SPD and beyond.

[pie]

Ok, well I'm 25 weeks gone and thinking about my birth plan as I want to make it clear what I can and cannot do. I'm just about to get delivery of my wheelchair too, so I want my midwife (who I'm sure I'll have never met) to know just how severe my SPD is.

I know about the best birth positions, finding out the max comfort zone for parting my legs etc.

But I was doing some reading and saw that some physios recommend not letting the mother out of a wheelchair for up to 48 hours post delivery, even for going to the toilet. I was hoping for an in and out delivery, but not I'm worried the SPD will automatically mean a stay in the hospital.

Also no where seems to have any info on whether the symptoms will improve and how soon.

I know everyone has different degrees of SPD so no one may know how long it takes to recover from my severe kind.

When I had DD 4 years ago I didn't have SPD so this time it really is all new to me.

If you been through childbirth with SPD how did it effect things? Did it mean a longer hospital stay? How long before you noticed an improvement?

TIA!!

[motherinferior]

Mine seems to be much improved, but I guess it's very early days...much more distracted by nasty second-degree tear, though, so that pain may be masking other things. As you know, last time it took a while - if ever - for SPD to clear up completely but it did improve v quickly to some degree. HTH. xxx

[Angiel]

I suffered from SPD with all 3 of my pregnancies, although it wasn't diagnosed until I was pregnant with my second.

Mine obviously wasn't as severe as yours, but I did use crutches for a while.

Finding the best position for labour is going to help you a lot, when I was pregnant the second time, I had a very understanding midwife he did lots of research and was very helpful. I then went on to have a home birth.

When I was pregnant the third time, I ended up having a caesarean (not because of the SPD) and I really do think that this helped. Obviously you have other things to worry about, but it was good not to aggravate the SPD during labour.

As for recovery times, mine has never totally gone away. My youngest is 21 months now and I still find it difficult to put all my weight on one leg. It has definitely improved though, I can roll over in bed now with no pain at all.

It was suggested to me, that I had an xray after delivery to see the extent of the problem and also to go for physio. Unfortunately, neither of those happened and I wasn't in a position to pursue it.

HTH

[JaneyT]

pie - I had spd with both my pregnancies - worse during second one from 20 weeks.

I was dreading the birth first time round - during pregnancy midwife kept saying - you'll have to open your legs at some point to let this baby out - but during both labours I didn't feel any pain from the spd at all- must have been all the gas and air - and the spd stopped both times literally as soon as I had delivered.

I very occassionally get a twinge now if in a funny position, but nothing bad - dd2 is now 2.

HTH

[milch]

I had spd (have?) and found good info on thi site: Association of Radical Midwives

I gave birth with no pain relief lying on my left side. I found that I did not need to spread my knees apart, just to have the upper leg (ie the right one) supported at the knee and foot. I think there was a gap of 10 -12 inches between my knees. What also helped was tucking my knees up as close to my chest as possible.

My midwife gave me some very good postural advice during the pregnancy, which also held true afterwards. From what you write, I obviously had a much milder case as I was mobile, but it might help nonetheless. The main thing was to keep hips and shoulders in line, especially if doing anything weightbearing. So, for example, to get out of bed (assuming you're on your back) wriggle away from the edge, then roll your whole body over on to your side facing the edge, then bring your knees up so that your feet are over the edge and your hands up to rib height on the mattress, then push yourself into an upright position with your feet swinging down over the edge and you end up sitting on the edge of the bed.

Swim as much as you can - but not breaststroke - even if it's just a gentle doggypaddle with floats.

There are various mobility exercises - none of them weightbearing - which also helped, but frankly I wouldn't dare presume that I'm qualified to advise on that. The best would be for you to see an obstetric physiotherapist.

After the birth everything downstairs can be somewhat numbed by the stretching, and for me that included the spd pain. But as things healed I became very aware of it! However, it did improve very quickly, until by my 6 week check it was quite live-with-able, the worst being pushing the buggy and sitting cross-legged (impossible for at least 2 months!) Now, 6 months postnatally I just get the occasional 'reminder'.

I hope this helps!

