SPD (Pelvic Instability) and Birthing Choices - Your Stories Wanted

[fionas]

I would like to do some very informal research on SPD/pelvic instability and the impact that birthing has on post-birth recovery.

I am scared s***less of having another baby because my SPD was pretty full-on for six months after the birth. I suspect this was because I was pushing for 2.5 hours flat on my back (no other choice as I had an epidural) with my legs raised to my chest.

So, I am curious as to whether having a caesarean would be a better option for me.

To that end, I have a few questions:

1. How far into your pregnancy did you get SPD?

2. Before the birth, how severe (1-10, one being the lowest, 10 being the highest) would you say your SPD was? eg. 1 being a bit niggly, 3 you needed a belt, 8, you needed crutches, 10 you were wheelchair-bound.

3. If you had a vaginal birth, how long was your pushing stage and in what position? Did you have forceps/vacuum?

Or

4. Did you have a caesarean? If so, how would you compare the pain recovering from a caesarean to the SPD?

5. How severe was your SPD after the birth (using the same scale as before) and how long was it before you could bend, walk or stand relatively painlessly?

6. How did you manage your SPD eg. wearing a belt, regular clinical pilates etc. etc.?

[*bLuE*]

Hi Fi,
I have had SDP to a degree with all my pregs and it got worse with each of them. I think that it was the worse with baby number 4. I could barley move toward the end of the preg and the pain was pretty interesting afte5r the birth for about three months.

to answer your questions that are relevant to me..
1. How far into your pregnancy did you get SPD? About week 12

2. Before the birth, how severe (1-10, one being the lowest, 10 being the highest) would you say your SPD was? eg. 1 being a bit niggly, 3 you needed a belt, 8, you needed crutches, 10 you were wheelchair-bound. I would say around the 4 mark for the last two pregs.

3. If you had a vaginal birth, how long was your pushing stage and in what position? Did you have forceps/vacuum? Pushing stage was only short for all my births. No vaccuum or forcepts..

I hop that this helps. I dont blame you for being scared s****ess cause it hurts and there is very little that can be done for it..

Bec

[Arimeh]

Hi Fiona,

I got diagnosed with this after having DD - didn't know what the pain was before that, just kept on going with life and putting up with it!!!

I had a c-section. Pain immediately afterwards was not helped by the condition. On day 4, I was unable to walk around the hospital without hanging onto walls - before having her it was not that bad.

I started going to physio 2 weeks after birth - now its 4 weeks and i can walk unassisted and without the belt.

I can honestly say that i did not notice the pain in my belly compared to my pelvic pain. However, all that lurching around trying to walk did not help the recovery of my stitches!!

I'm not doing pilates, just physio.

[Schmickers]

1. How far into your pregnancy did you get SPD?

DW has suffered from back and hip pain for years. During her first pregnancy, she had some minor hip pain, but nothing major. During her second she had strong hip and pelvic pain from about 12 weeks onwards. She was still able to walk and move around. Since then, she has suffered from sacroiliitis, which is an inflammation of the hip joints.

2. Before the birth, how severe (1-10, one being the lowest, 10 being the highest) would you say your SPD was?

Between 2 - 3. Some days she wore a support belt. Mostly she just tried to rest as much as possible, as she was already pretty debilitated with nausea.

3. If you had a vaginal birth, how long was your pushing stage and in what position? Did you have forceps/vacuum?

Kneeling up in the spa. Laboured for about four hours, pushing for maybe 20 to 30 minutes. No interventions.

5. How severe was your SPD after the birth (using the same scale as before) and how long was it before you could bend, walk or stand relatively painlessly?

After the birth - 1-2. DW still gets hip pain after a long day on her feet of if she has to spend time in awkward positions, but it doesn't interfere with her mobility.

6. How did you manage your SPD eg. wearing a belt, regular clinical pilates etc. etc.?

After the birth? Osteopathy, and massage.

[Janie]

Fiona, I don't have any personal experience, but I'll share my step-sister's experience, I hope that helps.

