page contents

living eco-friendly on a budget + ​natural parenting + fresh takes on theology

≡ Menu

Pelvic Pain in Pregnancy: Symphysis Pubis Dysfunction (SPD)

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 pubis 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), pubis 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.

Symphysis Pubis

Location of the symphysis pubis


*93% of people who have SP loosening during pregnancy heal quickly and easily after delivery. I am one of the 7% who didn’t. My major issue now—two years out from PG2 and four years from initial onset— is that my ilia torque easily causing one leg to present longer than the other which causes back and knee pain and tripping and injury. You can read more about my story at the end of this post.

DISCLAIMER: This post 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 or a professional and listen to your body. The resistance of the water can be too much for some people. In that case, my PT suggesting 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 pubis symphysis or sacroiliac. It generally happens closer to delivery, but it happening earlier 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. Symphysis Pubis For those interested, here is more about my story: After PG1, my body did not get better. My pain got worse. My OB told me that it was all in my head, my primary care physician sent me for laying-down x-rays and ultrasound that showed my gap was no longer at the diastic point so he didn’t know what to do with me, an anesthesiologist told me that injections were my only option. Finally a non-surgical pain specialist who saw casually me as a favor to his wife had me stand on one leg and then the other and noticed that my ilia were torqued. I went to back physical therapy and that didn’t do any good. I was told that my only hope was to stop nursing so that my relaxin (loosening hormone of pregnancy that continues at a lesser degree during nursing and as part of the menstrual cycle) would chill out and my ligaments would hold. I finally found a chiropractor who specialized in pregnancy as well as natural healing methods from applied kinesiology to nutrients to homeopathic remedies and more. With a few sessions, I had major improvement but she said that I probably needed “stork x-rays” taken while standing on one leg (which my insurance refused to give me since they were only familiar with laying ones) and pelvic physical therapy (which I was able to get). Between weekly pelvic PT and weekly (or more) chiropractic appointments, I was able to have periods of pelvic stability that allowed my inflammation, and thus pain, to abate. I was diagnosed with pelvic nerve damage and was able to address that, which also made a huge difference.   Though my instability has never completely gone away, I remain active and am avid babywearer. I manage my pain through regular chiro visist, yoga, deep breathing, diet change to minimize inflammation, and tracking my monthly cycle. Post-ovulation each month, my pelvic ligaments relax and the instability and pain ramps up. There is still hope that someday when I am neither pregnant nor nursing—and my relaxin goes down— my ligaments will hold. Until then, cycle awareness helps me keep perspective and take helping steps.

Improved, but still not great. The rest of the  body is also impacted.

Improved, but still not great. The rest of the body is also impacted.

 

pamm_profile

About More Green for Less Green

Hi, I’m Pamm. Welcome to my little slice of the web! As a progressive Evangelical female pastor and crunchy homeschooling mom, I’m never quite what anyone expects of me. But, hey, that’s what makes blogging interesting, right? Join me as I try to wholeheartedly parent my three little boys, slowly fix up the trashed foreclosure we bought in 2009, and live simply.

{ 6 comments… add one }

  • Cara August 12, 2014, 11:54 pm

    Wow thanks for this post! I found your blog through an article posted on Mothering. I tore the ligament in my pubic symphysis during the birth of my daughter. By the time I figured it out at five months post-partum my pubic symphysis was still separated 5 cm. today I’m at 3 cm and feeling great after a lot of work. I have yet to find an OB, midwife, orthopedist, or PT who has ever seen this before. So I’ve felt totally alone. It’s nice to hear or story. Best of luck healing! Also, there are great UK-based Facebook support groups if you are interested.

  • Kathy January 26, 2015, 5:47 am

    I’m glad to have found this. The blog and the comment above is encouraging.
    I am one week postpardom and tore mine during delivery. I didn’t really show symptoms of this during pregnancy other then a general achyness in theower back and pelvis which I assumed was normal.
    I am walking with a walker. Pain has subsided for the most part other then a kind of campiness similar to periods. My worst fear is never being able to walk with out assistance or shower without help. Any info you can provide me with would be appreciated because my midwife isn’t really talking much. she suggested a brace and patience.

  • Pamm January 26, 2015, 7:43 pm

    Kathy, I am so sorry about your pain. The unknown is really scary. I have felt that same fear. As an encouragement I want to remind you that your body is doing a ton of recovery at one week post-partum: tightening, healing, hormone fluctuation, etc. Even the cramps you feel could be normal (unpleasant) uterine shrinkage. So, while right now this is all very new and very hard, time is on your side (not that it makes it any easier, right?). Just like at one week—or six weeks— after an ankle injury you would need crutches and have pain as part of the normal healing process, this injury will need time.

    That general advice for new moms to rest, rest, rest sounds especially important for you: stay in bed, let yourself heal from delivery (let alone injury), care for your baby. Even with an optimal birth, 6-8 weeks of taking it easy is prudent. For you, it sounds vital.

    All of that said, you need a provider who you feel heard with. If your current provider is not accomplishing that, I encourage you to get a second opinion. Sometimes taking a step (even if you end up hearing the same thing) can be encouraging because you know you’ve done what you can at this point. Best, Pamm

  • Amy October 19, 2016, 1:57 am

    Hi Pam,

    I also suffer from severe pelvic instability as a result of pregnancy and am wondering how you’re doing a few years after this post. My daughter will be 3 in February although I realize my case is very highly unusual. Feel free to message me offline if you’d rather at amybgreen@icloud.com.

    Amy

  • Pamm October 23, 2016, 1:18 pm

    Hi Amy, I keep meaning to write a follow-up, as I’ve gone on to have baby 3 since this post (a planned homebirth and my most well-managed pregnancy in terms of instability). I am still dealing with pelvic instability, so it’s been 6 years now since it started. I actually had 10 months pain-free after baby 3 but when my cycle returned, the instability did, too. I ended up with an acute injury to my sacro-illiac joint which was horrible, but it led me back into pelvic physical therapy (PPT). It has been AMAZINGLY helpful. Between PPT and continued chiropractic care, I do not have constant pain or torquing. I have pain daily still, but it isn’t constant and the instability is not as great. I can feel my body getting stronger and actually have hope for the future. Best, Pamm

  • Amy November 23, 2016, 7:31 pm

    Hi Pamm,

    Many thanks for your response. Pelvic instability has been a major ordeal for me. I just started with a new osteopath and am undergoing PRP prolotherapy injections. It is difficult but I am hopeful eventually I will conquer this once and for all.

    I’ve found The Pelvic Partnership to be a very helpful resource.

    Keep in touch!

    AmywaydLe

Leave a Comment