Symphisis Pubis Dysfunction (SPD or PSD)

[fionas]

Unfortunately, this is not a science and no-one can give you a guarantee. I'm weighing up my options right now but will probably have an elective caesarean.

With DD the pain started at 28 weeks. Everyone told me it would go away after the birth. I wasn't careful, was in a lot of pain, was still standing to cook dinner every night for half an hour and worked up to 38 weeks. This was completely nuts but I thought it was just one of those things that I had to put up with. I saw a physio who advised a belt and icing, neither of which I was good at doing.

I had a vaginal birth with an epidural. The pushing phase lasted almost three hours with me instructed to hold my knees against my shoulders for that entire time.

I think that's the primary reason why it took 18 months to recover.

Yes, EIGHTEEN FRICKEN MONTHS.

So when obs/physios now tell me that the recovery is longer with a caesar, I tell them I don't know anyone who has taken eighteen months to recover from a caesar.

[Traveller]

I had a vaginal birth with an epidural. The pushing phase lasted almost three hours with me instructed to hold my knees against my shoulders for that entire time.

I think that's the primary reason why it took 18 months to recover.

Yes, EIGHTEEN FRICKEN MONTHS.

how horrendous for you, that is exactly the position you must avoid if you have SPD. Without an epidural your body would have been screaming at you to stop but with one you rely on your caregivers to consider your SPD when advising positions and in too many cases they don't think about your hips.

If it is any consolation almost the exact same thing happened to my friend (except she ended up with a c-section after the 2 hours of pushing which damaged her pelvis). She went on to birth twice more, both times vaginally, and by avoiding the pushing on her back with an epidural she recovered much faster from the births with no post birth physio required.

[fionas]

how horrendous for you, that is exactly the position you must avoid if you have SPD. Without an epidural your body would have been screaming at you to stop but with one you rely on your caregivers to consider your SPD when advising positions and in too many cases they don't think about your hips.

I know that now but unfortunately I didn't know that at the time!

Mayaness, it's great that you had good births but I did not have a great first birth. I had a very long prelabour with the first two nights rolling around alone on my concrete floor with very little sleep with a posterior baby (no, I had not discovered Spinning Baby) to be followed by hospital where a long labour ensued with an 8lbs 10oz baby. I don't care whether this baby is born via caesarean or vaginally. I just want the best outcome for my pelvis. Having to go through 18 months of post-natal pain almost cost me my relationship, resulted in me being housebound for much of that time and has now resulted in me moving to Woodend so that at least I can get used to driving and won't be housebound any more. In addition, I have spent almost $30K on getting my kitchen reconfigured to be more pelvis-friendly. That's how big an impact this has had on my life. I feel like a cripple and I'm not happy.

So, I don't trust my body. Why would I? It has let me down. If I try another vaginal birth and have a long recovery, I will feel incredibly dumb.

The Pelvic Instability Association recommends that you measure how far you can comfortably separate your legs and then advise your caregivers. At 17 weeks I can't even open my legs wide enough to put a pillow inbetween them at night without experiencing pain and after two minutes walking I need to sit down. I honestly don't see how a vaginal birth could possibly be good for my pelvis.

As I said before, this is not an exact science. Obs will tell you different things, physios will tell you different things. The only thing I care about is what my body and my mind are telling me and both are telling me not to do a vaginal birth because I've done it before and it's ended in absolute disaster.

And by the way, the two midwives that I've spoken to have told me to have a caesar.

[Smoke Jaguar]

Mate, I haven't had the easy ride with SPD - birth was the only good thing about pregnancy, and everyone in my circle knows it! DP wants me to have another baby and I've told him I'll need my very own quad bike for that to occur. He says quad bikes are too exxy, I tell him that living in hilly country, in order to do ANYTHING, I'm gonna need a mobility vehicle cos I won't be able to ride my horse to the post box...I won't be able to walk without pain to give my friggin horse a carrot at the gate!
Still, I'm big on second opinions after being told by physios (not just one) that cessation of breastfeeding was my answer...and it was not.
Glad you found the association useful, I've told all my caregivers about it and my midwife loves to have it on hand for her clients who have SPD.

[fionas]

I wasn't implying that you had BUT you said yourself that you had great births. How would you feel if birth wasn't great, it was terrible and infact you felt that it had led to being almost crippled afterwards? Would you be prepared to give vaginal birth another go or would you rather try something else? Especially if you had no particular desire to have a vaginal birth in the first place?

[Rigga]

Hey Fionas
You sound very much like me, My last midwives didnt even bother to take my spd seriously last birth, it was awful. My current physio has said if it hurts dont do it, so thats what im doing. Hope eveyones pain gets better soon
Andrea

[Smoke Jaguar]

I'm not sure what you want me to say, all I'm saying is that as a follow up to my OP, I got a second opinion and I'm glad I did. I'd already had my first birth by then, despite the hideous pregnancy I'd had. This time round I was armed with MUCH better information and caregivers who helped me achieve my goals. If your goal is to have a safe CS, then take your information with you
My responses aren't specific to any posters here - this kind of thread can be found by anyone, and there may be someone who finds it having been told CS is the only way, or cessation of BFing, or any other unfounded blanket prescriptions.
I'll fill you (general 'you') in on what happened after my OP. I posted a similar thread on the ABA forum and was directed to a clinic recommended by one of the members there. I never looked back. The twisting of my pelvis was awful and it took a while to correct it (it kept wanting to go back, because the surrounding muscles were 'trained' by then to brace in maladaptive bays). I took up yoga again and eventually fell pg again. This time the pain began a lot earlier and I got onto it with a new osteo who was just even more fantastic than the first osteo clinic I went to! She really knew her stuff about women's physiology and pregnancy physiology. So, I still had loosening and pain, but it was managed a lot better and whilst the pain would get to me, I knew that what I had been doing meant it wasn't as bad as it could otherwise be.
It's only just started to arc up again, 4 months post-partum, but I can put that down to some casual regard for my pelvis and getting overconfident, physically.
ANyway, that was the spirit of my responses here. SInce when, on BB, do we suggest taking caregiver's advice at face value??

