SPD and delivery...does it impact on it?

[4blue1pink]

Just a bit of advice please.....suffering from what i assume is spd ...sharp stabbing right at front of pelvis - pain on exertion etc for a few weeks.

I have started dreading this searing pain on top of the pain of labour....will this happen.

Never had spd before and this is babby no 5. Any experiences of this I am so worried ...suppposed to be having homebirth but considering hospital and epidural!!!!!!

I was in a wheelchair for six months with SPD when I had DS1. I did have a very long and painful delivery, but there were other complications too (you name it - pre-eclampsia, gestational diabetes, retained placenta, post-partum haemorrhage...I had the lot!) I did deliver DS1 naturally but tore very badly indeed, partly because the pain of the SPD made it almost impossible to relax during the contractions and very hard to push properly. I would advise that you talk to the delivery team/midwives soon and draw up a plan for pain relief and positions during labour. I was forced to give birth lying on my back because I was hooked up to various drips and monitors for other reasons - but I did read afterwards that women with SPD should never be made to give birth lying on their backs as it makes the pain unbearable.

It is possible to have a natural delivery even with very severe SPD but you will need to talk to the staff at the hospital beforehand, ask about some physiotherapy and make sure they KNOW that you have got SPD. Good luck!!

hi. ive just had my fourth baby and suffered with spd but i was'nt wheelchair bound.it didnt make any difference in labour,to be honest labour pains over-ride the pain of spd.i had a waterbirth and this really helped a lot because i could move about really easily in the water and change position.if you do a bit of research, the general opinion is not to give birth on your back, but to try other positions.have a look in the archived messages and you'll find some info there. the only problem i found was i was very,very stiff afterwards in my pelvis for the first 24 hours after delivery, but as i made the midwives aware of it, they gave me some major painkillers afterwards, which helped with the afterpains too.

I have moderate SPD and had a homebirth last time, and planning on doing the same this time ( due in 6 weeks ). The labour pains over rode the SPD and it had no impact at all on labour. However, I would have found it agony - in fact - impossible to deliver on my back - I was kneeling over the sofa - a wonderful position for SPD - plan to do the same again. Hospital and epidural definately isn't the way to go, because the epidural will mask the pain and you will not be able to tell if you are in a bad position for your SPD. Legs in stirrups is also a definate no no, with SPD in labour - it can cause permanent damage. Write this in big red letters all over your birth plan, so your carers are fully aware. Unless your SPD is very extreme, ie you are wheelchair bound, there is NO reason why you can't have a homebirth. In fact, home is the best place because you can labour and birth in any position you find more comfortable without any hassle from hospital staff.

I didn't find that the labour pains overrode the SPD. Perhaps I have a low pain threshold. I had a 24 hour labour with excruciating labour pains, but they didn't override the SPD. I still think a plan for pain relief re: worst case scenario would be a good idea.

I think it depends on the severity of the SPD meanoldmummy, you sound like you had it a lot worse than me as you were in a wheelchair. I am in a fair amount of discomfort, but so long as I don't actually do anything, I'm coping. I'm just pottering around at home, not walking anyway, lifting anything etc. It also sounds like you had a really rough time during pregnancy and labour as well

I agree, a "plan B" for hospital is a good idea, that's why I write it all over my birth plan and make sure my dh knows all about it too, so he can convey my needs to the staff. And definately agree - talk to the hospital staff before hand, so you know they are clear about your needs. However, if you have a straightforward pregnancy and your SPD is not too severe, there is no reason why you can't have a homebirth. BTW, I didn't do it without any pain relief - I had tonnes of G&A!

Hi,

I had also SPD with my last one and I can say that waterbirth was perfect for me. I could move into position very easily, and give birth kneeling which is the best position for SPD as you don't need to have your leg wide open.

With an epidural you have big chances to end up with your legs on stir up and make your SPD worse after the birth. not a very good option

Hi. Does sound like spd. I wasn't wheelchair bound or on crutches but had it from 12 weeks of pregnancy and it was very debilitating. I had to give birth on my back and in stirrups. Had epidural but it only worked on one side. Don't think the epidural would've made any difference at all to spd as labour pains blocked all other pain out. I also found that as soon as ds was born my spd vanished (reappeared briefly when I got my first period). Hopefully this will be your experience. I would like to try for home birth next time but it is other gynae issues that make me wonder if it' feasible - not the spd.

i had bad spd and it was written in my birth plan to not put my legs in stirrups or open them too wide etc, but my midwife didnt even look at them.
i gave birth on my back with just gas and air clutching both legs up to my chest and then had a manual placenta removal with stirrups and a spinal block, but at the time i was far too out of my mind to complain.

i didnt feel (or perhaps didnt notice)any spd pain and the night after the birth i was fine..i so loved being able to turn over in bed without excrucitaing pain!

i would advise it being highlighted in your birth plan though, as if you get a complacent midwife like mine you could do damage to yourself..i guess i was just lucky

If it is SPD you need to have your 'abduction gap' - the distance you can move your knees apart without pain - monitored and this should be all over your birth notes. You should ideally keep within this gap during labour (although in fact I ended up splatchcocked for a ventouse with my first birth).

