What is SPD -Symphysis Pubis Dysfunction and what can I do about it?
What is SPD?
SPD – Symphysis Pubis Dysfunction, is a painful condition cropping up during pregnancy. It is caused by the hormone Relaxin. This hormone is responsible for softening the ligaments in the pelvis in preparation for birth. Women suffering SPD produce too much of this hormone and too early on in the pregnancy. This leaves the pelvis out of alignment allowing movement which causes the pain. Though the problem is caused by the hormone, it leads to a physical problem that requires treatment.
SPD is also known as Pelvic Girdle Pain (PGP). It is characterised by pelvic joint pain at the front or back of the pelvis. This pain can be constant but exacerbated by standing on one leg, climbing stairs, walking, rolling over in bed, or any movement requiring the legs being separated.
What can I do about it?
SPD can be treatable or managed by your maternity health professionals both antenatally and postnatally.
Your first call should be to your midwife or GP. They can refer you to an obstetric physiotherapist who specialises in this area of the body during pregnancy. As soon as you recognise symptoms ask for a referral because waiting lists can be long.
An obstetric physiotherapist can confirm SPD and provide you with exercises and ways of managing the condition to help with your day-to-day life. Depending on the level of severity, you may be fitted with a Tubigrip, a stronger pelvic support band or even crutches.
If the SPD fails to clear up postnatally, ask your GP for another referral. The physio can help you to come up with a exercise programme to help manage the pain and improve muscle groups.
Women with moderate to severe cases of SPD are likely to need pain relief. You must always consult with your GP before taking anything. Taking painkillers during pregnancy is never ideal but sometimes necessary. If you are prescribed codeine, do not use it during labour as it can depress the baby’s heart beat.
With very severe cases of SPD, women may not be able to walk at all. Those with a supportive family can hire a wheelchair, but for the moment, there is very little support or services available for women with the condition.
How will it affect my pregnancy and labour?
When giving birth, it is important to keep the midwives in attendance informed about what level of movement you have. Pain relief such as an epidural, will mask SPD, so make sure everyone in the room is aware of how far you can open your legs. If you find you are stuck with very unhelpful midwives, tie your legs together with a dressing gown tie at the maximum width they will open. Problem solved.
Practice birthing positions before going into labour or being induced. Work out which ones are the most comfortable.
Some women report finding it incredibly hard to get an elective caesarean, even with very severe SPD. If you are promised a caesarean section, make sure it is written in your notes by your consultant in large clear words.
Health professionals will be quick to reassure you that the recovery period following a caesarean is longer for SPD sufferers. This is highly subjective. It is a decision only you can make yourself.
Bristol mother of two Linda says: “I had bad SPD with my first child and severe with my second. For other issues I had a caesarean the first time around, but second time a vaginal delivery. I can honestly say I recovered faster with the C section. I was running around within 24 hours like normal. Eight weeks after giving birth the second time I still couldn’t sit down. Partly due to so many stitches and partly due to continuing SPD. I would pay for a C section third time if I have to.”
Living with SPD
If you have family, you will need their support as much as possible. Simple tasks such as washing up, vacuuming, going shopping, even having a shower can become an impossibility.
Tips:
Avoid stairs as much as possible. Use lifts, escalators and yes, even easy access toilets.
Bring as much as you need from downstairs during the day so you don’t have to keep going up and down.
Advise people to contact you on your mobile and keep it close to hand.
There is no shame in weeing in a bucket at home if the toilet is far away. Just don’t get the behind wedged in it.
Get a good V shaped support pillow, this is essential to place around your body and between your legs.
Rolling over in bed is one of the biggest pain triggers for SPD. Instead of rolling over, sit up and then lay down with your head at the foot of the bed and your feet at the top. This will stop the pelvic bones moving.
Put a plastic bag on your car seat or any seat – where it is safe to do so if you have children. This will allow you to move easily and keep your legs together when getting out of cars.
Shop online, search for deals where you can get your weekly shopping delivered for free.
Do the exercises your physio gave you.
Let your callers and the post person know it will take you ages to answer the door but you are in.
Avoid standing on one leg
Get:
Birthing or big exercise ball
V shaped pillow
Crutches
Any form of bath support
Wheelchair
Garden chair in the shower
Will it go afterwards?
Yes and no. Generally, midwives will advise that SPD will improve immediately after giving birth. But the honest answer is that it can take some women as long as six months before symptoms disappear. Some women may find they have SPD for life which will come and go according to hormonal changes within the body. Very extreme cases may need surgery.
What support is available to me?
There is scant support available to women suffering from SPD. Here are some places to get you going:
Home Start is a charity supplying volunteers with parenting experience to families who are struggling with aspects of home life.
Wheelchairs can be hired from the British Red Cross.
For the service in Bristol/South Gloucestershire phone 0117 3012600
If you are unable to work due to SPD, you may be entitled to claim a benefit. The process to claim benefits, especially sickness ones are actually very difficult for a ‘temporary’ disability.
For more information, visit: http://www.direct.gov.uk/en/MoneyTaxAndBenefits/BenefitsTaxCreditsAndOtherSupport/index.htm
If you already have a young child under the age of five, talk to you local children’s centre to find out if there are any services or support they can offer you.
Do consult the Citizen’s Advice or your local disability initiative.
http://nailseadisability.wordpress.com
Speak to your midwife and GP. Only a GP can prescribe pain relief
http://www.nhs.uk/Planners/pregnancycareplanner/pages/Backache.aspx
For more practical advice and support, visit: www.pelvicpartnership.org.uk