the nesting instinct and just want to tidy, but it is essential to your condition that you try not to strain your pelvis.
Pelvic floor excercises are thought to help with pain management, and will also help after birth with getting your pelvic floor back into shape (no embarrasing accidents when you cough or sneeze...!!!), so do these at every opportunity- speak to your midwife about pelvic floor excercises if you are not sure how to do them- I wouldn't want to advise and give incorrect advice which may end up doing more harm than good!!!
Natural Labour with SPD
Something I was worried about with SPD was that I would not be able to have a normal and natural birth as I wanted to have, but this was not the case. You SHOULD be told to speak with your midwife about a birth plan, and it will be put in your notes very clear so that the delivering midwife knows you have SPD and can help you with birthing positions, sadly, for some reason, my notes were never updated, or were not read when I went into labour, and I was not helped for my SPD in labour, and I think that made my SPD worse (6 months after giving birth, I still get bouts of it sometimes!).
You will be able to have a normal birth, and won't be forced into a C Section (unless your SPD is so bad that you really cannot move), and an epidural is actually considered to make the condition worse as it makes you feel like the pain is not there so you could strain it too much.
You should not be laid on your back with your legs in stirrups if you have SPD (this is where my midwives during labour messed up as this was exactly as I was laid, and I did not know until AFTER birth that this is the one position I should not have been put in to). A birthing pool is considered the best birthing option for a lady with SPD as the water supports the weight of the pelvis meaning pain is taken away slightly.
Make sure your delivering midwife knows you have SPD (so ensure your birth partner knows about it so they can tell them as trust me it is the last thing on your mind when in the delivery suite, and if you have been given drugs to take away pain chances are you will be a little bit out of it!)- the use of forceps should be avoided as well as the position outlined above and stirrups should only be used with great care. So you should ensure they know about your condition to ensure no long term damage is caused!
SPD isn't a nice condition- it can be very painful in some cases, but it is a common condition and midwives are used to dealing with women with it- so do not worry if you are told you are suffering with SPD. Following simple lifestyle advice really will help, avoid doing things which you have noticed bring on the pain (for me it was walking up stairs and walking in general so I tried to not go upstairs as much as possible, and took breaks when I was walking long distances to rest my pelvis and it did help). You can request pain killers if you want them, and you will be given something which is safe in pregnancy- and in the worst cases a support will be fitted to help you with the pain. SPD is just another of those pregnancy things which we don't know about until it comes on, it isn't pleasant, but it isn't dangerous either, there are much worse things you could have whilst pregnant that's for sure. So don't worry when your doctor says oh yes you have symphis pubis dysfunction, it sounds scary, but it isn't! In 93% of cases it will clear up as soon as you give birth- and even of the 7% of cases where it doesn't, it clears up soon after. It is very rare that intervention is required after giving birth.
~~What is it?~~
It is a condition that occurs during pregnancy to some (unlucky) women - it is thought to be caused by too much of the hormone called 'relaxin' that is released around the body to loosen the pelvis in preparation for birth. It means that the hips and/or pelvis can start to or actually separate. It usually begins around the end of the 2nd trimester although it can start as early as day 1 of the pregnancy (this is thought to be proof of it not being caused by the weight of the baby).
~~What causes it?~~
Sadly, as with many women's health complaints - in such a male dominated industry, little funding has been given to research this very common and often debilatating condition (estimated at 1 in 3 women get this to some degree of severity). However, speculation suggests a few pointers:
# those who do a lot of manual labour - such as factory workers, nurses, carers, gymnasts, postal workers etc...
# a different father - it is believed that some men will give women more difficult pregnancies than others due to genetics
# having more kids - the more children you have, the more chance of having it at all or having it more severely
~~So, what is it like?~~
It can vary greatly in severity - from the common end of the spectrum of feeling a slight twinge on standing and walking, to the disabling more rare situation where you cannot walk or turn in bed.
It began in the 14th week of gestation. I noticed a sharp stabbing pain in my righthand side whilst fastening my shoes. It gradually got worse and would sometimes happen even when stationery. My partner and I agreed it would be a good idea to get it checked out by the GP as it had all the earmarks of appendicitus.
