Symphysis Pubis Dysfunction (SPD)
What is the common condition that makes standing on one leg or climbing stairs unbearable for some pregnant women? Christine Hill examines.
What is Symphysis Pubis Dysfunction?
The symphysis pubis is the name given to where two bones meet at the front of the pelvis. The pelvic bone is roughly in the shape of a heart, and is actually formed by three bones, which are held together by very strong ligaments.
The bones meet to form three 'fixed' joints - at the front (the symphysis pubis) and at each side of the bottom of the spine (the sacro-iliac joints).
Normally, these joints are not designed to allow movement. However, when a woman becomes pregnant, a hormone called relaxin is produced which loosens all the pelvic ligaments in order to allow the pelvis slight movement at the time of birth.
For some reason, the ligaments occasionally loosen too much and too early before birth. This means they can't keep the pelvic joints stable so the pelvis moves, especially on weight bearing. All this is made worse by the increased weight of the growing baby and sometimes the symphysis pubis joint actually separates slightly. The result is mild to severe pain, usually in the pubic area, and is called SPD.
What are the symptoms?
The most common is pain and difficulty when walking. Some women describe the feeling of their pelvis coming apart. The pain is made worse when turning in bed or doing something that involves standing on one leg, such as climbing up stairs, getting dressed and getting in and out of a car.
The pain is generally felt in the pubis and/or the sacro-iliac joints, but can also be experienced in the groin, the inner side of the thighs, the hips and in one or both buttocks.
When is it most likely to start?
At any time from the first trimester onwards. Some women can be fine during their pregnancy, but get the condition a few days after their baby has been born.SPD sometimes occurs following a period of immobility, an unusually busy overactive period or a particular activity such as swimming breaststroke or lifting something incorrectly.
Is there any treatment?
Unfortunately there is no way of tightening the ligaments again during pregnancy, so no treatment will be able to cure SPD. This includes any sort of osteopathy, reflexology or acupuncture. However, after the birth the body stops producing the hormone, so the ligaments tighten up and (for the majority of women) the symptoms gradually disappear.
So what can be done?
The most important thing is to avoid doing anything that aggravates the condition, such as standing on one leg. Sit on a chair to get dressed. Be very careful to get into a car by putting your bottom on the seat first, and then lifting your legs into the car. When you get out, lift your legs onto the pavement and then lift your bottom off the seat.If you go swimming, don't swim breaststroke.
Always turn over in bed with your knees firmly together.Make sure you get a rest (in bed) every day. If you already have a child, you will need help, as you will find it difficult to lift him or her. If the pain is severe, ask your GP for a referral to a physiotherapist, ideally one who has specialist training in obstetrics and is called a Physiotherapist in Woman?s Health. She or he will be able to assess you and may fit you with a pelvic support belt, which helps to stabilise the pelvis. Your GP will also be able to prescribe painkillers that are safe to take in pregnancy.
During labour and delivery
It's not really possible to decide in advance what position you will deliver in, because it all depends on how your labour goes and what you find comfortable at the time, but it is useful to have a few ideas. The most important thing is that the doctor or midwife who is delivering you knows you have SPD.
You will need to keep separation of your legs to a minimum - which is the tricky bit during delivery. If everything goes smoothly and you don't need an epidural, you might find it comfortable to deliver on all fours, kneel up against the back of the bed or lie on your side with your upper leg supported.
If you push in a sitting position during the second stage, do NOT let your feet be placed on your attendants' hips.
If you need an epidural, remember it will mask the warning pain of SPD as well as the contractions and the above is even more important.
If by any chance you need an assisted delivery, which requires you to have your legs in stirrups (lithotomy position), it is vital that your partner reminds your midwives that you have SPD. They will be very careful to lift your legs up together symmetrically. The same applies if you need stitches after your baby has been born.
Most women recover spontaneously soon after birth, but you will need to rest (as much as possible) and avoid doing anything that provokes the pain.