Doula/Midwife Experience with SPD (unstable pelvis)

[fionas]

Gosh, I don't know where to start with this post so forgive me if this is all a bit disjointed.

DP and I would like another child (our first is 9 months old) but I am REALLY scared of doing so because I suffered badly last time with an unstable pelvis (SPD). I am trying to do as much research as possible but time is also running out because I am 39 so obviously I can't dilly dally for too long.

I know next time around I could manage my SPD much better throughout the pregnancy by doing clinical pilates but I am scared that I will end up in a wheelchair (this is quite possible with SPD) after the birth with a toddler and a baby to look after. I have no support network other than DP and I have been told it is difficult to qualify for in-home support.

One of the mistakes I made last time is believing health professionals who told me that it usually goes away as soon as you have the baby or soon afterwards. In my case, it was extremely bad for six months post-birth which meant that I could literally only walk for five minutes, standing was painful and even now, nine months after, rolling over in bed is difficult, carrying my DD is hard and bending down is uncomfortable. So basically I was housebound for six months.

I think the severity of my SPD may have been exacerbated by the type of birth I had last time as well as the fact that I could have managed the condition better while pregnant.

Basically, after a very long labour and 7 hours sleep in 3 days with a posterior baby, I had an epidural. Obviously that meant when it came to pushing, I was in the worst possible flat on the back position and the midwives got me to pull my knees back up to my chest with my arms whilst pushing. I did this for 2.5 hours with no success and ultimately DD was delivered with forceps.

I had no problem (emotionally) with any of this at the time but from what I've since read, this would have been very bad for my SPD and could explain why it has taken so long to recover. It's advised that women with SPD should not be put in positions that REALLY force apart their hips and that before labour you should measure how far you can part your legs comfortably with a piece of string and then take that to the hospital with you.

So ... I guess what I'm asking is:

a) do you agree that those circumstances could have contributed to the severity of my SPD post-birth
b) what would you advise in terms of birth position if you were my birth attendant and IF I chose to have an epidural again (obviously I would be closely following the Spinning Babies website advice to avoid a posterior position and support from a doula would make it much less likely that I would have an epidural anyway)

[BellyBelly]

Deb has posted in the trainee doula section (but has attended heaps of births before training) and has lots of experience (personal) with spd. Might be worth giving her a call, and she's on trainee rates too. She is very gentle, knows her stuff and heavily involved in the birth world.

[fionas]

ooooooh, thank you Kelly. I feel a bit silly asking when I'm not even pregnant but I'm not confident to get pregnant without having a bit more information. Kind of a chicken and the egg if you know what I mean. Thanks again.

[DoulaRobyn]

I had spd with my last three pregnancies and I feel for you! I found that doing the exercises that I was told to do (after my pelvis dislocated in my second pregnancy - first with spd) really helped with the physical severity of the problem. I felt more stable but the pain was still there. I continued doing my exercises daily - mainly out of habit - and then found out I was pregnant again I was glad to be feeling stronger in my pelvis. It got painful up at the end of pregnancy but much more manageable. In my last pregnancy it just gave me twinges on and off and wasn't too bad - until I tried to roll in bed!

Two years on, I am thinking of seeing a chiropractor because I am still not 100% but not too bad either.

My favourite position that worked for me was birthing on all fours leaning over a chair or firm pile of pillows. I liked this position because I could choose how far I wanted my legs apart. The midwife attending my birth commented that I could do with my legs a little wider apart and I explained to her that at the end when the head comes right down I will adjust my position - and did, naturally and when I wanted to.

Be confident in your body and see about some strengthening exercises - the really do work but take a while for you to notice the effect. ---- good luck

[Holly Jean]

I am 32 weeks, and developed SPD at around 26 weeks. I have gotten Better in the last week and this is what I did. I saw an osteopath and a physio. The osteo did some gentle manipulations and did some massages which helped me hobble less. Check if they understand working with pregnant women. I didn't find the physio that helpful. I was told by the physio to rest it alot and not to move around on it. This i found made it worse and most probably weakened the muscle more. Instead i realised that the opposite was true, gentle walking daily (just 10 minutes a day for me) on the treadmill or somewhere very flat helped me hobble less and i have been walking straight without hobbling (and minimal or no pain) for the last week.

I started gentle walking 2 weeks ago and saw an improvement a week later. As I think i may have a mild version or caught it early, this may have helped make it better sooner (so it may vary between persons before you see a difference). Only do a level gentle enough that doesn't cause you pain or aggravate it. I have also religously done pelvic and core exercises everyday. 3 sets of 10 minimal each and then as many as i can do during the rest of the day. So just with the pelvics, pull up and in like a J shape, and hold for 10secs, then do 3 short burst ones, and then relax, repeat 10 times for 1 set. with the core exercise, pull your belly button in towards your spine and hold for 10 seconds and do 3 short bursts ones and relax, repeat 10 times for 1 set. The pelvic and core exercises and gentle walking daily helped immensely.