She had minimal problems during her pg. She was concerned about having a big baby, but the midwives assured her she would be fine (which most women obviously are). During the birth her pelvis seperated, doing alot of damage. The hospital really tried to brush it off, wouldn't even acknowledge anything was wrong for the first two days (she couldn't walk at all). She went home with a support belt and crutches, and couldn't be alone with her baby for 10 weeks. She started physio, and swimming, which helped alot. She fell pg again when her DS was almost 2. She wore the support belt from about 3 months, used crutches from about 5 months, and by 7 months didn't really leave the house, if she had to she was in a wheelchair. It was by about 7 months that she needed someone with her nearly all the time to look after her DS. It was thought that she would be able to manage another vaginal birth (especially as this baby was much smaller), but she WOULD NOT, she said she could not cope psychologically, even if she could do it physically. This was some years ago, and she had to really 'shop around' to find an Ob who would do a caesar for her. The birth went well, she actually enjoyed the time with her new baby, and bonded much better with him. They would have liked more children, but it was suggested that it wouldn't be a very good idea for her body. And she agreed. She still has back pain, but I don't know how bad it is, because she is not at all a complainer.

Clearly, her case was rare, and severe, but that's her experience. HTHs

[fionas]

Thanks to everyone who's posted so far. It's really interesting to read of other people's experiences!

[~clover~]

I never had problems with this with my girls.

1) It started with DS at around 16 - 18 weeks & slowly got worse.

2) If I didn't do too much it was around a 2 - 3. If I sat for too long, or walked to far it was hell. By the end of the pg it would've been an 8 - 9. I waddled every where VERY slowly if I left the house at all. I didn't leave the house much. When I did I used a trolley or something for support. Or just went REAL slowly
I probably would've had a chair or something if I wasn't treated like a twit by the first doc I asked about it.

3) I birthed on my back with my knees up to my chest. I had to have someone lift my leg & hold my feet with each contraction as I couldn't lift them myself.
I was hooked up to a monitor though coz of mecconium in waters, so I couldn't really move around at all.
I Pushed for about 20 - 30 minutes I guess. No forceps/vacuum extraction or pain relief.

5) Nearly 6 months on I am still in a lot of pain. If I walk any further than DD's bus stop 100m away it starts aching. I've had to walk somewhere twice & I wake up the next morning with a severe burning pain in my pubic bone area & it is almost impossible to move.
It also aches when I'm tired, or when I have to get up in the night.
Basic house work hurts. Vacuuming & hanging out the washing adds to the pain.

6) It got better post birth, & once my body put itself back together it probably went down to a 3 -5 & has stayed there.
I'm on the waiting list to see a physio to see what I can do to help it. It's stayed pretty steady since about 6 - 8 weeks.

[Smoke Jaguar]

Mine appeared at about week 20 and I had no idea what it was till I self-diagnosed at about week 32. I had been horse riding, infrequently, till week 28 (separated muscles main reason I stopped - even with the belt it felt like a sack of potatoes hanging onto me by a thin thread).
I did have to use crutches on and off and I would rate the pain during the day at about a 5, and at night having to get up for a wee it was about a 9 - I fell over a couple of times and DP thought I was exaggerating, but my leg just kept giving way under me in the wee hours!
I saw the hospital physio for it and the treatment was pretty useless, but only cost me $10, so no biggie.
I never intended to 'push' in the birth and HypnoBirthing was great to teach me how to 'breathe' the baby out - just awesome. I 'breathed' him out in about 40 or less minutes, I was on my knees with my hands resting on the edge of the bath, and the tub was full, so I had a waterbirth, as planned - DP pouring warm water over my lower back. I'm sure the waterbirth was a major factor in my SPD taking a backseat during labour.
Of course, I also had no intention of using any form of artificial pain relief, so I was quite free to birth in the most comfortable way I felt at the time.
I only noticed the SPD came back about 4 weeks after the birth, and the physio's ended up giving up on it saying that if I didn't wean, there wasn't much they could do.
I got onto the ABA forum and asked around there for breastfeeders with SPD. I was referred to a nearby clinic and they have been wonderful. When I have a set back it's because I have neglected to do my strengthening and stretching exercises, especially before doing something strenuous.
After the birth, when I'm not careful, the pain can get to a 6 or 7, but it's never been quite like the 'sledgehammer up my pelvis' strength that it was in late pregnancy.
Also, I think my core strength has saved me from the worst of it. A combination of horse riding and yoga has kept up my core strength. When I feel it coming on, I immediately adjust how I'm using my legs and hips - getting out of the car and bed carefully, lifting things properly etc.
I recommend a good osteo, and I wore a stretchy band the midwives gave me at the FBC, can't remember the name! I wore it over my belly (separation) and over my hips, but I probably could have done with the belt my SIL kept saying she'd lend me and never ended up doing so!

