To be disatisfied with my ante natal care

[Reallytired]

I have SPD, I am 33 weeks and I can barely walk. My GP won't prescibe me pain killers or refer me to a physio. He says that me seeing a physio would be a complete and utter waste of nhs resources as the problem will resolve itself in 7 weeks. I would like a support belt and maybe some crutches if my ablity to walk gets any worst. The only think he has offered to do is sign me off from work.

I feel like my pelvis is being pushed apart. Walking a short distance is so painful I am almost in tears. It is making simple things like picking my son up from school a nightmare.

My bump is lying transverse and I asked him if this was normal at 33 weeks and if there was any possibly of my bump being turned to a better position. I think if my bump was head down then I would not be in so much pain. My bump is not turning summersaults. It is still moving, but it seems stuck in the same transverse position.

I got told off for asking such a stupid question and made to feel I had wasted his time. Apparently I should have asked my questions at the next ante natal appointment in two weeks time. I have been told that its unlikely the consultant would attempt to turn my baby and cs would be the most likely outcome if the baby does not turn.

When my son was born 7 years ago, you were allowed to phone your midwife and ask questions like that. You also were allowed to make an extra an appointment if something was really worrying you.

I think that my ante natal care is p!ss poor!

Have you actually tried to ring your midwife, as opposed to your GP? Because that is what I would do and I would complain to the practice manager about the GP's attitude.

Your GP sounds like a twat, Reallytired.
Ring your MW, can she not refer you to a physio?

I got spd at about 20 weeks pg, saw my gp who said that i could self refer my self for physio, i actually only needed to go the once, but my gp gave me some codiene - which she said was alright to take but only up to 30 wks (i think) ...

R.e . What your gp is talking about that your consultant would unlikely turn your bump, is in my opinion a load of old tosh, when i was 30 weeks my dd was breech and was until 37 weeks and they was talking about turning dd round as they would much rather you try and give birth naturally then have cs, but i ended up having emcs cus dd didn't progress after 2 days of labouring, but thats a different story.

Really hope they sort it out for you!

I have to say I don't think the way you're feeling is unreasonable but your GP isn't an antenatal specialist and there's no reason why you couldn't have made an extra antenatal appointment if you're struggling with your pain levels.

WRT bump being transverse, it's FAR too risky to attempt ECV at this gestation because there's a high chance the procedure would rupture your membranes. Some consultants won't attempt it now because it can be a very painful procedure and has a low success rate.

Additionally, I am on bedrest at 28w with PGP and my bump is transverse which has actually taken a significant weight off my pelvis and helped with my pain levels. There is still plenty of time for baby to turn, especially with this not being your first.

Physio at this stage won't help. Physio after the birth might, but other than prescribing you a belt there's nothing else that they can do just now, and the belt is not a particularly comfortable thing. SPD is a reaction to the lignin hormone, it means that your body is preparing a little too well for labour and letting your ligaments stretch further than is comfortable.

Have you been prescribed pain relief? Codeine is probably the strongest thing you can and will be offered (30/500 strength) but be aware this can affect your baby's lung maturity.

Good luck. The best thing you can do for your SPD is nothing. Literally.

"Physio at this stage won't help"

Not sure if this is correct?My friend had mild-moderate SPD and was referred for physio around 25 weeks. She found it very useful, although I am not sure it was physio exactly, mainly strategies for coping and ways of moving etc so as not to excerbate the problem.

As for ECV, there's no point in doing it now of course as the baby will probably turn naturally, but if you stay breech your consultant might well be happy to do it - I know 2 people who've had it successfully.

Have you tried phoning your hospital and requesting physio or a MW appointment to discuss all this? Your GP sounds like a tosser frankly, and I'm sure you would get more knowledgeable advice going direct to the experts.

also the same friend found her belt extremely helpful - I think it varies from person to person but you should certainly try it. She really found it helped and made walking fairly bearable as oppose to excruciating.

Blotted, I am not sure it's as simple as saying "do nothing". Reallytired has another child so lying back and taking it easy, while attractive, may not be possible.

My son's school is not prepared to let a seven year old walk home on his own. Even though he would not have to cross a single road and its only a two minute walk. I can understand the head teacher's view that its setting up a dangerous preceedent. Not all seven year olds are as sensible as my son or live as close.

His school has been sympathetic in letting me park in the staff car park. However I still actually have to get out of the car and fetch him.

I have tried to make another ante natal appointment and there is a two week wait. There is a major shortage of midwives in our area and its not possible to phone my midwife directly. I have a phone number for the the hospital though.

Physio could help at any stage of pregnancy and SPD, they can do lots of things including massages, pelvic movements, give you exercises and teach you better ways of moving to lessen the pain. They can also give you support belts and crutches/wheelchairs if it progresses that far.

I would kick up a fuss and get referred to a ante-natal physiotherapist - both for you and Blottedcopybook - physio can help.

(Speaking as an ante-natal physio anyway)

Definitely bypass the GP and go straight to your midwife. I had horrendous SPD during my second pregnancy from about 32 weeks. I was about 35 weeks when I got a support belt from the physio and it made a massive difference.

