SPD/pelvic girdle pain and childbirth

[duzida]

Does anyone have experience of giving birth after having quite bad SPD/pelvic girdle pain? I'm 34 weeks pregnant with first baby, have had SPD since about 23 weeks, mainly at front, at the symphysis pubis, which is quite tender. Have got quite a lot of associated back/shoulder/leg pain and have been using crutches on and off, and am off work already. Oh, and I have a nice little inguinal hernia to one side of my symphysis pubis.

Midwife and physio are very nice and supportive and say I should be able to have a quite active birth at the hospital if I want, and that being in the birth pool will help if it's available the day I go into labour. I'm just wondering if the pain of SPD + labour will be really hideous, or whether, as annoying GP said, 'labour is so excruciatingly painful, you'll forget about the SPD'. The SPD is already 'excruciatingly painful' at times.

I'm really interested to hear anyone's experiences of SPD and birth, and how soon after birth you started to feel better from the SPD. Have been told the pain may go immediately or could drag on for a few weeks or months . I'm really looking forward to the baby and hope I can carry him or her around - at the moment I can't carry very much at all!

Hi there

Well it's not so bad during labour that I'm not doing it again! (I'm 37 weeks with DC2!)

It is pretty much true that during the labour you are so focused on the contractions that you really don't 'feel' the pain of the SPD but I did personally find that my legs got very tired and I would have loved to be in water! You need to find you maximum knee distance before you go into labour:

Move your knees as far apart as is comfortable. Measure the distance. Get a piece of string and use it to measure out that distance, then when pushing make sure your knees never go further apart than that. Have someone responsible (DP?) for making sure you are not encouraged to spread further than that and also avoid the dreaded stirrups for any stitching - my mw did my stitches with my knees up but feet on the bed and knees closer together.

That should save you lots of recovery time!

I took about 3/4 weeks to recover from the labour (mine was loooooong!) but with an active birth that is well managed you may find relief well before then. I class my recovery as from labour to being off the crutches and not really thinking about the SPD at all in day to day activities.

HTH xxx

Hi Duzida - I had quite bad SPD with my second pregnancy, although not on crutches. I didn't find the labour and delivery any worse than first time (much quicker in fact). I had a drug-free birth and felt really good pretty much soon afterwards. I did make sure I stayed in hospital for two nights (could have left the same day/next day), because I knew I would start doing things when I got home. The extra couple of days' rest was really helpful.

Try to rest as much as you can afterwards. Although I felt fine afterwards, I got tired legs much quicker when out walking as I had not really done anything for about 5 months beforehand. Remember you'll need time to recover your previous fitness level!

Would also second what Becca said about measuring the pain-free distance - they did this for me at the hospital too. Make sure all midwives/doctors/nurses know about the SPD so that they can make sure you don't get into any positions that will cause you damage.

I had SPD (needed a wheelchair to cope with Bluewater by 7 months, left work early), and an easy, easy labour. The pain-free distance is very important though - if you get shoved around it could cause damage you can't feel at the time, but will come back to bite you later. I had a obs. at the hospital do an internal at 8 months that left me hardly unable to walk afterwards, but my midwives for the labour itself were really clued in, and very careful not to cause any harm. I didn't need any internal exams (they could see from my breathing and temp. and the baby's heartrate that all was well), gave birth in water with just gas and air, and the pain from contractions honestly wasn't ever that bad. I am a wimp, too. Need to take pain meds to get my legs waxed, am scared of the dentist, you name it, I try to avoid it. I had nightmares before having ds about how painful it would be, totally freaked out on the subject. But it isn't that bad for a surprising number of women - there's a thread here on that, actually.

Unfortunately my SPD is still very faintly reminding me to be careful if I overdo it now, almost 8 months post-birth, but it's an echo of what it was. I'm double jointed and began to suffer at 13 weeks, so really not a great candidate for a fast bounce back. You may be luckier. I'm also feeding my son, so the hormones from that may still be having some effect.

I'd definitely fight for the pool all the way if possible as it supports the ligaments and joints. I actually felt less pain than I had in a long time, contractions or not, when I first went into that pool. It was bliss. My SPD at its peak was a shedload worse than my labour - and you get drugs if you need them for the latter, too! And whatever you do, avoid stairs in favour of lifts; if you can't, take them one at a time.

SPD and morning sickness were horrible - labour was a comparative cinch. I'll have far more fear about the horrors of being pregnant than giving birth next time; your GP can't ever have had SPD! And I was told by my physio that some women with SPD are believed to have easier labours because their pelvis is so open! That's what the ligaments soften for, after all.

I would get it written in your notes, in capitals, that you have SPD, and the safe separation distance. And then I'd make sure your birthing partner is willing to fight for you tooth and nail on the point, because if you're anything like I was, you'll be so stoned on the gas and air the midwives will be talking Greek and you won't be able to string a sentence together.