[fionas]

Sorry if I sounded grumpy Mayaness - I just feel pressured to have a vaginal birth from my ob and some of my physios (I take pot luck on who I see at the same clinic so I've seen about five so far which I don't mind because as you say, it's good to have more than one opinion).

So I'm getting lots and lots of different opinions - the midwives I've spoken to have been in favour of a caesar and so has one of my physios.

I'm not finding the case for a vaginal birth compelling because my physios are just simply saying that it generally takes less time to recover from a vaginal birth. But I know that already. My point to them is that it took me 18 months last time to recover from a vaginal birth. I feel that they are generalising and the information they are giving me is not specific or reassuring.

So I've told my physios that if closer to the time there is a labouring position that I can hold without being in pain then yes, maybe I'll go for a vaginal birth. But, to me, it seems insane to try it IF I can't hold any position without being in pain because surely that would be further harming my pelvis - especially when it took three hours of pushing (after an already-long labour) then forceps to get DD out.

My most recent physio when I expressed my frustration about all the varying advice said that the above sounded very sensible and told me that yes, of course a vaginal birth is better for most women with SPD but my SPD is very severe and a vaginal birth could potentially harm it further, as it did last time. She recently saw a woman who'd just had her baby (she does visits to the hospital) who had it very bad the first time but had a caesarean the second time around and said that her pelvis was absolutely fantastic and she was stoked.

This is a huge issue for me because if it wasn't for the long recovery last time, this would be Baby No. 3 and basically if I'm going to try for No. 3, I really can't afford to be buggerising around waiting for nearly 3 years to TTC again. I don't mind my family size being limited by my fertility but I deeply resent it being limited by my stupid pelvis.

So, once again, sorry for sounding grumpy - part and parcel of SPD and generally feeling peed off with a housebound life.

[fionas]

My current physio has said if it hurts dont do it, so thats what im doing.

Andrea, you said it so much more simply than me! That's where I'm coming from too. If opening my legs causes immediate pain now and infact any position hurts immediately then I don't see how being in those positions in labour could possibly be good. Out of all the positions that my physio has recommended, I reckon there's only one that doesn't cause me immediate pain (propped on pillows leaning forward on me knees) now so will see whether I can still do that closer to labour but it ain't looking promising. All the others are no-gos. I laughed out loud when my physio suggested I lie down with my knees apart with someone supporting each leg. I told her, "mate, I can't even lift my knees up and apart without being in pain, so that ain't gonna work."

[Rigga]

I am literally housebound as well, because of my spd. I was informed yesterday by a male Dr that any womens spd is nothing but us getting it into our heads that we dont like pain. So with listening to his garbage about knowing more than physios and me was told to put up with the pain, even though at times its that bad i actually vomit. He pressed that hard yesterday on my pelvis i nearly passed out, and he laughed, hence after that I yelled at him to get out, had the ante natal manager running in to see what was wrong. She told him right off and said I wouldnt have to see him again. Arrogant, pompous ass. So they handed me over to a lady dr who was fantastic.
I know my limits and do what I can.
Andrea

[entreat]

I had/have that from about 15 weeks. Now I sleep on my side with a pillow between my knees to align my pelvis & the pain has been reduced by 90%, but goes back up again if I get lazy & want to sleep how I used to.

Fingers crossed that I can keep it at bay with exercises, stretching, & keeping my pelvis aligned.

[Smoke Jaguar]

I've had it through two pregnancies now, had fantastic births both times and having managed it so much better 2nd time round can't for the life of me see how a CS is going to make anything better. Pelvis is unstable in premature preparation for vaginal birth, it's not going to get much worse than carrying to term is and, as others say, there are positions you can use to protect the pelvis. I found all fours in water was ace. Squatting on land is the worst, anecdotally. Birth won't damage the pelvis if you're careful, as those ligaments have already pulled you out of alignment.
I recommend Osteo and gentle yoga.
Also, a must visit is to google the pelvic instability association - fantastic links and information
BTW, since my OP, I have discovered that it's not hormones still in my system - it's just mismanagement of the pelvic misalignment. My osteo and yoga kept me fairly even

[Rigga]

Thanks for the advice but I will be following the advice of dr and physio. The physio wont touch my pelvis as its damaged from the previous fall and it was left, so there is more than just spd. The physio thinks vaginal delivery will damage beyond repair. I wish everyone the best :-)

[Smoke Jaguar]

No worries, Rigga. I woukd definitely recommend a second opinion, though - it's a big decision to make based on just one physio-type caregiver. People get second opinions for knee surgery, why not for something with as large a knock-on effect as birth? Good luck