Pregnancy

Antenatal Care 

 

Please note:

 The new "umbrella term" for Symphysis Pubis Dysfunction(SPD)  is Pelvic Girdle Pain  and we have used this name throughout this website. However  Symphysis Pubis Dysfunction or   "SPD" is still probably the most commonly used name for this collection of symptoms and the one which you are most likely to come across  when attending for antenatal care.

 

Hints and Tips

Remember everyone is affected differently and the difficulties you may be having e.g with lifting and carrying, mobility, pain  etc may not be obvious to other people. Explain how  pelvic girdle pain affects you and  talk through any concerns that you have about the pregnancy, labour and birth or caring for your new  baby  with your midwife.

Antenatal Care

Ensure the fact that you have Pelvic Girdle pain/Symphysis Pubis Dysfunction(SPD) is recorded clearly in your maternity records so that all the health professionals involved in your care are aware of this.

If you are having problems  getting to your ante natal appointements because of mobility difficulties discuss this with your midwife. It may be possible to visit you at home  and if you do need to attend the hospital, scheduling all your appointments including physiotherapy for one visit can make a big difference to the amount of travelling involved. Negotiating hospital car parks and corridors are not easy at the best of times.

Birth Planning

Where you give birth is a hugely personal choice and depends on many factors including your current and previous obstetric history, the facilities available in your local area and your own personal opinions.

Depending on where you live you may be offered the options of giving birth in a community midwifery unit or a large consultant led maternity unit.  In addition, there are often midwifery led birthing units within large maternity hospitals. If you have a normal healthy pregnancy, homebirth is another  option you might consider.   The team responsible for your care  will be able to discuss all  your options with you taking into account your  own individual circumstances.

If you have pelvic girdle pain/symphysis pubis dysfunction having a supportive birth partner/s  and a midwifery  team who understand how pelvic girdle pain/symphysis pubis dysfunction affects you and what you can/cannot do can make a huge difference.

If you have pain moving your legs apart ask your physiotherapist or midwife to measure your pain free gap. This is how far apart you can separate your legs without pain while lying on your back with your kness bent. Make sure that this is recorded in your notes and that it is not exceeded during labour or any intervention that may be needed.

Discuss with your midwife and physiotherapist suitable positions for labour and birth which may include supported kneeling or standing, side lying with your upper leg supported, on all fours or  giving birth in water. Try to avoid giving birth lying on your back as this position is particularly unhelpful. Experiment with what position/s you find most comfortable before you go into labour. If you require intervention during delivery with forceps or ventouse make sure that your birth attendants move your legs symmetrically observing your pain free gap.  Ensure that your birth partner is aware of how your pelvic girdle pain affects you and what your pain free gap is.  Further information is available in the ACPWH Guidelines below.

It would be  well worth considering writing a  birth plan and include  information  discussed above about how pelvic girdle pain/symphysis pubis dysfunction affects you, what positions are comfortable, what your preferences are  for pain relief  etc.

Have a look at  Birthchoices , AIMS  and our useful links page for  further information relating to the options available to you regarding your maternity care.

 

Care on the maternity ward and after your baby is born

Explain what difficulties you are having to the staff on the maternity ward.  Practical things like  having  an ensuite room or failing this a room close to the toilets can make a big difference. If you are having difficulty getting to the dining room ask for assistance or request that your meals are brought to your bedside. Baby checks are another thing that sometimes require long walks along corridors - ask for help or enquire  if it is possible for the paediatrician to perform the checks at the bedside. Request assistance  if you are having difficulty lifting or caring for your baby. Some hospitals have facilities to enable your partner to stay overnight. Good communication with the staff caring for you is essential.

At home with your new baby

This is both an exciting and challenging time for any new mother and present s additional challenges  if you are experiencing pain or mobility difficulties. Help and support is available but knowing  how to access it is important.

Recovery time after the birth varies considerably. Some women notice an immediate improvement after giving birth, for others it is more gradual over days or weeks.Research studies have shown that the majority of women (approximately 93%) recover within the first three months after giving birth.

We will be updating this page shortly with information about potential sources of help for after the birth and how you might best gain access to them. In the meantime have a look at our practical advice, useful links and Dad's pages.

 

 New Guidelines

 Further information  can be found in the Guidelines recently published by the Association of Chartered Physiotherapists in Women's Health which can be accessed by clicking on the titles in bold below:

 Guidance for Mothers-to-be and New Mothers

 Guidance for Health professionals

These guidelines contain information about antenatal care, physiotherapy, birth planning and post natal care and have been written by a panel of experts.