[milch]

ps I'm sure I remember reading somewhere that when giving birth with spd, it's important to let the sacrum move freely (the flat bit at the back between your hipbones) because if it doesn't then the symphisis pubis has to open up instead, which is why birthing on your side or in a waterpool can help.

[pie]

Thanks for the replies,

milch, I have been seeing an obstetric physio for some weeks now, and she said that she will go through the birthing positions nearer the time. I try to go swimming at least 3 times a week though to be honest it doen't help at all, though at least its keeping the rest of me fit.

I'm hoping to use the birth pool, but there is only one at the hospital so if someone else is already in in when I go into labour I'm up the creek as it were.

Its good to hear recovery stories though!

Can I assume as no one has mentioned it that the SPD in itself did not entail a longer stay in hospital?

[motherinferior]

Pie, are you quite sure the swimming is a good idea? I only ask because it hurt me. But hey, it's swings and roundabouts. I could walk. In fact I did walk to pick up dd1 from her childminder every day, including the day before I gave birth, so obviously I'm much less serious a case than you.

[pie]

Both the physio and my doctor are insisting that I swim as I'm immobile the rest of the time. They say that there is a real risk of atrophy, if I don't keep using my muscles somehow. When I'm in the water the pain is reduced by about 50% and its fine for the time I'm in the pool, but getting in and out is agony!!! I only do backstroke as well as breaststroke would certainly make it worse. I think that the pain is better in water as it carries the weight for me.

I haven't been able to take DD to or from nursery for 2 months now

[KMS]

did read in leaflet, given to me by obstetric physio, that some are advised to have c/section if SPD is very severe?

[mears]

That is correct KMS, but not all women are happy with that. I know a midwife colleague who had an elective C/S for that very reason. I think she was disappointed that she still neded crutches/zimmer for quite some time and actually had difficulty bonding with her baby. She had a vaginal delivery first time round and actually heard her symphisis 'crack' at delivery. Can I say that she delivered with her legs supported on the midwives' hips - an absolute no-no now that is has been recognised to be a position that can cause problems such as hers.

[pie]

I've read this two ks, but I really want to try a vagainal delivery.

Mears, if I were to try a vaginal delivery but my pelivs starting showing signs of severe stress could I have an emergency c/s?

[SueW]

I don't know much about SPD but I heard of a woman giving birth recently in our local hospital with the aid of a trapeze - she is paraplegic.

Would something like that be able to help women with SPD during labour/birth?

[motherinferior]

Just thought I'd add that my SPD seems much better now. Pity about the tear, of course

[pie]

So glad to hear that motherinferior!! How is the little one anyway?

SueW, I don't think that a trapeze thing would offer enough support, SPD is made worse by anything weight baring. I dunno though, anyone tried it with SPD?

[mears]

Pie - I don't think you would get particular signs of pelvis stress during labour. The main thing is making sure you are not placed in inappropriate positions in labour. For example, if you decided to have an epidural then the width you can comfortably open your knees should be measured before the epidural so that you do not cause further damage by over abduction of the legs. The decision regarding C/S would be best made prior to delivery.

[motherinferior]

Little one is starting to open her eyes and clock the world. Bigger one is currently besotted with her. mummy and daddy tired but in much better shape this time last time round!

And rather gratifyingly I am less fat than I was at this stage last time. Would like to think I look amazingly slender and babe-like but dp has kindly and lovingly disillusioned me of this...

[KMS]

I saw M/W and told her that physio had recomended that measurement be taken for comfortable distance between knees and she laughed! "how do these physio's expect the baby to come out" she said making me feel very silly! I have also noticed that SPD is not noted on my hand held notes! I don't want to make things worse during delivery. how do i make sure as I am a people pleaser and will smile and go along with what i'm told.

[pie]

Oh KMS, how terrible!!!

Your physio should really be able to write about the SPD on your notes. And I have read about women giving birth on their left side with the right leg lifted and only a gap of 9 inches.

Can you ask to see a MW with SPD experience, can you see a consultant and point out that if no one is going to take this seriously you want a c/s. Not that you would actually have a c/s but maybe you could call their bluff.

Maybe you could print out some info and show it to the MW, would she be the one at your birth??

I don't know what to suggest, maybe you could contact Mears in a couple of days if she doesn't see this thread?

