To help do that, your body produces an aptly named hormone called relaxin to allow the usually taut ligaments that connect the three bones of your pelvis to relax and make way for baby. While this added flexibility is quite useful during labor and delivery, it can cause pain during pregnancy, sometimes in the form of SPD, or Symphysis Pubis Dysfunction, also called Pelvic Girdle Pain. The good news is that while up to 25% of women experience some form of SPD during pregnancy, only about 7% have symptoms after giving birth. (To find out more about how to handle hurting hips, read this article.)
Symphysis Pubis Dysfunction occurs most commonly as a result of the hormonal and physical changes of pregnancy. With SPD, there is increased front and/or side-to-side movement of the symphysis pubis joint, which connects the two halves of the front pelvis, and causes pain with movement.
Read on for more info about SPD and how to alleviate the pain associated with it.
- Pain or ache in the pelvic area that may radiate to the lower back, hips, buttocks and even down the legs. Some women experience the most pain at the front of the pelvis where the joint meets. There may be pain and tenderness at the front of the pelvis when pressure is applied to that area.
- Increased pain with certain movements, such as getting out of bed or a car and other positions where one leg drops down in a scissor like movement. Walking and other weight-bearing activities can increase pain degree and cause a flare in symptoms.
Many women don't get an early diagnosis with this condition and suffer for months before seeing help. It's helpful to diagnose SPD as early as possible so appropriate treatment can be given. Many healthcare providers aren't aware of this condition or don't know that there are treatments, so it's important for women who suspect they may have this condition be proactive and ask for a referral to a physical therapist who is trained in treating SPD. Appropriate care should include a thorough exam to make sure that other conditions are not causing the symptoms.
Treatment for SPD can vary widely depending on a woman's degree of pain and disability. For some women, a pelvic support belt and pregnancy safe pain medication can decrease discomfort and enable them to continue with their daily activities. A course of physical therapy can provide exercises that can improve stability and therapy that reduces pain, and is strongly advised to help prevent increased disability and help speed postpartum recovery. Visit the American Physical Therapy Association website for information on physical therapists in your area who specialize in women's health.
Birthing Techniques for SPD
SPD sufferers aren't advised to have a cesarean section except in instances where the woman has extreme disability and restricted movement. In addition, caution should be used with pain medications during labor as the medications may mask the pain and allow a woman to strain the joint and increase the injury. It's important for women with SPD to make all caregivers in the birthing room aware of their condition and instruct them on safe birthing positions. Some literature recommends that women who have SPD birth in an upright position with knees slightly apart, not exceeding the degree where pain sets in. During labor, keep in mind:
- The birthing team should all be familiarized with the birthing modifications needed for a woman who has SPD.
- Avoid allowing legs to part to the degree where it is painful.
- Caregivers should assist in moving the legs. Move the legs by holding them together and at the same level.
- If pain medication or an epidural is given, special care is needed to avoid injury to the joint with movement and during pushing, as the patient may not have a pain response.
- Rest when needed. Don't push to the point of pain.
- Avoid lifting and carrying any heavy objects.
- If possible sit instead of stand when doing tasks.
- Tighten your tummy and do a Kegel contraction and hold when making any movements that normally cause pain.
- Don't step up and over objects--especially baby gates. Avoid any scissor type or straddling movements or with your legs.
- When bending, rolling over in bed or rising from any position, move as if your legs are attached at the knees so they move in tandem.
- When lying down place a pillow between your legs to help keep your pelvis level.
- Avoid any motions that cause you to twist at your waist or put pressure on your pelvis.
- The use of crutches or a rolling walker can help to take weight off your pelvis and is sometimes needed in more severe cases of SPD. In very severe cases a wheelchair may be required for mobility.
Cathy Cram, M.S., is a BabyFit Resident Maternal Fitness Expert.