I wrote a piece on SPD for a baby mag a while back (I had it in both pregnancies); email me if you would like a copy.

motherinferior..i don't think my midwife even glanced at my notes while i was i nlabour, and me and dp didnt even think about mentioning the spd.
mine was about 50cm, but i opened much much wider with no trouble. no doubt this won't be the case for everyone though.
please can you email me your article, i am interested in the subject, especially how it's so overlooked by many health proffessionals.
also, do you know if the chances are you'll have ot with subsequent pregnancies oor is it a random occurence?

CAT me and I will send it to you.

Given that SPD is caused by (a) a slightly misaligned symphisis pubis (b) secreting too much relaxin hormone in pregnancy, I would think it is extremely likely to happen again. I don't know the figures. I got it the second time.

is there anything that can be done about aligning the pubis before pregnancy?

I've had SPD in both pregnancies more severe second time around but mine was also sacro-iliac pain as it was worse at the back.

Had a baby 10 days ago and tbh it was only a 2 1/2 hour labour so was very intense from the start laboured mostly on my hand and knees but turned to deliver on my back. As someone else said the pain of the labour (only had gas and air) overrode everything else. Still get quite stiff at night or when I've been sitting for a while but nowhere near as bad as when pregnant, hopefully it will all go soon.

I had SPD from 6 months onwards. Didn't end up on crutches, but walking was very painful by the end of the pregnancy. The doctors and midwives ignored the fact I had SPD during labour. I found it impossible to turn over or move around in labour, especially during the 2nd stage and the midwife was very nasty about this. I ended up in stirrups for about 90 minutes due to a ventouse and forceps delivery. I did manage with no pain relief. 1 year after giving birth I still have SPD. I have seen a physio who said I should not have been left in stirrups for more than 1 hour and this is what caused the damage. I am not sure it will ever go away now and I still cannot do any exercise. I have been told by a doctor and the physio that a 2nd pregnancy will be more difficult and painful.
I think it is worth telling your midwife as soon as you are in labour, just in case they don't read your notes.

Sympathies for SPD sufferers. I had it (fairly mildly by all accounts) in both my pgcies. It didn't affect my labours badly (not much fun in any case!), but I did find it really hard to do any exercise after babies were born - and I mean for a whole year afterwards, not just the first few weeks.

In my case, SPD just didn't go away, though it seemed to last longer when I b-fed longer with dd1. I am convinced breast-feeding kept my ligaments looser, though I had a really easy time with B-feeding apart from that.

I had pain in my pelvis and couldn't move freely for ages after each baby. Also I broke my ankle really badly after the first baby, which I put down to the very relaxed ligaments. My ankle just turned over and 'crack', I had to have a metal plate put in to mend it, hospitalised for a week and was on crutches for 6 weeks, not easy with a 4month old.

I also had two simultaneous trigger thums because of too much of that loosening hormone - not useful when trying to push a pram, do up a nappy etc.

It is much better now, (dd2 17 months) but I am still careful about twisting to get out of a car - and I still havn't yet attempted breast-stroke (which I used to do a lot) becasue my pelvis doesn't feel stable enough.

I know this experience was a doddle compared with many, but I was surprised how it didn't clear up after the baby was born and I got quite depressed about it after dd2.

I really am much better now - jsut realised how grim my last post must sound to people who've just had/about to have babies! I can go running and everything (well, in theory..)

I had SPD towards end of second pregnancy, but went through with home birth with wonderful private midwives. Didn't notice the SPD pain, and gave birth on hands and knees, so no real problem with my 'pain free gap'. Would have been worried giving birth in hospital as wouldn't really trust NHS midwives to read my birth plan, sorry for huge generalisation but even the best tend to be terribly overworked and also constrained by hospital 'policy'.

Went to see an osteopath afterwards because the pain does carry on for quite a while after baby born, but I made the mistake of taking ds2 with me and he spent more time on ds2. Now wish I had gone to see physio while still pregnant, especially with current 'anterior pelvic tilt' - see my message in Health. But I don't have any pelvic pain any more (ds2 20 months old).

Have just found this very useful website: \link{http://www.pelvicpartnership.org.uk/1152.html\The Pelvic Partnership} which has some information about options during labour in 'how will I get my baby out' on the FAQ page.

hth

I had very bad SPD during my pregnancy and my consultant said that delivery would very likely make it worse, as labour itself puts strain on the ligaments and the actual pushing the baby through the birth canal would stretch the pubic bones even further apart, which could result in them separating (if that happens you have a real problem you'll need surgery and will probably end up in a wheel chair for a good while). However, that's very rare. He suggested trying to stand or kneel during delivery and KEEP THE LEGS together as much as possible (which made me lol). He warned against lying on my back and said that I must not be put into stirrups as that can also lead to the pubic bone separating. However, I then wondered how to avoid stirrups if they need to pull the baby out via ventouse or forceps, so he said that should that scenario occur they would probably consider a c/s unless I was totally against it.

In the end I was very very lucky as my baby turned herself breech and I got a scheduled c/s, so I didn't have to worry about the delivery aspect.

However, and I know this next comment is very controversial (but that's what my physio explained to me) is that breastfeeding prolongs SPD because the hormones keep your ligaments soft for as long as you produce milk, so although your SPD is going to get a lot better once the baby is out it will not dissapear until you stop breastfeeding. I still chose to breastfeed because I believe it was the best for my baby girl but I did struggle with my SPD for the whole time. My decision to stop breastfeeding after 6 months mostly had to do with the fact that I wanted to get rid of the pain and now, three months after stopping I am almost pain free.

Anyway, this is just my experience. Good luck, and you have my full sympathies for you pain !