Symphysis Pubis Dysfunction (SPD) many american OBs don't even recognize this.Bear with me, this is a cut and paste from many different posts I have made when I was in the middle of this....
Many providers do not take you seriously. My own OB's office, who I think very highly of - tried at first to dismiss this as round ligament pain, I looked at the nurse and said,
"This is my third, this is not round ligament pain, I know what that feels like, it is not it."
Long story short - I have been diagnosed with Symphysis Pubis Dysfunction (SPD)
My personal issues were
- after I sat down then tried to get up -
- I couldn't stand, walk etc.
- It kept getting worse and worse.
- I couldn't turn over in bed,
- I hurt when driving a car.
- Stairs became murder.
- Swimming made it worse, not better.
I got a referral to a good PT and it turned out that my pubic bones were out of alignment by 2 1/2 inches. There are great exercises that can be done to put these back in place.
The symptoms of SPD vary from person to person, but almost all women who have it
experience substantial pubic pain.
- Tenderness and pain down low in the front is common, but often this pain feels as if it's inside.
- The pubic area is generally very tender to the touch; many moms find it painful when the doctor or midwife pushes down on the pubic bone while measuring the uterus (fundal height).
- Any activity that involves lifting one leg at a time or parting the legs tends to be particularly painful.
- Lifting the leg to put on clothes,
- getting out of a car,
- bending over,
- sitting down or getting up,
- walking up stairs, standing on one leg,
- lifting heavy objects, and
- walking in general tend to be difficult at times.
- Many women report that moving or turning over in bed is especially excruciating.
If you are experiencing this, take it seriously! There are major implications during labor and your OB and the staff need to be on board with this issue. My PT was really firm about this.
There is a great website -http://www.plus-size-pregnancy.org/pubicpain.htm please do not let the pluz-size part of this deter you. A person's size is not an indicator of SPD - it just happens that this is a great site on SPD.
The best exercise my PT had me do - lay on the floor on your back with your knees bent place a smaller ball - like those somewhat squishy soccer balls not a full size one - like a small basketball size. Squeeze. Keep your feet together. You will be shocked at how hard this is.
Anyway - once you do the squeeze for 5 sec. - (my husband usually does this with my by placing his first in between my knees - then - the next step is to place his hands on the outside of your knees (or you can use a tight belt) keep your feet together - start in the same position as if the ball or the fist was there and this time press out against his hand or the belt. Do this for five secondsRepeat 3X eachThen your DH should use two fist next to eachother - and repeat the exercised at that level. 3X eachThen the last set should be the width of the forearm. This I can do with the PT - but I can't do with my DH - it causes my hips to spread too far - his forearm is longer that my PT's - so we skip it =- you are not supposed to spread your legs to the point of hurting. That is dangerous - which is why you will also need to labor and push in different positions.
After my first appt - I was pretty good, somedays I had to do the exercises a lot - which is a pain - because I needed to use the ball and belt but you make do. I also wore a siloc belt whenever I will be sitting for an extended period or walking. Like I did a 2.75 mile walk the other day - and if I hadn't had the belt on - I don't think I could have made it You have to be really careful with these belts and make sure you are in postition when it is put on, or it can make it worse.
Another help - What the PT did was amazing! She massaged the muscles on the inside of my thighs which connect directly the the pubis synthsis joint - oh my - wow. At first it literally felt like a needle was being pushed at the muscle, then by the end it was just sore. After I got up - oh my gosh! I hadn't felt that good in a long time. She said those muscles were so tight trying to protect the joint.
For pain meds. I have darvocet - which is an enhanced tylenol. I shouldn't drive with it and it can make you sleepy - but if you only take it at night when you get home, you should be fine. tylenol - just the regular stuff doesn't cut it. Get yourself a referral to a PT. If your OB can't give it - get it from your reg Dr. This is not something to just pat someone on the back and say - tough it out. If the PT can get your joint back where it should be - you will be so much better off.
Now on the ice topic -
Better than heat - ice it. I am serious! It is strange at first to stick an ice pack you know where - BUT do it. Get the small lunch size ice packs that are flexible and freeze them in the shape that will comfortably fit between your legs. Ice for at least 20 minutes. The way my PT explained it, is if you don't get the inflamation down, the joint cannot even begin to heal. What I did is ice the pubic joint while applying heat to the inner thigh muscles at the same time. That will reduce the inflamed joint and relax all the inner thigh muscles that have tightened trying to protect the injured joint.
Seriously though!!! Ask your OB how she plans to handle delivery differently. A nurse at the hospital that I am going to said to have my Dr call that morning and make sure that he specifically requests a nurse with the most experience and that the charge nurse knows or understands the issue.
You should not be on your back and most importantly do not allow two different people to press on your knees. You are asking for not just a disruption - but also a separation. This is a lot more serious. I am bringing my doula into my PT in a few weeks and she is bringing a sheet of labor positions that she wants the PT to look over and let her know which ones would cause the most damage....
Remember if you have to sit - do not lean back like you are in a recliner. That feels good when you are sitting because the baby is not pressing on those muscles, but when you get up - you will be in more pain. Sit up straight. As the baby gets bigger - try pelvic tilts. They are great! Get on all fours and arch your back like a cat. Slowly - try to imagine lifting each part of your spine at a time. This moves the baby off that joint and actually is known to be great for making sure the baby is in a good position for labor.I will post my labor plan later... It involved exactly how I needed to birth. IE I could not have my legs more than shoulder width apart, I could not lay down, I could not be on my knees.... it was really involved. I used a high birthing stool, not the ones where you sqaut, but like you are sitting on the toilet. It was wonderful
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