SPD

Self-help tips

  • Avoid pushing through any pain. If something hurts, if possible don’t do it. If this type of pain is allowed to flare up, it can take a long time to settle back down again.
  • Move little and often. You may not feel the effects of what you are doing until later in the day or after you have gone to bed.
  • Avoid heavy lifting or pushing (supermarket trolleys can be particularly painful).
  • When dressing, sit down to put on clothing such as your knickers or trousers. Pull the clothing over your feet and then stand up to pull them up. Don’t try to put your legs into trousers, skirts or knickers whilst standing up.
  • When climbing stairs, go up them one step at a time. Step up onto one step with your best leg and then bring your other leg to meet it. Repeat with each step.
  • Avoid swimming breaststroke if you can and take care with other strokes. Swimming can often feel like it is helping whilst you are in the water but cause an increase in pain when you get out.
  • Performing regular pelvic floor exercises and lower abdominal exercises can help to reduce the strain of the pregnancy on your pelvis. To perform a safe and easy lower abdominal exercise, get down onto your hands and knees and level your back so that it is roughly flat. Breathe in and then as you breathe out, perform a pelvic floor exercise and at the same time pull your belly button in and up. Hold this contraction for 5-10 seconds without holding your breath and without moving your back. Relax the muscles slowly at the end of the exercise.
  • You can get in touch with other women in your situation by contacting The Pelvic Partnership, a charity which was set up to offer support to women with SPD. The National Childbirth Trust also offers information and support to women with a range of pelvic dysfunctions.
  • Avoid twisting movements.
  • Take paracetomol (suitable for use in pregnancy).
  • Physiotherapy may help.
  • Osteopathy may help.
  • Chiropractic may help.
  • Cut down on stimulants e.g. nicotine and caffeine as they aggravate pain.
  • Polarity Therapy – Elizabeth Noble, a physical therapist and birth activist, wrote about pubic pain a bit in her book, Essential Exercises for the Childbearing Year. She describes polarity therapy for pubic symphysis pain this way: Lying on your side, a partner places all five finger tips firmly at the union of your pubic bones, and the other hand rests flat on your sacrum. The hands should remain still on these two points until warmth, tingling, vibration, pulsing or other evidence of your body’s electric field can be felt equally in your partner’s both hands. Usually only one to two treatments is necessary. I have successfully used polarity balancing to treat painful PS laxity for fifteen years.
  • TENS – Some women report that TENS (Transcutaneous Electronic Nerve Stimulation) has helped improve their pain.
  • Pressure points – One mother with SPD reported that using pressure points seemed to improve her pain levels. Here is what she wrote about it: ” If you can’t [see a chiropractor], I will tell you of an exercise you can do at home to help relieve some of the pain yourself! First, I know you are going to say, ‘Yeah, right, you’ve got to be kidding’ but you have pressure points right on the top, corners and sides of your pubic symphysis bone [the pelvis]. Basically, lie down flat on your back (or as close to it as you can get!) and wherever you are feeling pain, take your fingers or thumbs and press on those point for about 10-20 second at each point and do this once or twice a day. It will hurt like hell at first but it will actually feel a lot better once you do it. It’s even better if you can get someone else like your husband to do it because they will exert a little more pressure than you will let yourself do! Just grin and bear the pain and I promise you that the pain will subside somewhat – maybe not all the way, but it worked wonders for me! “
  • Movement/strengthening therapies – Several women have reported that movement and strengthening therapies like the Alexander Technique and Pilates have helped them postpartum. The Alexander Technique is supposed to help retrain you into more efficient and better muscle usage. Pilates is supposed to work on strengthening the core muscle areas (abs, back, etc.). However, some women report that Pilates actually worsened their back pain in the long run.
  • Acupuncture – Acupuncture has also been reported to help pain levels. It does not resolve pelvic misalignment, but it has been used successfully to treat many different types of pain. Some acupuncturists are reluctant to work with pregnant women; seek someone who is very well-trained and experienced in working with pregnant women, even if you are postpartum.
  • Homeopathy – Some women report improvement in pain with the use of the homeopathic remedy, Kali Carb, 30c. However, homeopathy is very much based on an individual’s personal circumstances, personality, and needs, and you would need an individual consultation to know what remedy would work best for you.
