Pelvic Pain in Pregnancy: Help for Symphysis Pubis Dysfunction (SPD)

pregnant_mama

I was 24 weeks pregnant with my oldest son (I’ll refer to this as PG1) when I woke up one morning and felt like someone had kicked me between my legs. I felt bruised from the inside and outside. It was painful to walk but also painful to lay down on my side. I made an appointment with my OB practice and I was diagnosed with diastasis of the pubic symphysis, a more extreme version of the symphysis pubis dysfunction (SPD) that many women experience late in pregnancy.

Diastasis symphysis pubis (DSP) is such an extreme separation of pubic bones that they are considered dislocated.  For simplicity, I am going to refer to all of these as SPD in this post, but for the record: SPD can also be referred to as pelvic girdle pain (or PGP), pubic symphysis pain, and a few other names that may refer to the same specific issue or some broader ones, like pelvic instability, which may also refer to issues with the sacroiliac joint (naturally, when the front of your pelvis spreads the rear pelvic joint is impacted, too).

The pelvis naturally widens during pregnancy, especially in late pregnancy, to accommodate for delivery. This increased pelvic girth and flexibility is part of a woman’s amazing ability to birth a baby. But for me, it happened too much and too soon. The obstetrician (OB) I met with at the time told me that my diastasis was the most extreme case he’d seen in over twenty years of practice, but there was nothing to be done, save for taking pain medication and making some small comfort measures.

Getting a second OB opinion didn’t yield me any additional hope. From a physiological standpoint, the doctors were correct— the gap wasn’t going to close itself during pregnancy. But, there is more to health and healing than mainstream western medicine’s focus on medication, surgery, or bust. For my next pregnancy, where SPD became intensely painful at just 20 weeks, I knew better and utilized many strategies to make the pregnancy considerably healthier and happier. So, here’s what I know now through two pregnancies and four years* of pelvic instability.

Location of the pubic symphysis
Location of the pubic symphysis

*Something like 93% of people who have SP loosening during pregnancy heal quickly and easily after delivery. I am one of the 7% who didn’t.

DISCLAIMER: This post is based on my lay-person’s understanding and my personal experience. It should not be construed as medical advice. Please consult medical professionals about your particular course of action.

Pursue Healing Help
Chiropractic care is something that entered my life only after PG1 when I didn’t get better. For whatever reason, I was afraid of chiropractic care, didn’t believe it could be beneficial, and couldn’t comprehend paying out-of-pocket for it. When I finally reaped the benefit of chiro care (post-partum PG1 and then throughout PG2), I shed many tears that I didn’t recognize as an option before things got so bad. I was very angry that the OBs I’d consulted hadn’t recommended this (or even an adjustment with a physical therapist). I was distraught to remember that I actually had booked a chiro visit late in PG1 out of desperation and then chickened out. I so wish that I’d been more open minded! Here’s what I now understand:

  • Chiropractic care from a practitioner who specializes in pregnancy is safe, gentle, and highly effective. Ask questions ahead of time to gauge how much experience a practitioner has with pregnancy-related care.
  • If the chiro is certified in the Webster Technique, that is a good sign that they have put in extra time in the area of pregnancy care (but you don’t have to rule out someone just because they don’t.)
  • A chiro can actually put things back in place. Even if the ligaments don’t hold for long, it provides some relief. I saw a chiro though all of PG2 and it made a HUGE difference. I would feel some relief right after the adjustment, then increased soreness (like how muscles feel after a good workout), and then 1.5 days after the adjustment I would feel amazing. Not all adjustments took. Sometimes my body was just too loose and one of my ilia would torque right away. But, it did work most visits. I went one time per month early in the PG and moved to one time per week at the end.
  • If you try one chiropractor and it isn’t a fit, try another. The first guy I went to was clueless about pregnancy and asked it was healthy for me to lose five pounds in a week at five weeks post-partum. That was my clue to cancel my follow-up appointment.
  • If your insurance doesn’t cover alternative treatments or doesn’t have a chiro who specializes in pregnancy, don’t rule out paying out-of-pocket. The cost may not actually be much higher than a copay. Budgets and costs vary, but if $50 meant the difference between pain and relief, wouldn’t that be worth skipping a dinner date or getting a used stroller instead of a new one to allow you to function for the next several weeks or months?
  • When it comes to professionals, get a second, third, even fourth opinion. Chronic pain can make you very angry. You have the right to be angry, sad, and depressed and you also have the right to a caregiver who can help you. Even if you’ve never done anything but mainstream Western medicine, give something else a try: chiropractic, acupuncture, working with herbs and vitamins to help your body (Vitamin D, magnesium, and fish oil are all helpful when facing inflammation). You have everything to gain!

