Symphisis Pubis Dysfunction (SPD or PSD)

Hi girls,
Hopefully none of you have a clue what I'm talking about, but in case you do, I have a word of warning.
I was informed by the midwives and the literature that the SPD would clear up after the baby was born. Indeed, I didn't think about it for ages...until a couple of months later when I felt a familiar 'tugging' feeling. Admittedly, it did not feel any way as painful as before Oscar was born, but I knew exactly what it was when I felt it.
I've been to the hospital physios and it turns out that it's not just 'left over' relaxin, it would appear that the relaxin will be in my body until I stop breastfeeding. I will follow this up and hopefully have an update for you down the track, but I just wanted to let any sufferers know that if it comes back, don't be too dismayed. Perhaps the literature is based on women who had it in pregnancy who went on to wean early, or FF from day one. Who knows?
It's just something I'm going to have to learn to manage because I'm in this breastfeeding lark for the long haul. I have to take a lot more care of my pelvic area whilst horseriding and doing yoga, but it's a small price to pay to get my activity levels back up and to get back on my horse.
Watch this space!

Yep :) And AF makes it worse too. I recently suffered a herniated disc that is a result of SPD, hormones and an old back injury. My SPD is still with me no way near as bad as it was during pregnancy but it is definitely still causing me grief. I am on a strict exercise program and have some oh crap what's it called rubber tubing to do stretches etc. See my physio ever week to fortnight and its not fun. Some days are better than others but its definitely a struggle when it is bad. And as a result I think my brain has programmed me to not sleep because I have become a severe insomniac lately I think my body is afraid of my bed as it hurts to sleep and I wake up quite sore and stiff in the morning.

I think this is often too readily diagnosed and then when it comes to people like yourself and me who have it severely there isn't really enough useful information. Its not just a saw pelvis its quite debilitating.

Anyway I feel your pain unfortunately.

But my phsyio (whom I saw this evening, she's also highly trained in SPD) told me when I first saw her how disgusted she was that I never had follow up care. She said it probably would have saved me alot of discomfort in my last pregnancy had I been given an exercise program.

Goodluck!

*hugs*
Cailin

It was really interesting to read this as I was just told by a friend to watch out for this due to some pelvic pain I've been having. Haven't done any research on it yet but what were your symptoms, how did you deal with it.

Thanks

I had phsyio nearly every week, to every couple of weeks and I was taped up when it first started playing up, and by playing up I couldn't move LOL! Then after it settled I was given a brace to wear. It was just a matter of realising my limits, knowing I couldn't walk for 20 mins sometimes less without being sore later. Knowing that I had to try and keep my pelvis symetrical at all times otherwise it would click (and that would KILL). I had to watch how I sat, how I slept. It was a PITB but in all honesty after all I went through to get pregnant with Seth I didn't mind that much... The hardest thing for me was not being able to do housework, no vaccumng, mopping etc and getting in and out of the shower (as we have a shower over a tub). I tried to avoid stairs where I could and sex was interesting LOL had to be very careful LOL! In my first pregnancy I did hardly anything because I didn't have a child to run around after and I had people to drive me around. But this time even though I did have MIL to help out when it got really bad I still had to take Paris to Kinder and do all the usual mum stuff. I did notice it came about earlier in the second pregnancy than it did in the first too. The biggest sign of SPD is the clicking, along with the pain I would get aching, but as well as aching a shooting pain (almost felt as though it was in my vagina) and it would come from my legs sometimes too.

If you do end up with SPD I highly recommend seeing a physio that specialises in pregnancy and or SPD.

Goodluck!

ETA: sorry for this being a bit mumble jumble its late and my brain is starting to shut down ;)

*hugs*
Cailin

Thanks, that sounds aweful! My pain is nowhere near that bad thank goodness. I think mine must just be round ligament pain but my friend suggested SPD as it hurts to seperate my legs and the pain comes from the outside to the middle. Do you see your OB or just a GP to rule it out.

I'd say a physio to be honest. It sounds like it could be the start of it. That is how mine started. But I was told I had it quite severe not everyone has it so bad they need a brace etc. Your ob would be able to advise of a physio that works with SPD.

Goodluck :)

*hugs*
Cailin

A question related to something I posted earlier.... It seems I may have SPD, by reading online and a bit of self diagnosing.....

Taken from my other post, " I am extremely sore in my pubic area, it feels very swollen and bruised and hurts especially when i get up from lying down or a sitting position to the point where I can't walk!! Around my groin is fine and I have no pain in my hips... just the front bit!! "

I wanted to find out from those who had given birth with this condition how they went on in Labour and how they dealt with the pain... is it just going to get worse and if so, what can i do about it!! Bit worried here because its so painful and I want to have an active birth and move around as much as I can!!

Thanks
L

Hi ladies, just a very quick post to say there are a few us on here at the moment with SPD - both ante and post natally. Mayaness, like you I was utterly dismayed when the condition recurred 3 months after baby was born (I expected it to resolve itself, based on my reading). I"m now seeing a physio each week who has me doing pelvic and abdominal exercises daily to strengthen all my muscles, to hold the bones in the correct place so the ligaments can finally tighten like they are supposed to. Other ladies have had success with clinical pilates.

Sorry, Leeloo, can't help you with the active birth advice, I had a CSection this time round.

If you google the Pelvic Instability Association you will find plenty of useful information there.