At the appointment, the GP was happy to confirm it was not anything dangerous but offered no further advice. It was only when I mentioned this increasingly unbearable pain to the midwife at 20 weeks that she explained to me about SPD (also known as pelvic girdle pain). She said that the only thing that can be done is to see a physiotherapist and that they cannot offer much help so not to bother.
By 22 weeks, the pain had spread to my left side and inside my pelvis - it felt very similar to having being kicked by a horse in the private regions, I felt constantly bruised and my mood was starting to get affected by it. I returned to the GPs many times only for them to prescribe me increasing strengths of co-codamol (a codeine and paracetamol mix) which made me lethargic most of the time. When I mentioned a support belt to one GP, he said they were just a placebo and would not do much for me (this later on turns out to be untrue).
Finally in desparation, I spoke to a suportive GP who agreed to send to the physio marked as urgent to get me up the waiting list. I first attended a group session where with a PowerPoint show they explain about good posture and how to minimise damage etc... It was quite helpful and they provided some crutches for me. I then attended an individual appointment where they said it was so bad that a caesarean section would be a better birth option for me - hearing this was a relief, I had been worrying about the birth for a long time and this took a weight off my mind. She insisted on me purchasing a belt that was necessary for me - these were not available on the NHS, they cost over £20.00.
My c-section was reluctantly agreed by a consultant for five days before the due date. I had a consultation with the surgery team who agreed to write in block capitals SPD all over my notes to ensure no separation of my legs during any examinations. They also promised a wheelchair into surgery. In the end, I was asked to hobble in on crutches in agony.
I will not mention other complications of the birth as I see it as irrelevant for this discussion. Although gentler on my pelvis than a natural birth, the surgery had exacerbated the SPD severely, so alongside feeling very raw and fragile, mobility was extremely tough and the ward was very understaffed and did not have disabled facilities.
~~10 months later.~~
It did gradually start to clear up, and I noticed a difference in just a fortnight after the delivery. I can go for a walk quite regularly and lift my baby boy from his cot without much difficulty. Occasionally my hips or back will make a loud clunk and shift around and I will need to rest for a couple of days but I am a fiercely independant woman and refuse to let it prevent me living a normal life.
If by 14/15 months, it has not cleared up completely, I will be visiting a private chiropractor - they are meant to be the best option for this condition however (yes, you've guessed it!) unavailable on the NHS.
~~General tips and hints.~~
I am not a GP or physio, and everyone is different but they do tend to advise the following:-
# take steps and stairs one at a time
# sleep with a pillow between your knees on your side
# get in and out of cars by using both feet together and swivelling
# avoid opening legs at all costs as much as possible
# get a medical support corset or belt A.S.A.P!!!
# discuss birth options with someone in detail - a caesarean is only a last resort, there are some great pain relief options, water births are supposed to take the weight off your hips, and laying on your side is a lot safer than the traditional lithotomy position that could result in permanently dislocated hips.
# try some alternative (qualified) practitioners - they may have some better pain relief and relaxation techniques that are safer for your unborn baby than codeine.
Please visit www.pelvicpartnership.org.uk for further information. They are a great charity that need more publicity.
While there are many wonderful aspects to pregnancy there are some that are not that pleasant and some that are altogether unpleasant and even painful. One of these less-pleasant aspects is a condition known as SPD or Symphis Pubis Dysfunction. SPD is something I've suffered from in previous pregnancies and something I'm suffering from right now. And before I go any further I can categorically state it is probably the most uncomfortable and painful condition I've ever experienced and in my opinion is worse even than being in labour.
===What Is SPD?===
SPD is a painful condition most commonly associated with pregnancy and childbirth which affects the pelvis and surrounding area. While the Symphis Pubis (the pubic bone joint) naturally softens due to hormones released in pregnancy, when suffering from SPD it softens and moves excessively causing pain and mobility problems. Generally SPD first raises it's ugly head in the third trimester (6-9 months) but can occur earlier especially in 2nd and subsequent pregnancies. SPD is also known as Pelvic Separation (a far more accurate description) or pelvic girdle pain and causes pain in the pelvic area, lower back and legs.
