SPD/PGP and vaginal birth(26 Posts)
I have just had a home water birth with very bad SPD (I was wheelchair bound, although oddly it got a little better for a couple of days just before the birth).
Can you not labour in water and just get out at the last minute (if you need to)?
Or try kneeling upright with your legs parallel perhaps. Also frequent use of TENS in the weeks beforehand is advised - a minimum of five hours is needed to build up the endorphines properly. If contractions start when you don't want them to, they will stop as soon as you take the machine off.
I have to say the one thing that's good about SPD is that babies having a habit of practically dropping out of you. I had a five minute second stage this last time (after a 2 hour 45 minute first stage).
Depends how well you cope with pain anyway, the SPD pain disappeared into nothingness when labouring with my last delivery, was walking, albeit slowly with help of DH, but delivered lying on bed in stirrups, as I had breach twins ;)
Unless they can give you a blinking good reason not to let you try, stick to your guns, its your body, and your delivery! I did, although never had a CS with first DD, they were a little jumpy with my insistence for DTs, but I bit down, and found a lovely consultant and proved them all wrong!
Good luck x
They generally recommend VB for SPD people because the recovery from VB plus SPD is less awful than recovery from CS plus SPD.
Really I was in a terrible state before the delivery, and yet I managed it!
I had SPD with all 3, progressively worse each time.
DS1 - spent much of early labour kneeling on bed leaning over a huge bean bag. Was very comfy to bury bump into. Actually delivered lying on my left side.
DD1 - only 13mths later - fast labour only 80mins after arriving in hospital. Again delivered lying on left side with a HCA holding my right leg up but parallel to the bed iyswim. I'd been on crutches and couldn't even lift my leg AT ALL.
DD2 - further 2.5yrs later, 3mths on crutches - laboured and delivered in pool at hospital. Was fantastic for taking the weight off pelvis. Sorry that bit's no use to you.
I can't say that for any of them I was terribly active during labour. With DS I was knackered after 29 hrs back to back labour and just wanted to rest. DD1 I sat and watched a Formula1 GP before going in! DD2 got DH to take me out for a lovely Italian meal then went home to bed before it all really kicked off. Get crutches if you need them, Red Cross loan them out, even if it only to take the weight off so you can stand/wander the corridors in some comfort.
Like previous poster commented, they tend to make a fast exit once once you start to push. Mine were all between 8-15 mins and only a few pushes. Guess there has to be some advantage to all that relaxin hormone!
Forgot to add...
I found the TENS a bit useless, more an irritation but I guess also a distraction. Otherwise I stuck to G&A to take the edge off things. I didn't want an epi for fear of not being able to tell when a certain leg movement was causing me pain/problems.
Had SPD with all four and found that standing or on all fours was best position, the SPD didnt really affect the amount of pain i was in. and also a VB is apprantley better for SPD as it is meant to reconstruct pelvis,.. as told by my midwife.. maybe ask yours what she thinks..
P.S my water births didnt feel any different to giving birth outside water, hope it helps. xx
That's a good point. It's really important to avoid an instrumental delivery as that's where the damage is often done. If they have to use stirrups (which is avoidable - they have loops that can fit to the side of the bed as an alternative that is less damaging to the pelvis), then two HCPs should lift your legs carefully into them symmetrically at all times.
Nevertheless on my notes I made it clear that I would not consent to an instrumental delivery and that they should go straight to a section if necessary. My mw backed me up.
That having been said, I did my homework, and so did my consultant, and it was clear that letting nature take its course and having the simplest birth possible would result in a healing period of a few days, with improved mobility, whereas ripping abdominal muscles apart would take 6 weeks and lead to reduced mobility for the duration, as well as increased pain. It was a no-brainer really.
My consultant thought the home water birth option was the best of all in terms of helping the SPD, and was really supportive, even though I had been on loads of codeine and we had to be careful in case of depressed respiration in the newborn (we had a back up action plan for that and being near the hospital geographically helped).
LeninGrad, I would maybe ask for a consultant appointment to discuss this. They see a lot more of this than GPs tbh. But I think you can have a reasonable amount of confidence in being able to do a satisfactory VB with the right support (eg have you thought of asking for a particularly experienced mw to attend, or something like that?) If not, you can always change your mind up to the last minute, of course.
Also a key thing for me was getting a tertiary referral to the acute pain team, who knew loads more about pain management than my GP, and who got me a lot more comfortable very fast. Put it this way, I went in for three days for this to be monitored and supervised. After 24 hours I was pottering around the ward without crutches, carrying my own breakfast tray from the Dining Room . That was down to getting the right level of meds at the right time, in multiple ways. It did a lot for morale and confidence as well. I had ups and downs after that but was much more able to cope.
This is what I was on:
0800 - 1200 - 1800 - 2200
30 mg codeine phosphate
15 mg oromorph for breakthrough pain between times, on request.
TENS machine on for about 8 hours a day, special settings.
GP had only put me on 15mg codeine PER DAY! Which didn't even touch it.
Good news on the mobility.
I complained to PALS at my hospital and made a big fuss, and ended up with amazing care. It may be worth agitating, to get your appointments on time, ensure paperwork isn't lost, and to be assigned to one particular consultant.
I had a really easy labour, and was told beforehand SPD can do that - after all, very mobile joints/ligaments are finally useful! But I did need a waterbirth. Why can't you try starting in one, at least? Isn't as if that decision is irreversible.
Why not get her to use an osteopathic spring loaded hammer instead of cracking the joints?
I had SPD with my dc2 and delivered lying on my left side with my knees tucked up towards my chest. My legs were barely spread, maybe 30cm between my knees. Dh helped support my knee, and my foot was on the midwife's shoulder while she was at the action end. It was far more comfortable than dc1's birth, which had been in the 'classic' reclining position wtih knees akimbo. It was also far easier to push on my side.
I think that I had mild undiagnosed SPD with dc1, and I'm convinced that my delivery position with him was what caused the more sever SPD with dc2. With dc3 I did not have SPD at all until the very end, and then only mildly. This was possibly because of less trauma to the SP during dc2's birth, but probably because I was aware of the risk of developing it and was cautious in my movements from the very begining.
Yeah, they went on about PGP to me, too, but most people wouldn't know that term I don't think.
I'm sorry about the water aspect, because it does help - but they truly did tell me at physio that people with SPD/PGP often have easier labours, several women in the clinic confirmed it (second babies) and it was my own experience. Horrible pregnancy, but easier labour. Just try to measure your pain-free distance, have it written on your notes in red, in capitals, and keep on top of your birth partner? You won't be able to fight your own corner that well in hard labour, so an informed and stroppy assertive person to do it for you is really important, I think. They can insist nothing potentially harmful is done unless for some reason it's essential.
Also I was told squatting and kneeling can be really good ways to birth? I knelt, and it was fine.
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