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SPD
Self-help tips
- Avoid pushing through any pain. If something hurts, if possible
don't do it. If this type of pain is allowed to flare up, it
can take a long time to settle back down again.
- Move little and often. You may not feel the effects of what you
are doing until later in the day or after you have gone to
bed.
- Avoid heavy lifting or pushing (supermarket trolleys can be particularly
painful).
- When dressing, sit down to put on clothing such as your knickers
or trousers. Pull the clothing over your feet and then stand
up to pull them up. Don't try to put your legs into trousers, skirts
or knickers whilst standing up.
- When climbing stairs, go up them one step at a time. Step up onto
one step with your best leg and then bring your other leg to
meet it. Repeat with each step.
- Avoid swimming breaststroke if you can and take care with other
strokes. Swimming can often feel like it is helping whilst
you are in the water but cause an increase in pain when you get out.
- Performing regular pelvic floor exercises and lower abdominal exercises
can help to reduce the strain of the pregnancy on your pelvis.
To perform a safe and easy lower abdominal exercise, get down
onto your hands and knees and level your back so that it is roughly
flat. Breathe in and then as you breathe out, perform a pelvic
floor exercise and at the same time pull your belly button
in and up. Hold this contraction for 5-10 seconds without holding your
breath and without moving your back. Relax the muscles slowly
at the end of the exercise.
- You can get in touch with other women in your situation by contacting
The Pelvic Partnership, a charity which was set up to offer
support to women with SPD. The National Childbirth Trust also offers
information and support to women with a range of pelvic dysfunctions.
- Avoid twisting movements.
- Take paracetomol (suitable for use in pregnancy).
- Physiotherapy may help.
- Osteopathy may help.
- Chiropractic may help.
- Cut down on stimulants e.g. nicotine and caffeine as they
aggravate pain.
- Polarity Therapy - Elizabeth Noble, a physical therapist
and birth activist, wrote about pubic pain a bit
in her book, Essential
Exercises for the Childbearing Year.
She describes polarity therapy for pubic symphysis pain this
way:
- Lying on your side, a partner places
all five finger
tips firmly at the union of
your pubic
bones, and
the other
hand rests flat
on your sacrum.
The hands should remain still on these two points
until warmth,
tingling,
vibration, pulsing
or other
evidence of
your body's electric
field can be felt equally in your partner's
both
hands.
Usually only
one to two
treatments
is necessary.
I have successfully
used polarity balancing to treat painful PS laxity
for fifteen years.
- TENS - Some women report that TENS (Transcutaneous Electronic Nerve
Stimulation) has helped improve their pain.
- Pressure points - One mother with SPD reported that using pressure
points seemed to improve her
pain levels. Here is what she wrote about it:
- " If you can't [see a chiropractor],
I will tell you of an exercise you can do at home to help
relieve
some of the pain yourself! First, I know you are going to say, 'Yeah, right,
you've got to be kidding'
but you have pressure points
right on the top, corners and sides of your pubic symphysis bone [the pelvis].
Basically, lie down
flat on your back (or as
close to it as you can get!) and wherever you are feeling
pain, take your fingers or
thumbs and press
on those point for about 10-20 second at
each point and do this once or twice a day. It will hurt
like hell at first but it will
actually
feel a lot better once
you do it. It's even better if you can get someone else like
your husband to do it because
they will exert
a little more pressure
than you will let yourself do! Just grin and bear the pain
and I promise you that the
pain will subside
somewhat - maybe not all
the way, but it worked wonders for me! "
- Movement/strengthening therapies - Several women have reported
that movement and strengthening
therapies like the Alexander Technique and Pilates have helped them
postpartum. The Alexander Technique
is supposed to help
retrain you into more efficient and better muscle usage. Pilates is supposed
to work
on strengthening
the core muscle areas (abs, back, etc.).
However, some women report
that Pilates actually
worsened their back pain in the long run.
- Acupuncture - Acupuncture has also been reported to help pain levels.
It does not resolve
pelvic misalignment, but it has been used successfully to treat many different
types
of pain. Some
acupuncturists are
reluctant to work with
pregnant women; seek someone who is very well-trained and experienced in
working with
pregnant women,
even if you are postpartum.
- Homeopathy - Some women report improvement in pain with the use
of the homeopathic
remedy, Kali Carb, 30c. However, homeopathy is very much based on an individual's
personal
circumstances,
personality, and needs, and you would
need an
individual consultation to know what remedy would work best for you.
-
Herbs - Herbalist Susan Weed recommends Teasel tincture, which
is for "internal tears that are hard to get at," and
comfrey infusion (the
other name for Comfrey
is Knit
Bone).