Ring the hospital and see if they can see you quicker. GPs (some of them) can be very unknowledegable IME.

You can self refer for physio in pregnancy.

My SIL is 17 weeks pg with SPD. She has just had physio, and it has helped her enormously. She still has pain, but it is not as bad as it was last week. So I don't think BlottedCopybook is correct when she say it won't help, though perhaps there are cases where it won't.

When I say it won't help, I mean it's not going to make the SPD go away or make the pain better long term. I'm on my 4th pregnancy with such extreme PGP (which encompasses SPD) that I've been signed off work - I've had all the advice from midwives, consultants, physios. I'm not saying what I'm saying to make you feel miserable or bad, I'm saying it because it's what you're likely to hear.

theyoungvisiter - I have three other children and I can assure you that "lying back and taking it easy" is far from an ideal solution, particularly when your other child(ren) want you to play/feed them/entertain them/chauffeur them but the fact of the matter is by pushing through the pain barrier and over exerting with SPD, you significantly weaken the ligaments, make it more likely you'll suffer from SPD in subsequent pregnancies and endanger your mobility in later life. SPD usually goes away after pregnancy but the people saying "take it easy" aren't doing so for no reason.

Reallytired I totally empathise. My eldest is 7 too and he does walk home himself, when I was pregnant with his sister my next door neighbour collected him every day for me which was amazingly helpful. I'm not sure how much jurisdiction the school have in stopping you from allowing him to walk home himself though, if that's what you decide. If they are insistant on you attending to collect him then the least they could do is have him escorted to the car park to meet you? You mentioned that it'll be two weeks for a midwife appointment - could someone at daycare assess you? Or even a health visitor? They might also be able to refer you to support services.

Have you been given advice on standing up/sitting down/rolling during the night etc?

Hi Reallytired

You are NBU at all. I'm sorry you are hving a bad time. I am 38 weeks pregnant myself and I am finding this last bit hard but do not have SPD!

Can you cahnge GPs - he sounds like a miserable sod.
At my MW's you can make an appointment earlier than planned but only when clinic is on IYSWIM? Could you try this, the MW might refer you for physio? And generally be more helpful.

I have a support belt as I have had syatica (I bought it through the NCT website).

I have chronic sinus problems and my Gp has prescribed cocodamol which he has said is fine to take when really needed in preganacy amd can also be used in early labour! Infact he has just upped the dose as my pain is so bad at times.

Is there anyone who can help by taking your DS to school and collecting him? If not can the school send him out to you? I would defintley address this as you have quite a few weeks to go yet!

I hope you get the help you need.

Self refer. Keep phoning people. If needed, turn up at your labour ward and say you can't cope.

Physio will help. I was going all the way up to 37 weeks to have my pelvis realigned AND I got crutches.

Plus you might want to mention to him that it doesn't magically correct itself after birth in all cases and you may need ongoing support for a few months.

Hope you get things sorted, I really feel for you.

Blottedcopybook

I have missed quite a few days off work and I was signed off for a week. My GP was prepared to sign me off for four weeks. However work have changed my role and allowed me to work fewer hours. I just have a couple of weeks to go. In someways being at work is great at taking my mind off the pain.

I just feel utterly desperate with the pain at the moment.

I thought about buying myself a support belt but there are so many out there. I don't know which one is best to get. I have a birthing ball and its really helpful sitting on that and I have found being on all fours with my bum in the air helpful.

Reallytired - please try to self refer yourself to physio - just ring your hospital and ask to be put through to the ante natal physio and speak to them to see if this is possible or if not find out the quickest way to get seen.

What size are you (clothes)? I have got a load of tubigrip that I was given to help with my spd that I can post to you.

Where do you live? I'm in South Wales and could get a pair of crutches for you.

Can I ask what dress size you take? I'm a 16/18 and have a couple of belts I'd be happy to post you although physio will prescribe them for free. I've heard that the body stocking is actually a lot better (I believe it's like a tubigrip?) but my main advice would be to take the belt off when you sit down because I found they cut into me and really hurt my skin.

Birthing ball and being on all fours are excellent, both for relief and for shifting bub into a head down position. I sat on my birthing ball constantly for the last 8-10 weeks of pregnancy with the last two because it was so much comfier than on the sofa plus it gave me a bit of leverage to stand up! You must make an effort now not to stand on one foot at all (so sit down to put pants/socks/shoes etc on, sit on the side of the bath and swivel round and out, keep your knees together when getting in & out of the car).

Are your work being understanding about you being off because of the pain? My understanding is/was that if you're signed off for a pregnancy-related ailment after 29 weeks then your work can insist on you starting maternity leave so bear that in mind - it may suit you, it may not. For me, I really enjoyed being at work it was just getting there and getting home that killed me!

The pain is horrible though and there's nothing I can say that'll change that. You really must try and take it easy though, you've got a maximum of nine more weeks of this and anything you do now to make your life a little easier will reap you benefits at the other end.

My work are keen to keep me. I'm good at my job. They have been fanastic, but working in a special school is not a restful enviroment for anyone. they have really bent over backwards to reduce the risks of my job. They have also let me have the odd afternoon off when the pain has just been too much.