  • Herbs – Herbalist Susan Weed recommends Teasel tincture, which is for “internal tears that are hard to get at,” and comfrey infusion (the other name for Comfrey is Knit Bone).
  • Pelvic support – A maternity support belt can offer extra support and firm pressure, which many women seem to find helpful. However, please note that if the pelvic bones are not in the ‘right place’, some women find that a maternity support belt can make the pain worse. One physical therapist atpregnancytoday.com wrote: If the pelvic ring, which includes your pubic bones and sacroiliac joints, is not lined up symmetrically, using the reenie belt will just increase the pain. This is because it serves to compress the front and back joints of the pelvis which are out of position…I recommend…a physical therapist in your area that specializes in treating pregnant women. The therapist can evaluate your problem carefully, and, if need be, provide hands-on treatment to restore normal joint alignment. Once you achieve that, the reenie belt can do its job of keeping the pelvis in alignment and will not be painful.
  • Use a pillow between your legs when sleeping; body pillows are a great investment!
  • Use a pillow under your ‘bump’ (pregnancy tummy) when sleeping.
  • Keep your legs and hips as parallel/symmetrical as possible when moving or turning in bed.
  • Some women also find it helpful to have their partners stabilize their hips and hold them ‘together’ when rolling over in bed or otherwise adjusting position.
  • Some women report a waterbed mattress to be helpful.
  • Silk/satin sheets and nighties may make it easier to turn over in bed.
  • Deep water aerobics or deep water running may be helpful as well (there are flotation devices to help you stay afloat easily during this; you do not need to know how to swim in order to do this).
  • Keep your legs close together and move symmetrically (other sources recommend a very small gap between the legs with symmetrical movement).
  • When standing, stand symmetrically, with your weight evenly distributed through both legs.
  • Sit down to get dressed, especially when putting on underwear or pants.
  • Avoid ‘straddle’ movements.
  • Swing your legs together as a unit when getting in and out of cars; use plastics or something smooth and slippery (like a black bin liner) on the car seat to help you enter car backwards and then turn your legs as a unit.
  • An ice pack may feel soothing and help reduce inflammation in the pubic area; painkillers may also help.
  • Move slowly and without sudden movements.
  • If sex is uncomfortable for you, use lots of pillows under your knees, or try other positions.
  • If bending over to pick up objects is difficult, there are devices available that can help with this.
  • Sciatica may be helped by stretching the hamstring muscles with a stirrup around your foot (long piece of rope, two neck ties tied together, etc.)
  • Back pain can often be helped by resting backwards over a large gymnastic or ‘birth’ ball.
  • Other tips include pelvic rocks, a lumbar pillow against the back when sitting, and very strong massage/counter pressure against the lower back. Pelvic rocks (getting on all fours and then slowly tilting the angle of the pelvis back and forth) are general recommended exercises for all pregnant women, plus they help promote good birth positions for baby. They can also help ease tight low back muscles. It is usually recommended to do 2-3 sets of 40 of these throughout the day. You can also do them sitting or standing against a wall, but on all fours is often most comfortable and has the added effect of helping the baby’s position, which may be important with SPD.
  • Lumbar pillows are very helpful to many pregnant women. If you cannot find one, try a small neck pillow (elongated like a tube), rolled up towel, or tube sock filled with rice or flax seeds. Put it behind your back when sitting, wherever it feels best; for some women this is down low in the small of the back, for some it is even lower against the sacrum, and for others it feels best up high in the middle of the back. Socks or pillows filled with rice or flax have the advantage of being able to be warmed in the microwave before using, which can feel really nice!
  • Massage of the lower back or strong counter pressure in that area feels really great to some women. Some women like it just to the sides of their spine (helps loosen the muscles there), and some like it really low and farther out (there are trigger points there). Others like it all up and down on either side of the spine. See what feels best to you and go from there. If your partner’s hands get tired (this is a tough place to massage!), try a rolling pin, tennis ball, or other hard object there. For women who like extra hard pressure on this spot, try getting on your hands and knees and arch your back a bit, then have your partner put his elbow against the area that feels best, lean his weight on it, and rub around in small circles. For others who like more gentle pressure, hand or finger pressure may be more than enough.