- Pelvic support - A maternity support belt can offer extra
support and firm pressure,
which many women seem to find helpful. However, please note that if the
pelvic bones
are
not in the 'right
place', some women find that
a maternity support belt can make the pain worse. One physical
therapist at pregnancytoday.com wrote:
- If the pelvic ring, which includes
your pubic bones and sacroiliac
joints, is not
lined up
symmetrically,
using the reenie belt will
just increase the pain. This
is because
it serves
to compress
the front and back joints
of the pelvis which are out of
position...I recommend...a
physical
therapist
in
your area that specializes
in treating
pregnant women. The
therapist
can
evaluate
your
problem carefully, and,
if need be, provide hands-on treatment
to restore
normal joint
alignment.
Once you achieve that,
the reenie belt can do
its job of keeping the pelvis in alignment
and
will not
be painful.
- Use a pillow between your legs when sleeping; body pillows are
a great investment!
- Use a pillow under your 'bump' (pregnancy tummy) when sleeping.
- Keep your legs and hips as parallel/symmetrical as possible when
moving or turning in
bed.
- Some women also find it helpful to have their partners
stabilize their hips and hold
them 'together' when rolling over in bed or otherwise adjusting
position.
- Some women report a waterbed mattress to be helpful.
- Silk/satin sheets and nighties may make it easier to turn over
in
bed.
- Deep water aerobics or deep water running may be helpful as well
(there
are flotation devices to help you stay afloat easily during this; you do not
need to know how
to swim in order to do this).
- Keep your legs close together and move symmetrically (other sources
recommend
a very small gap between the legs with symmetrical movement).
- When standing, stand symmetrically, with your weight evenly distributed
through
both legs.
- Sit down to get dressed, especially when putting on underwear or
pants.
- Avoid 'straddle' movements.
- Swing your legs together as a unit when getting in and out of cars;
use
plastics or something smooth and slippery (like a black bin liner) on the car
seat to help you
enter car backwards
and then
turn
your legs as a unit.
- An ice pack may feel soothing and help reduce inflammation in the
pubic
area; painkillers may also help.
- Move slowly and without sudden movements.
- If sex is uncomfortable for you, use lots of pillows under your
knees,
or try other positions.
- If bending over to pick up objects is difficult, there are devices
available
that can help with this.
- Sciatica may be helped by stretching the hamstring muscles with
a stirrup
around your foot (long piece of rope, two neck ties tied together, etc.)
- Back pain can often be helped by resting backwards over a large
gymnastic
or 'birth' ball.
- Other tips include pelvic rocks, a lumbar pillow against the back
when
sitting, and very strong massage/counter pressure against the lower back. Pelvic
rocks (getting
on all
fours and then
slowly tilting the angle
of the pelvis back and forth) are general recommended exercises for all pregnant
women, plus
they
help
promote good
birth positions for
baby. They can also help ease tight low back muscles. It is usually recommended
to do 2-3 sets
of
40 of
these throughout
the
day. You can also do them sitting or standing against a wall,
but
on all fours is often most comfortable and has the added effect of helping the
baby's position,
which
may
be important with SPD.
- Lumbar pillows are very helpful to many pregnant women. If you
cannot
find one, try a small neck pillow (elongated like a tube), rolled up towel, or
tube sock filled
with
rice or flax seeds.
Put it behind your
back when sitting, wherever
it feels best; for some women this is down low in the
small of the back, for some it
is even lower against
the sacrum, and for others it feels best up high in the middle of the back. Socks
or pillows
filled
with
rice or flax have the
advantage of being able to be warmed in the microwave
before
using, which can feel really nice!
- Massage of the lower back or strong counter pressure in that area
feels
really great to some women. Some women like it just to the sides of their spine
(helps loosen
the
muscles
there), and some
like
it really low and farther out (there are trigger points there). Others like it
all up and down
on either
side of the spine. See
what
feels best to you
and go from there. If your partner's hands get tired (this
is a tough place to massage!),
try a rolling
pin, tennis ball, or
other hard object there. For women who like extra hard pressure on this spot,
try getting on
your hands
and knees
and
arch your back a bit, then have your partner put his elbow against the area that
feels best,
lean his
weight
on it, and
rub around in small
circles. For others who like more gentle pressure, hand or finger pressure may
be more than enough.
Planning for birth
Certain common obstetric interventions tend to make Symphysis
Pubic Dysfunction pain worse, and may even lead to ligament damage
or severe separation of the joint, causing true Diastasis Symphysis
Pubis. Therefore, it is vitally important that your doctor or
midwife understand and believe in the existence of SPD and realize
its implications for birth. The following ideas (taken from a
number of sources) are supposed to help maximize your comfort
and help the normal birth process, while also minimizing the
risk for pubic symphysis-related trauma.
Be extremely careful of birth positioning. Certain positions
are better than others. Avoid stirrups!
- Don't give birth on your back - Many cases of pubic symphysis
injury occur in this position.