Done it twice. Wheelchair / crutches job with DS, had a back-to-back delivery as had spent 5 weeks in bed. Epidural, ventouse then forceps. Was far more mobile than I had been in weeks as soon as the epidural wore off (in fact got off the bed, walked to the bathroom, got in and out of the bath myself and came back only for DH to remind me that I couldn't have even got off the bed myself with the SPD before). Pain and mobility were 80% better and by the 6 week check with the doc, had gone completely.

Had it again with DD. Had another back-to-back (crappy pelvis turned her mid-labour), but delivery was fine. SPD was nowhere near as bad with DD as I saw the physio early on and she was fab (got referred at booking in with the midwife). I'm 3 weeks past the birth, and it's gone completely.

It sucks and I know some people suffer for months afterwards, but in my experience you feel a whole lot better after you've had the baby. I know that people kept asking me if I wanted to sit down after I had DS. I'd spent 5 weeks flat on my back, there was no way I was sitting down!

Let me know if you want to see my birth plan, I think it helped a lot that the midwives knew what I could / couldn't do.

I hope you have the same experience. x

((((duzida))))

I had SPD. What I found was that I did not notice the pain of labour as the pain of SPD was so bad. I was unable to walk without support a week before my daughter was born.

I had a lovely homebirth with just TENS for pain relief. My ligaments were so loose that I had a really quick second stage. SPD is hideous for every day life but it can make giving birth much easier for me.

I found it helped me to sit on a birthing ball.

thank you so much, all of you, I've got more information about labour from you in under 24 hours than my midwife or physio have been able to tell me to date!

I'm glad to hear that sometimes labour is more, er, fun than SPD as I have been dreading feeling something even worse. We'll see what happens, but at least baby will be getting out one way or another and things should get better! It will just be so nice to have him or her around with us on the outside - we'll be so happy to have the baby, even if he/she doesn't sleep/feed/stop crying. The pain and lack of mobility are tough because I'm off work but not really able to clear up all the crap in the spare room nest or meet up with friends often or even read a book - so it's quite boring, as well as being painful.

I'll remember that may take weeks or months to feel fully better post birth, but that maybe I'll feel miles better straight away. let's hope so. Ineedmorechocolatenow I'd love to see your birth plan, I think you can email/message me via my account, although not sure how that works.

Just hoping that noone else has the temerity to want to use the birth pools the day I get to hospital - I think there are 2 and one is usually free, but I can imagine I'd be trying to poke some poor woman out of the water with the rubber bit at the end of my lovely NHS crutch.

I've copied my plan here:

I have Pelvic Girdle Pain (PGP), which means that the joints in my pelvis are unstable and painful.

There are two main things that are important to me about my baby?s delivery.

• Firstly, it is important that I have a healthy baby
• Secondly, it is important that I, too, am healthy and able to care for my new baby and son. This means avoiding anything which may cause further damage to my pelvic joints.

My Labour

• I would like my husband, to be present at all times, whatever is happening to me, including if a caesarean becomes necessary
• I wish to be fully informed about any decisions or discussions about me or my care
• I wish to remain as active as possible
• I would like internal examinations to be kept to an absolute minimum. I find it painful to lie on my back; therefore I would like to lie on my side for internal examinations, if at all possible. When lying, I need a pillow between my legs
• I DO NOT want pethidine due to a horrible reaction I had last labour. I would rather have G&A, TENS, or an epidural, if it should become necessary
• If I have an epidural, care must be taken to minimise the abduction of my hips
• I only want an episiotomy if absolutely necessary. If the lithotomy position is needed, please take care to lift both legs at the same time, and for as short a time as possible.
• As far as possible, I do not want to have my feet placed on the midwife?s hips or shoulders as this will cause pain in my hips

My Delivery

• I need to avoid abduction of my legs. I would like to have a choice and deliver in a position that feels natural to me at the time, preferably on my side.
• I would like DH to cut the cord, if possible
• I would like baby put directly on my tummy (depending on my position)
• As far as possible, I would like to wait to feel a natural urge to push, rather than be told when

Birth of the Placenta

• If I?ve had a relatively short second stage, I would like to deliver the placenta naturally and I am aware that this may take some time. I had an infection after my last delivery due to retained products and therefore I am very reluctant to have syntometrine

My Baby

• I am happy for my baby to have the vitamin K injection
• I would like to breastfeed as soon as possible after the birth
• I would like to have skin-to-skin contact as soon as possible after the birth
• I would also like my husband to have skin-to-skin contact as soon as he can

After my Baby is Born

• I want to be able to leave hospital as soon as possible after the birth

Special Requests

• We may have music
• We may want to take pictures / video after the baby is born

Hope that helps (obviously some bits aren't relevant, but helps to see someone else's plan sometimes). With DD, everything went to plan!

I commented with my experience recently - the plus side to having mainly hormonal SPD that physios can't do anything about, is that it should get better soon after birth.
Which mine did, although I went back to the physios at 3 weeks saying 'the joints seem better but there's this other pain'

They pointed out Ihadn't used any muscles there for 5 months. D'oh! So was prescribed walking 30min minumum a day, at least 5 days a week. Which coincided rather well with needing to escape the house for my own sanity, and wheeling baby around to keep him amused.