Planning for birth

Certain common obstetric interventions tend to make Symphysis Pubic Dysfunction pain worse, and may even lead to ligament damage or severe separation of the joint, causing true Diastasis Symphysis Pubis. Therefore, it is vitally important that your doctor or midwife understand and believe in the existence of SPD and realize its implications for birth. The following ideas (taken from a number of sources) are supposed to help maximize your comfort and help the normal birth process, while also minimizing the risk for pubic symphysis-related trauma.

Be extremely careful of birth positioning. Certain positions are better than others. Avoid stirrups!

  • Don’t give birth on your back – Many cases of pubic symphysis injury occur in this position.
  • Don’t give birth semi-sitting – this tends to force the baby’s head against the pubic symphysis, putting pressure on it to ‘give’ more. It also prevents the coccyx/tailbone and sacrum from moving out of the way during birth, and thus the only joint available with any ‘give’ to it would be the pubic symphysis, which puts it at greater risk for damage.
  • Use ‘alternative’ birth positions – these include standing, kneeling, and all fours in particular. Some doctors will ‘permit’ women to use alternative positions until just before baby’s head crowns, but often want the woman back in the traditional stirrups or semi-sitting position for crowning of the head and delivery of the shoulders. However, crowning and birth of the shoulders is the most critical time for prevent pubic symphysis damage, so really look for a doctor or midwife that is willing to ‘let’ a woman be in whatever position feels best to her for birth. If you must be in a more ‘traditional’ position because of other concerns, try side-lying as this takes the pressure off of the pubic symphysis and allows the coccyx and sacrum to move somewhat. Otherwise, all-fours or leaning back over a birth ball may be best.
  • Listen to your body – your body usually will tell you what position you need to take in order to help baby out while avoiding damage to your joint. For example, sitting forward in a “C” is the position promoted in most hospitals, but arching the back can be most helpful. This helps baby move under the pubic arch and be born rapidly, while in the traditional “C” semi-sitting position, there was no descent of the baby and great pain instead. Other women with pubic pain have reported that arching the back during pushing was helpful too. Use the position your body tells you to!
  • Be sure your midwife knows all about SPD, what movements can hurt or damage you, and what your comfortable range of motion is: work with a midwife that takes SPD seriously – many do not really believe that SPD really exists or that it is a serious concern for birth. If they do not really understand the concerns of SPD, they will not be as careful at the birth.
  • Work with a midwife that rarely uses interventions like stirrups, forceps, etc. – If these interventions are not part of your midwife’s normal procedures, chances are good that you’ll avoid them. If your midwife often uses these procedures, chances are they will have a hard time avoiding them, even when they know that they need to be avoided.
  • Consider giving birth in a non-hospital facility or at home – This might help lessen chances of damaging interventions, since stirrups, forceps, and other routine interventions are done less in these settings.
  • Educate your midwife and other helpers about SPD – raise the awareness of SPD problems so they can help you avoid problems during the birth. Be sure to especially discuss with them the importance of a ‘narrow gap’, avoiding interventions whenever possible, and how to avoid placing extra strain on the pubic symphysis area.
  • Avoid most common labour interventions, as these often cause pubic symphysis strain/damage. i.e.void the use of forceps or vacuum extractor – these may necessitate opening the legs wider than the pubic symphysis can safely tolerate.
  • Don’t pull your knees back too far – this puts a great deal of strain on the pubic symphysis joint. Be sure to let your midwife know not to do this!
  • Don’t put your legs on your helper’s hips – again, this strains the pubic symphysis joint.
  • Minimize or avoid vaginal exams – positions for vaginal exams tend to strain the pubic symphysis joint. Do as few vaginal exams as possible (most are not necessary anyhow) so there is less frequent strain, and use as small a leg gap as possible if a vaginal exam must be done.
  • Avoid an induction if possible – induction contractions are often abnormally strong and difficult to handle without an epidural to help, and this increases your chances of other harmful interventions.
  • Avoid breaking the waters early – since malpositions may be more common with SPD, it is probably sensible to avoid breaking the waters artificially during labour. If baby is malpositioned and the waters are broken, then baby often moves down in that malposition, cannot turn, and gets ‘stuck’, necessitating a c-section. If labor stalls around 4-7 cm or so in a woman with SPD, then baby malposition should be suspected, breaking the waters avoided, and changing maternal posture utilized to help baby turn.
  • Avoid an epidural if at all possible, as this often is associated with more severe damage:
  • Avoid an epidural so you can tell if damage is imminent – once your feelings are deadened, you may not be able to tell if they force your legs too strongly, and this is when many tears or severe separations occur.
  • Avoid an epidural to lower the chances for forceps, vacuum extractor, and stirrups – stirrups are standard procedure in many hospitals with epidurals, and stirrups increase the chances of damage. In addition, one side-effect of epidurals is to strongly increase your chances of needing forceps or vacuum extractor during pushing, which also necessitate a wider leg position and increase the chance for pubic symphysis damage. 
  • Use a ‘narrow gap’ position between the legs for any routine procedures that can’t be avoided: use a string to measure ahead of time the widest comfortable position for your legs – have your midwife use that in labour to remind helpers of the widest position that is wise.
  • Use a ‘narrow gap’ only – if vaginal exams is truly necessary or if any stitching is needed afterwards, be sure to remind helpers to use a ‘narrow gap’ only. 
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