[Rouge]

I had severe SPD with both pregnancies, second pregnancy I had to wear a brace and could barely walk for more than 5 minutes without issues. I was seeing my phsyio on a weekly basis and had to be strapped twice and bedridden for a couple of weeks here and there so I hear ya honey...

But guess what? It didn't affect my birth at all! But I'll answer your q's

1. How far into your pregnancy did you get SPD? 12 weeks both pregnancies.

2. Before the birth, how severe (1-10, one being the lowest, 10 being the highest) would you say your SPD was? eg. 1 being a bit niggly, 3 you needed a belt, 8, you needed crutches, 10 you were wheelchair-bound. I'd say about a 7 if 8 is needing crutches. I would have been bedridden had it not been for my physio weekly. I was also having ultrasound for the pain.

3. If you had a vaginal birth, how long was your pushing stage and in what position? Did you have forceps/vacuum? My pushing stage was about 20 mins. I birthed upright kneeling over the top of the bed. No forceps or vacuum and I also gave birth to a big baby (without tears or even grazes on my tailbone - which is common with SPD)

Or

4. Did you have a caesarean? If so, how would you compare the pain recovering from a caesarean to the SPD? I would say recovering from C/S was probably as annoying and painful if not more than SPD. Also given I've had both births I'd definitely go for the Vag birth.

5. How severe was your SPD after the birth (using the same scale as before) and how long was it before you could bend, walk or stand relatively painlessly? Both pregnancies it went away relatively quickly. I'd say I recovered quicker after a vag birth than after c/s.

6. How did you manage your SPD eg. wearing a belt, regular clinical pilates etc. etc.? I had to wear a belt, was on bedrest during the bad times when I had to be strapped as even the brace wasn't good enough. I also had physio fortnightly and then weekly when it was bad. I also had ultrasound to help with pain. And when the worst bout happened I was given anti-inflammatory medication and panadeine forte. But I also have a bulging disc between L4-L5.

[Julie Doula]

Hi Bec,

I don't have personal experience, but one of my clients had SPD late in her third pregnancy. After reading this on the Plus Size Pregnancy website, I suggested she see a Chiropractor who I knew was experienced with pregnancy and birth. Overnight, the SPD pain lessened significantly, and her baby turned to LOA. She laboured in the rain walking beside the river, and arrived at the birth centre 5 minutes before giving birth on hands and knees - no ill after-effects.

I have a client at present also with some SPD, going to see the same Chiro. I'll let you know how that pans out for her.

Implications for Malpositions and Cesareans

One of the most interesting side-effects of a misalignment of the pelvic bones is that anecdotally, it often seems associated with malpositions of the baby, including:

breech (feet or butt-first)
occiput posterior (head-down but facing the mother's stomach instead of her back)
asynclitic (head tilted to one side so that the parietal bones presents first instead of the crown)
compound (hand or arm by face)
All of these malpositions tend to cause more difficult labors, with greater pain and often great difficulty in dilation or descent of the baby. There is a high rate of operative intervention when malpositions are present, including lots of forceps in vaginal births, and many cesareans as well. In fact, research shows that only a small percentage of babies with persistent malpositions actually are born spontaneously and without interventions. (See the FAQ on Malpositions on this website for further information and references.)

As noted on the website of the Australian Osteopathic Association:

The descent of the baby through the pelvis is determined by factors such as ligament laxity, hormonal control, uterine contraction, gravity and position of the baby. If the mother's pelvis is mechanically unstable or is lacking mobility, it may interfere with the baby's passage through the birth canal.

Unfortunately, very few doctors in recent years have paid much attention to malpositions (except to do cesareans for breech). Only in the midwifery, osteopathic, and chiropractic communities have these positions received much attention, and then only recently. Interest is now just beginning to re-surface in the obstetric community, but is very limited in mainstream obstetric journals as of now.