We were supposed to measure my pain-free distance when I went into labour and MrNC was to make a loop of string to put round my knees to ensure no-one moved my legs too far. It got lost early on but the staff were all fantastic during labour. My SPD got even worse in labour so had an epidural for it, but otherwise all very smooth. Birth pool was great as was kneeling on beanbags.

I would make it very clear when you get to the postnatal ward that you will need your painkillers regularly and help picking up your baby. And once home swaddling blankets are great for helping you move your baby about, and bouncy chairs and rocking swings are fab for when it's early evening and you're just too physically tired to rock them yourself. I had been hoping to use a sling, but I couldn't in the early days and then got used to the pushchair (great walking frame!)

Oh yes - I saved a fortune by not being able to buy much before birth. If you're missing being able to buy cute baby clothes etc, I recommend Ebay...

I was advised to give birth in a supported kneeling postion by my physio. I was also advised to avoid being on my back. In the end I gave birth standing up.

My poor baby narrowly missed being born down the toilet.

My second stage consisted of about two pushes. I started off with a physiological third stage, but I got bored and had a managed third stage.

I agree reallytired - I gave birth on all fours leaning over the propped up bed-end. 20 mins of pushing and DD was in my arms. Oh and I had a mobile epidural which was fab as I could get on all-fours and feel the contractions but no contraction or SPD pain.

Agree - labour was easy compared to weeks on end of SPD! Just keep waddling around and don't let them spread your legs too much.

While I did end up in the lithotomy position, they were SO careful about lifting my legs up and down at the same time that I didn't do any damage.

Another possible bonus you might experience is that when the baby engages and the head stops resting on the rim of your pelvis the pain can ease greatly! I was so much better for the last couple of weeks after that happened!

Just take it easy afterwards, for a long time if needed- you stay stretchy for quite a while.

I gave birth kneeling up against the end of the birthing pool (giant bath, really). Was great.

Honestly, they say that SPD makes birth easier, because you're looser in the pelvis than most birthing women. I genuinely found SPD a lot more painful than birth, and it seems from this thread that I'm not alone.

I'm honestly so jealous of everyone whose midwives actually paid attention to their birth plans mentioning SPD. I wound up with a consultant shouting at me to hold my thighs back with my knees by my ears - when I couldn't physically do it, he harangued me for not trying. You might as well have asked me to snap my own finger apart. He then stuck me in stirrups with my legs wide apart for the next half an hour. My community midwife promised me that nobody would force my legs open past the point of agony, but that wasn't true once I needed a consultant. Fortunately, the SPD went away soon after the birth, and while I had some lingering joint issues, they've now cleared up.

I'm honestly not sure what to do this time around - I've hired a doula and I'm hoping that the staff will listen to her and DH even if they're not interested in listening to me or reading my birth plan.

duzida
i was lucky with dd2 my midwife was great when the consultants were holding my legs apart doing manual removal of placenta i was screaming in agony and she piped up shouting she has spd and they soon went easier on me...

i bounced on my birthing ball for most of the labour with dd2 or rocked on it as that was most comfy

you will just know what tgo do your instinct takes over

and like someone said before its not too hideous as im now pg with dc3

I'd make sure that your dp/dh yells about spd/pgp on your behalf. As others have said, sometimes it just gets ignored. I had it from about 30 weeks with the dt's, I was clear about it when I arrived at hospital, written all over my chart, physio ensured that. She also advised taking my own pillow/s for comfort. At our hospital, a red pillow immediately flags spd so I got a cheap one from Ikea.
Hope you recover quickly from it after the birth duzida, as most women do afaik. Mine's turned into a muscular problem, but the joint pain cleared up early on.

Tamlin - I sympathise. I explained to the obstetrician that I had SPD when she asked me to flop my knees apart, and she nodded, smiled, and said, "okay, now flop your knees apart..." I stupidly trusted that she knew what she was doing. Won't be doing that again.

The doula should be able to deal with the consultant. If all else fails, the magic words "medical negligence" may help.

Get the pool if you can, use those crutches! I had SPD from about 22 weeks and when the time came laboured on my knees and on a ball and gave birth on my knees in the pool and it was brilliant. I honestly enjoyed labour (somehow, although I ended up with a 3rd degree tear). Gas and air and TENS were a bit tricky and I'm not sure they helped; the water was bliss and as soon as I was in the pool I felt better than I had for months. The day after when I went to shower I found myself standing on one foot to wash the other and was overjoyed - it really was that quick. Now - 8 weeks later - I am not quite back to normal and when I walk a few miles it does kind of rattle a bit at the front - but I am hoping that is just a need to recover muscle tone.

Despite the tear I think I had the best possible labour because the water made it easy and I would not have had the stamina for a long hard slog, having been immobile for so long and so very unfit. Also, in advance, I did the crawling around exercises to line the baby's position up - I was afraid that not being mobile might hinder the baby's positioning. I have no idea whether what I did helped, I just had a need to try to do something positive instead of sitting on my arse the whole time and when the day came, the baby was the right way around.