The rules have changed on maternity and sick leave. Work can only insist on maternity leave starting due to sickness reasons after 36 weeks. I will be about 34/35 weeks when I give up work. Our LEA insist on 28 days notice on changing maternity leave dates and are very rigid.

Before pregnancy I was dress size 10 to 12. I am huge now.

First of all, ReallyTired, you have my complete sympathy, as this is a serious pg complication and a disabling one at that. I have it myself, and receive Disabled Living Allowance and have a Blue Badge for parking, so there is official recognition out there that this incapacitates women.

Whilst SPD is notoriously difficult to manage, your GP is completely wrong about treatment being a waste of NHS resources, because if you are not treated, you run the risk of this condition worsening and lingering for years, and even causing birth complications as a result of your lack of mobility. All of this would be much for expensive for the NHS to sort out.

Can I suggest an action plan for you, which overlaps with what other posters are recommending?

1. Refer yourself to the obstetric physio, who will be able to give you a properly fitted sacro-iliac belt, a tubigrip and a set of elbow crutches to take the weight off your pelvis. It may be best if you physically go up to the hospital in person waving a letter from your mw, and more or less demand an appointment, because you still have 7 weeks to go yet it can sometimes take a month to get paperwork sorted out otherwise.

1. Find an osteopath or chiropractor who treats pg women and get them to realign the pelvis a bit, as this might help the baby move into a cephalic position and relieve the pain. You will have to pay for this privately, but it will be worth every penny.

1. See another GP, or even the hospital acute pain team if you can, and get proper pain relief. It is a question of 'closing the pain gates' in medical parlance so overall your body becomes less sensitised to this pain, and you need to take medication in a timely and regular fashion. In pg you can take up to 60mg of codeine phosphate 4 times a day in conjunction with 1000mg each time paracetemol to enhance the effect. You can also be prescribed 10mg Oramorph (oral morphine) for breakthrough pain if this is insufficient. You will need to stop taking these drugs after week 38 to reduce the risk of neonatal breathing difficulties, but you will still be able to take paracetemol. You should also be using a TENS machine if possible - a good model is the Physio Med TPN200+, which is hospital grade. TENS needs to be used for a minimum of five hours a day in order to work properly, and it will reduce muscle spasms and create endorphines. It may induce mild contractions, but this is not a problem unless you are very prone to premature labour - if it happens to you, contractions will stop when you turn the machine off.

1. Most important of all, you need to get off your feet and do as little as possible, otherwise you will damage the ligaments around the pelvis. You have a duty to rest rather than struggle on. You also need a good 6 weeks off your feet having an old-fashioned confinement after the birth. Get your mw to refer you urgently to Occupational Health for advice about how to manage domestically, perhaps, and also speak to your neighbours and the mothers of your child's schoolmates about help with the school run and so on. If informal help is not forthcoming, then you have the option of informing the school and Social Services that your child will not be able to attend school because you can not get him/her to and from the school site on account of your health, and Social Services would be able to provide a taxi and possibly some sort of escort if necessary.

1. Warm baths and massage stretching out the muscles around the hips as well as the hamstrings can improve mobility a lot, and reduce pain, but you will still need to rest.

I have written an entry on wikipedia on SPD that has more information (please feel free to add anything else you find out) and also the Pelvic Partnership has useful information sheets you can print off and give to family members and so on.

Andrew Lansley, Shadow Health Secretary, is very interested in maternity issues at the moment (as we saw on MN during the webchat a couple of weeks ago) and you might care to drop him a line about your SPD and the lack of appropriate ante-natal care.

Disability Living Allowance Backdated to the day you apply. Opens the door to Blue Parking Badge, free car tax, and other benefits.

Find a chiropractor here

Wikipedia entry on SPD Many extra links at the bottom, including a Women's Hour radio feature link.

A leaflet for family and friends on how to help you

What a fab reply from Boffin!
I would add trying acupuncture for the pain of SPD. I used a chiro to help alignment, but acupuncture did take the edge off the pain. I agree that rest though can be the best thing.
I remember the pain of SPD vividly. It was very disabling and I felt totally overwhelmed with the pain. I recall crying that my dd needed a wee because it meant another trip up the stairs, crying because I had dropped a pen and I would have to bend to pick it up, and I stopped going out to a toddler group because I just couldn't walk the 100 yards without exhausting pain.
I found the NHS response to SPD pretty useless. Most staff seemed not to have a clue, or thought I was exaggerating normal pg pains. I did get a physio referral, but the physio was useless - hence the chiro. My midwife was fab in all regards, and very experienced, but even she was was fairly dismissive of it.
Be as assertive as you can, and don't let anyone underestimate the physical and emotional toll SPD can take - it is a horrible condition and you have my sympathy.
Hopefully, you will feel much better in seven or so week (although I know that feels like a lifetime away just now....).

Quite right HedgeWitch, I too would not hesitate in complaining about the GP. He is not following NICE guidelines, apart from anything else.

What we can all tell you is that the more you rest now, the less stress you are going to be putting on your pelvis, and the greater the chance of a good recovery, so really you should stop work immediately and go on sick leave until your maternity leave kicks in.