There is little scientific data to show that pelvic misalignment is associated with malpositions because traditional medicine does not recognize misalignment as a problem or research it, nor do they take the idea of "pelvic misalignment" seriously. Really, they barely take the idea of non-breech malpositions seriously! Therefore, it cannot be stated from an evidence-based point of view that pelvic alignment is associated with fetal malpositions or difficult labors, or that re-aligning the pelvis would prevent malpositions, prevent cesareans, or lessen the incidence of difficult labors.

Obviously, research into this issue is very important, but quite unlikely to occur anytime soon. The funding and interest is simply not there in the traditional medical community. This lack of data does not prove or disprove the misalignment theory; it simply has not been researched in the traditional scientific manner. Chiropractors, on the other hand, have seen in their own practices for years that women with misaligned backs and pelvises tended to have more malpositioned babies. There are some limited case series studies on this available in chiropractic research journals, but even this is not very well-documented.

The first really significant work was done by Dr. Larry Webster, founder of the International Chiropractic Pediatric Association. He found that simply by realigning the pelvis and releasing the soft tissues, most breech babies turned head-down within a few treatments. It is important to emphasize that he did NOT manually turn the baby in any way, but simply realigned the mother's pelvis and 'released' the ligaments supporting the uterus. The baby then was not "constrained" anymore from assuming the best possible position, and so usually quickly turned vertex.

Dr. Webster taught this "Webster In-Utero Constraint Technique" to many other chiropractors. Success rates depend on the skill of the practitioner, but usually are documented at about 80% or more in turning the breech baby. This is much higher than the success rates for manually turning the baby with the often-rough procedure known as a "External Cephalic Version". ECV success rates generally run anywhere from 40-65% or so, whereas the Webster Technique successfully turns 80% or so, at least in the data available so far.

Thus, it seems likely that many cases of breech babies are quite probably associated with pelvic misalignment, and that treatment to re-align the pelvis may help many breech babies turn head-down. However, proof of this is limited to anecdotal evidence, lectures and articles from Dr. Webster, a few small case series, and surveys about chiropractors' experience with the Webster Technique. Not overwhelming evidence by any means, but all we have at this point. Yet it may be women's best bet in preventing malpositions and relieving pelvic pain.

The Webster Technique also has a variant that can be used with babies that are head-down but facing the wrong way (posterior). Although little formal data exists on this, anecdotally many women and midwives have reported this to be helpful for non-breech malpositions as well. Thus, it is quite likely that in many cases, pelvic misalignment is often accompanied by baby malposition of varying types, not just breech presentations, and treatment may help resolve such malpositions.

Anecdotal evidence also suggests that many women who have had past cesareans for non-progressive labor or "Cephalo-Pelvic Disproportion" (supposedly, baby too big or pelvis too small) actually may have had malpositioned babies. It's not that the baby was too big or the mom's pelvis too small, it's that the baby's position did not permit it to go through easily, causing it to get "stuck." These women (one of whom is Kmom!) often report that if they get regular chiropractic care in subsequent pregnancies, they frequently go on to have a Vaginal Birth After Cesarean because the baby malposition is prevented or is more easily resolved. They also regularly report that their pubic symphysis pain decreases significantly with treatment.

So although little concrete scientific data exists from mainstream studies (largely because it has not been studied), and although anecdotal evidence has to be treated with caution, women with misaligned pelvises often seem to experience pelvic pain/SPD, and possibly a higher rate of malpositioned babies. It seems logical (though unproven) that treatment to help re-align the pelvis may help lessen pelvic pain, and may also prevent or correct a fetal malposition.

Although not every women with SPD experiences a malpositioned baby, it does seem to be very common in this group. Since baby malpositions commonly lead to lots of interventions like epidurals and forceps that tend to worsen pubic pain and may even damage the pubic symphysis permanently, checking for misalignments and working carefully to avoid/treat baby malpositions may be important to avoiding long-term pain or permanent pubic symphysis damage. This is a fascinating area that is just beginning to be researched but has potentially far-reaching implications.

[Smoke Jaguar]

How interesting! Thanks for that.
I know I didn't have a malpositioned baby because the midwives said he was textbook positioned at my later appointments and we had no trouble birthing, but I would love to see some more study done on this for 'pelvis too small' syndrome and other presentations.

[~clover~]

That was interesting. Both of my last 2 were sideways going into labour.
They both had a shoulder at my back & one at my front.
The back pain was excritiating with DS.