Activity
For me, being active was good my overall body, health, weight, etc. It was tough to find the balance of gentle activity vs. pain, but every woman’s body will give her different cues on where the line falls.

  • In PG1, I lived in relentless chronic pain until delivery. Although every, single step was a challenge, I chose to walk, work, etc. until baby was born at 40+ weeks. Walking was painful, but sitting or laying for too long also caused pain. So, it was mentally healthier for me to keep moving around and stay busy.
  • In pelvic physical therapy (PT) between my pregnancies, I learned that though the pain can be intense with activity, it doesn’t cause damage to my body unless I over-spread my legs (like with getting in and out of the car or bed and climbing things taller than stairs). In pregnancy 1, I was afraid of hurting my body through too much movement. With pregnancy 2, I felt empowered to stay active—and even grow in strength— knowing that movement was only good for me.
  • Exercise comes into play with pelvic stability. Strong muscles in the thighs, stomach, and pelvis all help to hold the ligaments in place. Walking is nature’s perfect exercise. Hold your abs in (like a string in pulling your belly button in) as much as possible when walking to support the lower back, also, practice kegels while walking. This will help keep things strong down there.
  • Swimming and soaking in the tub also feel great. Swimming and water walking is not advisable for all people with this, so talk to a professional and listen to your body. The resistance of the water can be too much for some people. In that case, my PT suggested treading water using the arms and not the legs for exercise. The flip-side is that swimming is incredible for strengthening the body. In my second pregnancy swimming was like magic. I stuck to flutter kicks (versus froggy-legs which spread the legs) and water-walking and it made a huge difference.
  • The action of pushing, like with a stroller or heavy grocery cart, can make SPD pain intensify. If your children will be closely spaced, consider babywearing. I am an avid babywearer, so my muscles were strong enough to continue wearing my older son through PG2, which actually was easier on my body than holding him. I wore my older son until a few days before the birth, which served as weight-bearing exercise to keep me strong (and had other benefits).

Sleeping:

  • PG1 I slept on my side with a pillow between my knees, per my doctor. I think the pillow was too wide, as knees should be no more than hip-width apart.
  • For PG2 I used a thick blanket when I slept on my side, but I slept on my back as long as possible. My midwife for PG2 was a proponent of back sleeping until my body told me not to.

Support Garments

  • In PG1, I wore a Prenatal Cradle Plus V2. On desk work days I skipped it because it was uncomfortable to sit in. For days at work when I was on my feet a lot (and on unyielding flooring of carpet over concrete slab) the belt was helpful.
  • For PG2, I sometimes bound my hips with a woven wrap for babywearing (with or without the Prenatal Cradle under my clothes) because the wrap gets so much snugger and gives a custom fit.
  • Mostly I did not bind at all in PG2. I would have the chiro get me back into place and then I use my natural strength to cope. In pelvic physical therapy between PG1 and PG2 the PT also encouraged not relying on a belt to allow the muscles to do the work. Conversely, my chiro saw no harm in recommending an SI belt sometimes, namely at night. So, obviously opinions vary.
  • Your pain may vary based on flooring: the floors at my home are wood and springy and gentle on my body—especially when I wear shoes. At work, the concrete was unyielding and hard in me. Good shoes really help cushion things and keep the pain away for longer. I now exclusively wear Naot or Sanita shoes.

Preparing for Birth
As you enter the late third trimester, be aware of baby’s position in the uterus. SPD is associated with non-optimal fetal positioning which leads to a higher chance of c-section. You also influence baby’s position, though. Spinning Babies has many tips for this.

Chiropractic adjustment (including that Webster technique I mentioned above) is helpful. Moxibustion (acupuncture) is also an option I tried. Some OBs will default to recommending a c-section for SPD, so ask many questions about your options because the other side of the camp is that unmedicated vaginal delivery is highly recommended for SPD. The unmedicated part is because you will remain aware of SP pain if spreading the legs and can adjust, and you preserve your ability to birth in a variety of ways (water birth, on all-fours, etc.). With an epidural, the typical birth position is flat on the back with feet in stirrups (or legs otherwise pulled apart) which can force over-spreading, and you can not feel the over-spreading which means you cannot adjust.

With PG2, an OB mentioned bedrest and a c-section because of SPD to me at just 7 weeks pregnant! Needless to say, I switched to a delightful, supportive professional midwifery practice and had a lovely delivery despite baby being occiput posterior (back of the head facing my back) well into pushing.