I had this with my last pregnancy and ended up in hospital and brace and crutches.
It never really went away after bub was born although it was better than it had been.
This time it arrived earlier and luckily the midwife/dr sent me to the physio early, after over an hour with him, he seem to think it started after a fall I had in my last pregnancy that the drs didnt follow up as bub was fine. So this time at 19 weeks I am already in a tube thing from bottom of belly to bottom of breasts, a brace and crutches with the advice to get a c section so I dont damage my pelvis anymore. As its really quite unstable and out of alignment by a lot.
Physio said 12 weeks after bub is born we try and start to make it better. Im hoping he can do something, its so painful and sex is just a no go:doh:

I had SPD badly with DS2 and severely to the point on needing crutches and occasionally a wheelchair with the twins. When it came to giving birth there was no extra pain, and in fact birth is often easier with SPD as your pelvis is already open a bit.

The only word of warning is try to avoid an epidural as this will rob you of your pelvic sensation. The pain you currently have is a warning system to go no further, so without that you may open your legs too wide (or have them hoisted into stirrups by a midwife) thereby damaging your pelvis on a much more serious basis.

Giving birth on all fours or in a pool is generally a good way to do it with SPD.

Good luck!

T
xx

Rigga - I had diastasis of the symphisis pubis with my 3rd pregnancy. DD3 was born vaginally with only the gas. I was wheelchair bound for the final month of pregnancy. If anything the separation made a vaginal birth quicker and easier. I was advised by my Ob (there are stacks of threads around about it) that she would not recommend a CS, but that if my pain increased during labour she would take me in for an emergency CS. I would recommend you do a lot of research prior to arranging a CS because the recovery from a CS is worse than I have found the recovery from the diastasis. I was walking (very gingerly) 3 days after she was born. With a CS they will not discharge you until you can walk around, and it will be harder for you to walk around with the combined pain.

I do know you pain, I was on panadiene forte for months, so believe me when I say that you may be able to have this baby vaginally. It may also help to align your pelvis having even pressure on it. Do avoid drugs, and if your pelvic pain increases in labour tell your caregivers.

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.

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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.

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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.

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 :)

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 :-)

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 :)

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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.

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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.

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.

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?

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

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?? ;)

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.

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.

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

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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."

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

That's terrible Andrea. Do they truly think we make this up?

Luckily this time around I'm not in too much pain but that's only because I really do know my limits and limit myself accordingly by not walking which has meant I had to stop working at 15 weeks because it takes me 50 minutes of walking to and from train stations to get there. Plus, I wear my support belt, ice three times a day and go to clinical pilates once or twice a week. My life currently revolves around managing my pelvis. So I'm sure when people see me walking around the house quite well they think I'm putting it on when I tell them that I can't walk for more than five minutes. Yes, physically I can but I can feel my body seizing up and if I keep on doing that then I won't be able to walk at all, not even around the house which is my worst nightmare. My physio warned me at 7 weeks that it was already pretty bad and I was looking at a wheelchair scenario. So I'm doing absolutely everything I can to avoid it - which includes looking at all possible birthing scenarios.

I was really sceptical but I've found icing is really good. They say if your pain gets really bad (like yours) you need to ice every two hours for 20 minutes each time. I know it's hard to do logistically but I reckon give that a go. I did barely any icing first time around because I didn't think it was doing any good but I think it's just that I didn't do it often enough. If you give the icing a red hot go for a day, it should help the pelvis settle down and become easier to manage and from there you can reduce the icing down to a few times a day or just once a day. Plus lie rather than sit as much as possible. My physio reckons sitting actually doesn't rest the pelvis because it's still working.

I'm really sorry that you had such appalling treatment from the doctor. Totally sucks.

Thanks I will try the icing. I usually lay as my chair reclines, its so much more comfy.
I am glad not all drs are as simple mnded as the idiot yesterday :rolleyes:

I wouldn't say to start anything new right now, and never do anything that hurts. But I would get yourself properly checked. Don't self diagnose! I did, and I wasted a whole month telling myself that I had SPD when in fact I had SI joint disfunction. I was in a world of pain and I could have been treating my actual problem much sooner.

Jo

What Lenny said!

Go to your Dr & get a referral to an osteopath.

My SPD is fairly low key now (a massive fall on my butt thanks to my horse knocking me down re-aligned everything... not recommended - but it worked!), but I find it does feel worse after BodyVive class, or any exercise that has you doing one-sided, leg spreading exercises. There are many parts in Yoga (BodyBalance) that I have to modify so I'm not encouraging further separation. But having said that - I do that class around 4 times a week now, & my pelvis feels stronger for it. However, I think my sacrum has opened a bit which I am attributing to the yoga.

If you do maintain classes, don't try to push yourself to your pre-pg abilities. And if you do moves that require leg separation, don't go as wide as any one else in the class. I can usually feel my pubic symphysis pull & open when I go too far.

Oh - And ALWAYS let the instructor know that you are pg & you have an unstable pelvis!

ahh - yes, they should know you're pg! ;)

Any of the standing strength poses (lunges / warrior poses) can open the pelvis lop-sidedly. Even balance poses (one legged poses) can be difficult.

Talk about it with the MW & the instructors at the classes. See if they think it's worth continuing with the yoga (with some modifications), or whether you should be doing only Aqua for the time being. Best of luck!