I only had SPD with DS, but he was malpositioned.

[fionas]

Any more for any more?

[sweetpea678]

Hi,

Here is my answers to your quetiosns.

1. How far into your pregnancy did you get SPD? started getting hip pains around 24wks, though was not diganosed and didn't get to bad till 34 weeks.


2. Before the birth, how severe (1-10, one being the lowest, 10 being the highest) would you say your SPD was? eg. 1 being a bit niggly, 3 you needed a belt, 8, you needed crutches, 10 you were wheelchair-bound. 3 most of the time, and 4-5 at night would need to wake dh to turn me over help me out of bed etc to go to loo and hold walls to walk.

3. If you had a vaginal birth, how long was your pushing stage and in what position? Did you have forceps/vacuum? Birthed on bed in a semi reclined postion slightly on side with midwife just holding leg up at knee enough for bub to get threw. Durring transition etc, my dh would push my hips together with each contraction and that helped heaps. The pushing stage was 12 minutes. no forceps etc.


5. How severe was your SPD after the birth (using the same scale as before) and how long was it before you could bend, walk or stand relatively painlessly? instant pain relief and was walking etc with out support withing an hour. Have had a few days of niggle pain on and off since but nothing bad.

6. How did you manage your SPD eg. wearing a belt, regular clinical pilates etc. etc.? I wore a support band and had massages and physio. Kept walking to a minnimum.

hope this helps you out.

[bianca73]

Not sure if you are still after info, but this is my part:

1. How far into your pregnancy did you get SPD?
With my first I was diagnosed about 5 weeks prior to giving birth.
With my second I knew I was pregnant as my pelvis started to give away and I was on crutches from 6 weeks onwards

2. Before the birth, how severe (1-10, one being the lowest, 10 being the highest) would you say your SPD was? eg. 1 being a bit niggly, 3 you needed a belt, 8, you needed crutches, 10 you were wheelchair-bound.
With my first 8
With my second 9 - 10 (needed a wheelchair but refused as I had a toddler in house) I did however needed a wheelchair when going out or shopping centre (motorised scooter from centre)

3. If you had a vaginal birth, how long was your pushing stage and in what position? Did you have forceps/vacuum?

With my first complete from start (contractions) to finish (holding my son) 4,5 hours. I was lying on my side with nurse holding up my leg to where i was able to.
With my second complete from start to finish 3 hours. Also on my side with nurse holding leg. Borth my births were very easy with no complications, no interventions or medications


5. How severe was your SPD after the birth (using the same scale as before) and how long was it before you could bend, walk or stand relatively painlessly?
10 as I could not do anything like get my baby from lying on bed to into my arms.. (this is same bed as I was in)
It was at least 1 year and a couple of months before I was able to do things with not a great deal of pain

6. How did you manage your SPD eg. wearing a belt, regular clinical pilates etc. etc.?
Had crutches, belt, tubigrip, clinical pilates, physio, osteo. But I found that once money ran out for those and I had to stop seeing them, I started to feel a lot better and was able to ditch my crutches for most of the time. Still need it when going walking for short distance.

My youngest will be 2 in February

Good luck

[Smoke Jaguar]

Oooh, that bump is really timely!
I've just got back from my yoga class - I started classes again about 4 weeks ago and I can't wait for my osteo appointment next week. Why? So that I can see her face when she sees my range of movement and the evenness of my hips!
I was in NZ last week and it was only the day I returned (the Friday) that I realised I hadn't used my thigh pillow for...about 3 weeks...funny that! I hadn't used it and didn't notice I hadn't used it, whereas previously I would grab at it and impatiently put it into place to ease the pain.
I have felt so limber and active and haven't really had to monitor my movements (or control them carefully to avoid wide or uneven movements) because I'm more inherently balanced and centred. Granted, my core strength has been excellent for years through horse-riding, but the yoga practice has give me a very balanced feeling, as well as thoroughly more energetic. I think the SPD kind of got me seized up and now I"m more 'released'.
Anyway, I recommend yoga. As it's about balance, a lunge on one side will always be counterbalanced and you can take it as deep as you feel comfortable.
The trick is to make sure you find a class you like at a time that someone can take your child...this was the reason it took me so long to return to yoga...3 years!