In regards to rolling over in bed. remember to do everything very slowly to gauge what movements hurt and which ones don't for you. (this would be easier if i could show you, so i will try my best to describe it in words). Please bear in mind that everyone may be at a different level with spd so these maneuvers may or may not work for you (or modify as you require. I was fortunate enough to move in to the spare double bed, which gave me more room to roll over in less moves than if my partner was in the bed. There are alot of moves involved and you have to do them slowly, but it's worth it.

To get in bed i sat on the side of the bed (helps if you have a box or step to rest your feet on) slowly lift your leg onto the bed, and try to keep your heel in contact with the bed as you gently slide your heel from the floor, up the side of the bed till you reach the top of the bed with your foot. do the same with the other foot (i am at a stage where i am still able to separate my legs very gently apart) if you cannot do this then it may help if you keep your kness together as you bring them onto the bed. When you shuffle to the middle of the bed, make sure your bum is still in contact with the bed always, only lift it minimally enough so that it can shuffle across in small moves (it helps to buy satin or silk pj's to help you glide across easier).

When you are in the middle of the bed, you can decide to turn to sleep on the left or right. (or your back if your baby belly allows you to) To the left (my sore bit is my left pelvis) straighten both legs and bend your right knee up while lying on your back (leave the sore leg straight). Use your right foot to push your body to turn to the left,. you can use your right hand to grab at the edge of the bed to help you over. put a pillow between your legs if that helps.

To now turn to the right. you must first get to the middle of the bed. to do this, I take the pillow out first to not restrict movement. With my right knee still bent i roll my right hand into a fist and use it to support my bum as i roll on top of it to my right (this way it doesn't engage my pelvis) and my hand takes my weight. Slowly move hand out from under your bum as you roll on your back. Straighten your right knee.

Next move is to bend both knees up towards you. First dig your bum into the bed, use your heel to gently and Very slowly 'slide/walk' your feet up towards your bum, (I found it helped to stick my feet into the air as well) keeping your heel in contact with the bed, left heel right heel left heel right heel till you r feet reach close to your bum. As both your knees are up now, rest/lean the sore leg on the right leg (try not to engage it but rather rest it on top of), as your right leg slowly drops down to the right side of the bed til it comes to a rest, place the pillow back in between.

To get out of bed, (while lying on my right hand side), i pull my knees up towards my chest and let it drop over the side of the bed, i use my arms and elbows to help push my body to sitting position and keep knees together as both hands push on both knees to help me stand up (slowly).

Very fiddly and wordy but hopefully something has helped someone out there. Gentle exercise is the key to getting better (rather than sitting still and letting it atrophy and getting worse and feeling like there's nothing you can do about it) (make sure the exercise is not rigorous or anything that causes you pain). Slowly get the pelvis and core muscles strong again so it can better support you.

I am now walking straight without hobbling and without pain (which i didn't think was possible after reading alot of forums). And with very slow and careful movements in bed i am able to get a good night's sleep most nights. I still have to be wary about certain movements and what i can and can't do. If stairs seem too high, I still take them one step at a time, and i sit down when I'm getting changed to minimise pain. I am going to be diligent with my walking and pelvic and core exercises everyday so i can keep this at bay, and increase my chances of being pain free. I saw my osteo for 3 sessions, and do not need to see her at the moment, but I may return to her if I need to in the future. Remember gentle motion is the key. Good luck ladies!

[fionas]

Hi guys - I'd forgotten about this thread. Thanks for all the info. I'm 29 weeks into a second pregnancy (I originally posted before getting pregnant). I had an 18 month recovery after my first pregnancy, did clinical pilates before and during this pregnancy. It struck again at 7 weeks and I was told by my phsyio that I would soon be in a wheelchair if I didn't rest it. Resting or not to rest seems to be quite a controversial issue. Some people advocated rest, some don't and I guess I say, whatever works for you. Carrying on as normal did not work for me in my first pregnancy. Resting in this pregnancy has worked wonders and I'm in much less pain now than I was 10 months postnatally last time. I wear a pelvic belt virtually 24 hours a day and ice up to three times a day. THese are also working wonders. I am basically housebound with a toddler - I can walk to the shops at the end of my street (50 metres) and back and that's about it. Any more than that and I will be in pain. I basically have a choice between mentally going nuts at being housebound (I don't drive) or doing more, being in pain and having a longer recovery post-natally. I choose to go bonkers.

After a long chat with my physio (who specialises in pregnancy), I've opted for an elective caesar. While SPD certainly does not mean that you need to have a caesar, in my circumstances it's the most sensible option. She said that if I went for a VB again, that I would need to specify only 20 minutes of pushing (regardless of the position). Any more could further damage my pelvis which is what happened last time with a 2.5 hour pushing stage. The three midwives that I've spoken to have also advised that they think a caesar would be better FOR ME given my birthing history and troubles with SPD.