Encouragement & Resources
It is common in pregnancy to have pelvic loosening and feel it in the pubic symphysis or sacroiliac joints. It generally happens closer to delivery, but it happening earlier is not necessarily a sentence for bigger pain. It is very possible that the extent of discomfort that a woman feels earlier in pregnancy is as bad as it will get.  If you are looking for more information, Relieving Pelvic Pain During and After Pregnancy: How Women Can Heal Chronic Pelvic Instability is the go-to book on this.

Additionally, this website has wonderful tips on keeping legs together when getting in and out of the car and bed, sitting when putting on pants, etc. are little things that make a big difference.

This is a version of a post originally published on More Green for Less Green, which includes more about the author’s journey with this condition.

Top Image: Teza Harinaivo Ramiandrisoa


13 thoughts on “Pelvic Pain in Pregnancy: Help for Symphysis Pubis Dysfunction (SPD)”

  1. I had never heard of this, but my son is 2 and I still have this type of pain if my activity level changes. I have found chiropractic adjustments to be quite helpful. This gives me terminology to put to my experience, which is a real gift and may help me in future health care encounters. Thank you!

  2. I applaud you for having more children after your diagnosis. I was advised not to have anymore because the pain would be unbearable. My son is 5 years old, and if I lift something heavy or walk a lot it still really bothers me. But along with PT, I also did acupuncture which helped a tremendous amount. I also found that exercise, and building core strength was the most help. Great article!

  3. Hi, I think you have a typo up there. You stated that “knees should be more than hip width part” when sleeping, but it should be “no more than.”

  4. oh my gosh I had this terribly during my first pregnancy and didn’t know what it was, or at least didn’t think it rose to the level of being a “condition.” I really thought it was just “normal aches and pains of pregnancy.” however it was debilitating towards the end to where I was unable to walk properly or even sleep at night because the pain was so much worse at night. I have no doubt my exhaustion in my third trimester contributed to my PPD/PPA diagnosis 🙁 I got some relief with chiropractic care in my first pregnancy but think I waited until too late in the game. I’m in my second pregnancy now and just like last time it started around 20 weeks but I am doing physical therapy this time AND chiropractic care and it has made a huge difference. Hopefully my recovery is faster this time too – last time my pelvic/lower back pain lasted until my son was 18 months old! Thank you for writing this, I feel like not very many women are aware or familiar with it including doctors and midwives (I feel lucky that my midwife was – she encouraged me to do PT last time and I didn’t listen). I have always wanted three children but really think after having to experience this with both of my pregnancies I will stop at two!

  5. I’ve never been diagnosed but I think this is what I am suffering from. I thought it might be adhesions from 3 c-sections but what you are describing here sounds exactly like my pain. I felt it toward the end of third pregnancy and now here and there, even a year after my last delivery. It is excruciating and makes me unable to walk at times. Thanks for the article and tips.

  6. I’ve never been diagnosed, but pretty sure this is me. And the ob/ midwives I use basically said nothing you can do.
    So true about the epi. Got one during my last labor (I let fear take over) and pretty sure I was over stretched in pushing. For over a month I could lay in no position but flat on my stomach, and now 5 mo later I still have problems on occasion. I feel my joint slide out of position and have to take a couple excruciating steps for it to slide back in. I’ll have to try your suggestions. Hubby and I wanted a big family, but I just wasn’t sure it was physically/ emotionally possible for me. This gives me hope

  7. This is exactly what I have dealt with for my 2 and now present pregnancy. Although it started at 11 weeks with my first and began sooner with each pregnancy. I saw a Chiro with my last that also did psoas massages. That seemed to help as I couldn’t walk after my first delivery, but was better after my second delivery. I am getting some immediate relief from once a week Chiro right now (i am 15 weeks) but am seeking some options for strengthening because any excercise outside of daily cleaning and caring for my family leaves me “locked up” for a couple of days. When going to a PT, how did you locate one who dealt with the issue? The Chiro after my last delivery prescribed I see an orthopedic dr. after my second birth, but I was unable to locate anyone who would do anything more than just pain management. Thank you for your help… It’s nice to just know someone else understands!

  8. Thank you for this GREAT article! I suffered with SPD horribly with the first one, and all I remember is days and nights of just crying waiting for it to be over as soon as possible. My PT was clueless and young, and my chiro made it worse… This pregnancy I’m determined to stay fit — even with SPD! I don’t want to gain weight and make it worse! Thanks for the great suggestions.

  9. What a tremendous article this was! It seems like you are very focused on your writing, which is a refreshing change of pace. I wouldn’t be surprised to see you get an offer to write for a famous publication. I hope you know that people actually appreciate quality writing like this!

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