===How SPD affects me===
In each of my pregnancies the SPD has started affecting me earlier and earlier into the pregnancy, this time round I felt the first twinges at around 8 weeks and was suffering discomfort by 11 weeks. I'm now 29 weeks, and in moderate to severe pain 24 hours a day. To start with I only felt the pain when turning over in bed, but as it's progressed the pain has increased to the point where I have extreme difficulty walking, getting up, sitting for prolonged periods, sleeping and get little relief from the pain even with painkillers. I find climbing stairs excruciating, which is a little inconvenient as I have to go up six flights of stairs to get to my front door. I need help to get in and out of the bath and more embarrassing, there are times when I can't even put my own underwear on or get off the toilet. The pain itself is hard to describe, there's the pain in my pelvis, which gets worse when the baby decides to kick there, there are shooting pains in my hips and down my legs (especially my right leg) and a severe pain in my lower back and tailbone that never quite goes away.
SPD is normally diagnosed by observation rather than by any clinical tests. X-rays would probably show the condition quite easily, but this is, quite obviously, ruled out due to the risks to the baby. In all my pregnancies I have been diagnosed by a physiotherapist, who used a mixture of manipulating my legs and watching me walk. SPD sufferers do have a very distinctive waddle, believe me, I sometimes think I look like a duck. Ultrasound scans can also be used, but to be honest, I've only ever had extra scans to rule out other problems rather than for the distinct purpose of diagnosing SPD. I will say though that even though SPD seems to be becoming more common, there are still a lot of doctors who either don't know about the condition or completely misunderstand it. My own GP has no idea how it affects me, he believed that it involves the pelvis closing up rather than opening.
While there's no cure for SPD, it can be managed to a certain extent. I regularly see a physiotherapist and have a set of exercises to keep me as mobile as possible. I also have a special belt to wear, which holds up the bump and supports my pelvis along with a stick to help me walk. At night I use a full-body pillow to support my pelvis as I sleep and take special care when moving from lying to sitting, or sitting to standing. I also take special care not to open my legs too wide (no playground humour intended, I'm normally in too much pain to even consider that), but when sitting I try not to have my knees too far apart (I was actually advised to hold a football between my knees, but found this too uncomfortable). I take care to minimise activities that involve parting my legs, for example I sit up to turn over in bed, sit down to do things like the ironing and try not to lift anything too heavy. I do remember being pregnant with my last child (a good few years ago) and being told not to pick up her 9 month old brother. I am lucky though, I have a wonderful fiance, who has taken time off work to look after me.
Pain management is a major problem, most painkillers aren't suitable for use in pregnancy and those that are suitable aren't really effective. Paracetamol doesn't touch the pain and the strongest painkillers I can take are co-dydramol (Paracetamol and codeine), which take the edge off, but never completely kill the pain and have risks of addiction attached. In previous pregnancies I have spent periods in hospital where I have been given stronger painkillers and bed rest, but I'm really trying not to go down that route this time round, even though there are times when I am crying with pain.
For most women the symptoms of SPD steadily improve after giving birth, and disappear within a few months, but not always. Special care needs to be taken during labour as it is possible to cause irreparable damage to the pelvis (Diastasis Symphis Pubis). Epidurals are NOT recommended as you may open your legs too far, not realising it as you don't feel the pain (that's your bodies way of warning you), it is important to let the midwife attending you that you are suffering from SPD so that they can take special precautions. Due to my SPD, I'm at risk of going into premature labour, as when the head engages there's not much to stop it. In fact I don't generally go further than 37 weeks, and one of my children was born at 33 weeks.
While SPD is indeed a very painful condition, to me it's one that's worth suffering as the end result is a beautiful baby. When I had my first child, eighteen years ago, it was a far less well known condition than it is today, but the treatment hasn't changed much in all this time. If you are pregnant and suffering from any of the pain I've described above then it's important that you talk to your midwife about it and learn the management techniques (from a physiotherapist) as although nothing will stop you being in pain, it will hopefully stop the condition from deteriorating to the point where it becomes permanent. If you have already been diagnosed don't be afraid to ask for help, because you will need it.
My baby is now 3 months old and I'm still experiencing a considerable amount of pain on a daily basis. However, this isn't the norm, in most cases I would have fully recovered by now, so I'm going to be having further tests to rule anything else out.