- Don't give birth semi-sitting - this tends to force the baby's
head against the pubic symphysis, putting pressure on it
to 'give' more. It also prevents the coccyx/tailbone and sacrum from moving
out of the way during birth, and thus the only joint available
with any 'give' to it would be the pubic symphysis, which
puts it at greater risk for damage.
- Use 'alternative' birth positions - these include standing, kneeling,
and all fours in particular. Some doctors will 'permit'
women to use alternative positions until just before baby's head crowns,
but often want the woman back in the traditional stirrups
or semi-sitting position for crowning of the head and delivery of
the shoulders. However, crowning and birth of the shoulders
is the most critical time for prevent pubic symphysis damage, so
really look for a doctor or midwife that is willing to
'let' a woman be in whatever position feels best to her for birth.
If you must be in a more 'traditional' position because
of other concerns, try side-lying as this takes the pressure off of the
pubic symphysis and allows the coccyx and sacrum to move
somewhat. Otherwise, all-fours or leaning back over a birth ball may be
best.
-
Listen to your body - your body usually will tell you what position
you need to take in order to help baby out while avoiding damage
to your joint. For example, sitting forward in a "C" is
the position promoted in most hospitals, but arching the back
can be most helpful. This helps baby move under the pubic arch
and be born rapidly, while in the traditional "C" semi-sitting
position, there was no descent of the baby and great pain
instead. Other women with pubic pain have reported that
arching the back
during pushing was helpful too. Use the position your body
tells you to!
Be sure your midwife knows all about SPD, what movements
can hurt or damage you, and what your comfortable
range of motion
is:
- Work with a midwife that takes SPD seriously - many do
not really believe that SPD really exists or that it is a
serious concern for birth. If they do not really understand the concerns
of SPD,
they will not be as careful at the birth.
-
Work with a midwife that rarely uses interventions like stirrups,
forceps, etc. - If these interventions are not part of your midwife’s
normal procedures, chances are good that you'll
avoid them. If your midwife often uses these procedures,
chances are
they will
have a hard time avoiding them, even when they
know that they need to be avoided.
- Consider giving birth in a non-hospital facility or at home -
This might help lessen chances of damaging interventions,
since stirrups, forceps, and other routine interventions are done less
in these settings.
- Educate your midwife and other helpers about SPD - raise the
awareness of SPD problems so they can help you
avoid problems during the birth. Be sure to especially discuss with them
the importance of a 'narrow gap', avoiding interventions whenever
possible, and how to avoid placing extra strain
on the pubic symphysis area.
Avoid most common labour interventions, as these often cause
pubic symphysis strain/damage:
- Avoid the use of forceps or vacuum extractor - these may necessitate
opening the legs wider than the
pubic symphysis can safely tolerate.
- Don't pull your knees back too far - this puts a great deal of
strain on the pubic symphysis joint.
Be sure to let your midwife know not to do this!
-
Don't put your legs on your helper’s hips - again, this
strains the pubic symphysis joint.
- Minimize or avoid vaginal exams - positions for vaginal exams
tend to strain the pubic symphysis joint.
Do as few vaginal exams as possible (most are not necessary anyhow) so there
is less
frequent strain, and use as small a leg
gap as possible
if a vaginal exam must be done.
- Avoid an induction if possible - induction contractions are often
abnormally strong and difficult to handle
without an epidural to help, and this increases your chances of other harmful
interventions.
- Avoid breaking the waters early - since malpositions may be more
common with SPD, it is probably sensible
to avoid breaking the waters artificially during labour. If baby is malpositioned
and
the waters are broken, then baby often
moves down in that malposition, cannot turn, and gets 'stuck', necessitating
a c-section.
If
labor stalls around 4-7 cm or so in a
woman with SPD, then baby malposition should be suspected, breaking the waters
avoided,
and changing maternal posture utilized
to help baby turn.
- Avoid an epidural if at all possible, as this often
is associated with more
severe damage:
- Avoid an epidural so you can tell if damage is imminent - once
your feelings are deadened, you may not
be able to tell if they force your legs too strongly, and this is when many tears
or
severe separations occur.
- Avoid an epidural to lower the chances for forceps, vacuum extractor,
and stirrups - stirrups are standard
procedure in many hospitals with epidurals, and stirrups increase the chances
of damage.
In addition, one side-effect of epidurals
is to strongly
increase your chances of needing forceps or vacuum extractor
during pushing, which also necessitate a wider leg position and
increase the chance for pubic symphysis damage.
Use a 'narrow gap' position between the legs for
any routine procedures that can't be
avoided:
- Use a string to measure ahead of time the
widest comfortable position for your legs - have
your midwife
use that in labour to remind helpers of the widest position
that is wise.
- Use a 'narrow gap' only - if vaginal exams is truly necessary
or if any
stitching is needed afterwards, be sure to remind helpers to use a 'narrow gap'
only.
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