“... I have just helped a woman with quite severe SPD have her first baby. She birthed at home and the baby was born with her lying on her left side and keeping her knees together but knees bent up as far as was comfortable for her.
Basically SPD is of itself not a reason to fear a longer or a more difficult labour in fact some midwives feel that the SPD indicates a flexible pelvis which assists the labour to be shorter and easier.”
Mary Cronk, midwife, author and speaker.
SPD, or Symphysis Pubis Dysfunction is also sometimes called PGP, or Pelvic Girdle Pain. Symphysis pubis dysfunction is a condition that causes excessive movement of the pubic symphysis, either anterior or lateral, as well as associated pain, possibly because of a misalignment of the pelvis.
The main difficulty with SPD in labour is that it can be quite painful to open your legs wide. It can also cause damage to the symphysis pubis. One of the things that you should do is to find out how far apart it is safe for you to open your legs.
The SPD means that it will be difficult for you to give birth flat on your back, or in a semi sitting position. Most women also avoid squatting. Alternative positions, such as on all fours, standing, or lying on your side (usually the left) are better for giving birth anyway, and especially suitable for people with SPD. The physio may give you a loop to put around your knees to prevent you opening your legs beyond the safe point while giving birth, or you can make one yourself!
Theoretically birth should be easier – after all the pelvis has got extra give in it!
Write down how far apart you can comfortably move your legs, called your "pain-free gap", depending on what position you are in. Write the positions you prefer in your birth plan.
Your midwife and birth partner should make sure that you don’t widen your legs any further than is comfortable. It’s particularly important if you have an epidural, as you won’t be able to feel your pelvic pain. This may cause you to irritate or over-stress your joints without realising it.
You won’t need an epidural solely because of your SPD. But if you want one, having SPD won’t stop you.
If you need continuous electronic fetal monitoring during labour, your doctor or midwife will work with you to find a comfortable position that allows them to monitor your baby’s heartbeat.
Your maternity notes should mention that you have SPD. Midwives, obstetricians and ward staff need to be aware of the help you'll need if you have an assisted birth.
If your legs are lifted and placed in stirrups, it can put a strain on your pelvis, so this should be avoided. Don’t rest your legs on the midwife’s hips, as it may make your SPD symptoms worse.
Leaning over the end of the bed, kneeling will allow you to control how much you open your legs and also being upright allows you to work with gravity and also to allow movement to come from your tailbone as opposed to your pelvis. Kneeling and leaning across Birth ball may also be comfortable and allow rocking movement and many women like the all fours position as it disperses weight across knees and hands.
Bear in mind that labour is unpredictable. You may find that a different position from the one written in your birth plan turns out to be more comfortable.
It’s very rare for the position you adopt in labour to be the cause of problems in the weeks following the birth, but ask to have a follow-up appointment post-birth with your physiotherapist, just in case.
Did you have SPD/PGP in pregnancy? What was your experience of birth and beyond? I’d love to hear your thoughts and experiences - or you can join in the conversation on Facebook and Instagram @relaxbalancebirth. If you'd like more advise or to learn about positive birth - get in touch or browse my website and see how I can help you!
- Sarah x