 Awareness of Pelvic Girdle Pain is improving and you may find that if you have had a baby previously, that knowledge and understanding of the condition is much better this time round.

Frequently Asked Questions

 

Will it affect my baby?

No, Pelvic Girdle Pain has no effect on your baby. However if you do have symptoms which suggest you may  have pelvic girdle pain don't ignore them and get them checked out by an appropriately trained physiotherapist. Physiotherapy aims to reduce pain and improve mobility making it easier to manage your pregnancy.

Will I need a C-Section?

Most women with pelvic girdle pain will not need a C-Section for this reason alone  but it is hardly surprising that many women request one given the often terrifying reports of giving birth with pelvic girdle pain in the popular press and women's magazines. At the other extreme many women are told that their birth will be much more straightforward as their ligaments are "already so stretchy"  and although many women with pelvic girdle pain do have very straightforward births for others it is not quite so straightforward as there does appear to be a tendency for some of these babies to lie in an OP position which can prolong labour and sometimes lead to intervention. (This is our own personal opinion based on our own experiences and those of others and and we are not aware of any research in this area.)  Ask your midwife for advice regarding optimal foetal positioning to get your baby in the best possible position for birth and talk over  any concerns that you have with your midwife and/or Obstetrician.  For further information click here for an article on optimal foetal positioning from the homebirth reference site. For a small number of women with severe pelvic girdle pain and  whose mobility is very restricted, elective C-section may be the best option but it is a decision to be made after a full discussion with your Obstetrician about the risks/benefits of the procedure. Be aware also that recovery time from a C-Section is longer.

Can I still have pain relief?

Yes, all the usual options for pain relief are still available to you and what you choose is a very personal decision. If you elect to have an epidural make sure that the team responsible for your care  take particular care when moving your legs, making sure that  they move them symmetrically, observing your pain free gap. Research has shown that  having an epidural can prolong labour and increase the chance of an assisted delivery.

Learning relaxation techniques and other strategies for coping with pain can be very beneficial and our useful links page has  links to information about  hypnobirthing, natal hypnotherapy and yogabirth.

What about waterbirth?

Water can be of particular benefit if you have pelvic girdle pain as it can be a very  effective method of relieving pain and an excellent way of allowing more freedom of movement. Advance planning is important  and it is a good idea to talk to the team who are responsible for your  antenatal care  who wil take into account all aspects of your pregnancy.  The following is a link to a water birth story from the Chair of the Pelvic Partnership Sarah Fishburn. Click here to access the link

Will I be able to breastfeed my baby?

 There is no evidence to suggest that breastfeeding your baby will prolong your recovery from Pelvic Girdle Pain. Many women have successfully breastfed their baby while recovering from pelvic girdle pain and this  has many health and emotional benefits for mother and baby.

 

What about having another baby?

This is a hugely personal decision and one which ultimately only yourself and your partner can make. If you have had Pelvic Girdle Pain previously you will understandably be concerned as to how this may affect  a future pregnancy.  Research does indicate  that if you have had pelvic girdle pain previously it is more likely to recur in a subsequent pregnancy so it is a good idea to become as well informed as you can about managing pelvic girdle pain before embarking on another pregnancy. Much has changed in the last few years and  the new guidelines above now recommend a more active hands on approach to the physiotherapy management of pelvic girdle pain in pregnancy. It would be a good idea to talk with the health professional who  treated you previously about the implications of future pregnancy in your own particular situation.  Some physiotherapists offer pre conception appointments and having your pelvis checked, becoming as fit as you can be and planning ahead are things that can be very helpful in planning another pregnancy. Practical considerations such as whether your younger children still need to be lifted and carried are important too as lifting small children is a commonly reported difficulty  for people who have pelvic girdle pain.

Our  Pain Management page has information about pain relief options in managing Pelvic Girdle Pain/Symphysis Pubis Dysfunction.

Contact us

 If  you have any experiences you would like to share or if you would like further information or support on any  aspect of pelvic girdle pain including finding a physiotherapist with experience in managing pelvic girdle pain please contact us by  email at  support@pelvicinstability.org.uk or phone Moira on 01586 830323.

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The information on www.pelvicinstability.org.uk is for information only and is not a substitute for examination, diagnosis or treatment by a qualified health professional. Pelvic Instability Network Scotland (PINS) is a registered Scottish Charity SCO 39222. Copyright Pelvic Instability Network Scotland (PINS) 2008