Sorry to volunteer your services Mears, but you are always the voice of reason and wisdom!!

How long till your due KMS?

[mears]

KMS - that is a shocking response from your midwife! Your physiotherapist should be able to give you a care leaflet that you can show your midwife. Your midwife should be very aware of SPD, there is plenty written up about it in the professional journals. I'll have a search and see if I can find a link to a midwifery journal for you. Incidentally - perhaps if she realised she could be sued if she did not take proper care of a woman with SPD, she might be less flippant!

[pupuce]

During my first pregnancy I suffered from SPD but I only know this because I reported similar symptoms at 2nd pregnancy and that was then FINALLY picked up.... I then questioned the MW who said some MW do not think it is a serious "enough" problem to discuss it !!!!

[motherinferior]

I don't think anyone does, dammit. I'm going to try and sell an article on the subject when I'm back at work in November - obviously I'll go through the proper mumsnet channels to ask anyone if they'd be prepared to be interviewed, but quite honestly the ignorance around the subject makes me VERY cross...

...OK, back to baby now!

[mears]

Sorry cannot find an electronic link to the article that I wanted, so I will just type the following info.

'The National Clinical Guideline for the care of women with Symphysis Pubis Dysfunction' was published in the journal of the Royal College of Midwives (called Midwives) in July 1997. Vol 110, no.1314 page 172.

The guideline was funded by the Dept. of Health and developed by representatives from the ACPWH (Association of Chartered Physiotherapists in Women's Health) together with women who have experienced SPD and in consultation with midwives and obstetricians.

I won't reproduce it all but under the heading of During Labour and Delivery it states:

All members of the team must be aware of the implications of CPD

Pain-free range of hip abduction should be measured and recorded in the notes prior to labour and delivery

Keep separation of the legs to a minimum

Perform vaginal examinations in the most comfortable position for the woman

Be aware of the masking effect of epidural and spinal anaesthesia in relation to excessive abduction of the hips

Enable mother to adopt position of optimum comfort in all stages of labour: lying on left or right side, or kneeling upright with support from cushions or partner, should be considered for delivery.

Actively discourage women from placing their feet on attendant's hips because of the excessive forced hip abduction and strain on the pubis.


I don't think water was mentioned because in 1997, labouring in the pool was not that well promoted.

Miwives and doctors have no excuse for not being aware of this condition IMO.
Perhaps your library would get thearticle for you to give to your midwife. Your physio should have leaflets with the complete guideline. HTH.

[milch]

KMS - I, too, did not have SPD mentioned in my notes , and had to keep bringing it up with all my carers. No-one seemed to take it particularly seriously except for my community midwife, and even she also had the attitutde 'well you're going to have to open you knees to let the baby out eventually'. Fortunately, the midwife who helped me give birth was perfectly happy to let me give birth on my left side, irrespective of SPD (actually, I think she was the one person I didn't tell - we arrived at hospital in such a rush!). Have a look at the Association of Radical Midwives website (the link is earlier in this thread). The info may be a bit old, but I found it helpful. Also, as I mentioned earlier, I gave birth on my side without spreading my knees very far apart. I found myself instinctively keeping them in a comfortable position, even while pushing.

[KMS]

thanks mears and everyone else for the support. I am just no good at making myself heared! I have 2 weeks left! I see the GP next week and then that community M/W the next week, before I go to see the consultant when I go overdue.(that sounds optimistic!!) the Gp wont have time, I wont be able to say anything to the M/w and by then it may be too late! I will have to remember to tell all at the hospital. I want a water birth but missed out both previous times. is it a good idea or not?

[2under2]

I had SPD with my first pregnancy (with the second one and this one too but nowhere near as severe). It was in my notes and I made sure to put in in my birth plan, including the comfortable distance - I might as well not have bothered as nobody seemed to give a hoot (so no, it didn't have any effect on the hospital stay).
Had no problems during labour as I had an epidural. the really acute pain took a couple of months to settle down and then I still had twinges a year later (at which point I was preggers again). Found the best thing postnatally are really tight support pants (Bridget Jones style ones, and get as small a size as you can bear) - just the ticket to hold your pelvis together.