From MIDWIFERY MATTERS, Spring 2000, Issue No. 84
Grainne O'Connor
WHEN I WAS A STUDENT MIDWIFE in 1993, my mentor - a sister working in the community would from time to time have client complaining of groin or low back pain.
"Ligament pain," she would say in a sympathetic way, "one of the joys of pregnancy, not much you can do about it."
She would then produce a maternity belt from her desk drawer, give it to the woman, and that was that. This, although I didn't realise it, was my first introduction to Symphysis Pubic Dysfunction (SPD).
My first pregnancy three years later went well. My husband and I attended yoga for pregnancy classes and I adopted the principles of optimal foetal positioning (OFP) with enthusiasm. I gave birth to my son relatively easily, at home, in a kneeling up position.
On my return to work in a different hospital, in a different part of the country, SPD seemed to have reached epidemic proportions. In a unit delivering 4,500 babies a year, the obstetric physiotherapist had treated 250 women that year with symptoms ranging from a dull ache when walking, to women requiring bed rest and using elbow crutches to walk. The hospital's five consultants had equally wide-ranging opinions. These ranged from: "It's a made-up condition that keeps obstetric physiotherapists employed", to consultants who worked closely with physiotherapists and, on occasions, anaesthetists to provide adequate analgesia for those women worst effected.
And what was my opinion? Pretty much what I had learned in the great oral tradition of midwifery from my mentor six years earlier... ...until of course it happened to me.
My second pregnancy was going well until, at 27 weeks, I began to have symphysis pain. I was job-sharing on a mixed antenatal/postnatal ward and I approached the obstetric physiotherapist for help. She assessed my range of movement, fitted me for a double Tubigrip and a Fembrace, and gave me some information from the The British DSP Support Group.
Gradually the pain increased, sometimes in my hips, sometimes in my lower back, mostly in my symphysis pubis. Some days were worse than others. My work colleagues were incredibly tolerant and helpful as I hobbled around. They assigned me the lightest workload or the bays nearest the midwives' station in an attempt to keep me at work as long as possible. The Tubigrip and Fembrace helped when standing or walking but proved inconvenient in the stand up/sit down work of the ward.
At home things were difficult. My son, now nearly three and equipped with an endless supply of energy, was learning what a sore pelvis was and why mummy couldn't lift him or run around the playground or walk without limping. My husband was trying not to look disappointed when the house remained untidy, the dog was not walked and his wife was crying over the dinner feeling like a wimp. When I discussed my symphysis pubis problem, my community midwife said what everyone else was thinking but was afraid to say: "Oh dear, and you have such a long way to go yet.."
I was fortunate at the time to have worked with an independent midwife - Chris Warren. I had done some antenatal and postnatal visits for her and had taught some of her Yoga for Pregnancy classes. I asked Chris to be my midwife and we set about trying to find things that might help.
Through trial and error we realised that most positions advocated in OFP were only bearable for 15-30 minutes. The best adaptation of this being kneeling on an armchair leaning over the back while watching television alternated with longer periods of rest sitting in the armchair with a cushion supporting my lower back. Basically the most comfortable position was the least conducive to OFP. The birth ball proved to be a winner with my son but wasn't supportive enough, and left me feeling unsafe while sitting on it. Leaning on it could not be tolerated for any useful period of time.
The British DSP Support Group had recommended osteopathy and this helped somewhat for short periods of time. In truth I was terrified that my long periods of immobility and poor posture would encourage my baby to adopt a posterior position and my plans for a straightforward home birth would not materialise.
Although few things helped, what really made a difference was the chance to talk about my fears for my forthcoming labour and to explore physically the limits of my capabilities. I feel I was fortunate to have a midwife who had the time to spend. I know that in my practice when I was a community midwife and in the hospital, the luxury of a two-hour antenatal visit is impossible. I felt a lot safer knowing I had a midwife who would attend my labour knowing exactly what my situation was and one who knew as much about SPD as me - particularly the guidelines for positions for delivery. It was a relief to know that I would not be at the mercy (as I saw it) of someone like me before I had learned from painful experience what it was all about.
In the end all was well. My daughter was born at home on August 2nd 1999, a day after she was due, after a very quick labour. So quick in fact, that she was caught by my husband 15 minutes before Chris arrived. I was in a kneeling upright position.
For most women and midwives the story ends ten days after the birth. For me my SPD was worse postnatally. My husband - a lecturer, had five weeks holiday in the summer. We had intended to have time together adjusting to having two children. I was barely able to walk further than a few yards. Chris came every day, she put the kettle on, let the dog out and entertained my son while I bemoaned my fate. She banned me from venturing out and constantly reminded me of the need to rest. She was an invaluable support.
So here I am six months on. I am back at work. My symphysis pain is resolving slowly and I am hopeful for the future. I have decided not to have any more children for fear of the same or worse happening again. I have heard of women suffering from as early as 12 weeks pregnant and for some women the recovery is never complete.
On reflection I wish I had known more about this condition and its more serious counterpart, diastasis symphysis pubis (DSP), so that I could have provided better care for women. There is so much to learn in midwifery, it is easy to adopt the sometimes inaccurate script of mentors. Surely things are different now? Unfortunately not everywhere.
Just last week while working I admitted a women who was experiencing quite severe pelvic pain . Her community midwife had produced a Fembrace from her desk drawer and had left it at that. There was no referral to a physiotherapist, no advise on dos and don'ts in pregnancy, labour or postnatally. She had no time to spare. Needless to say the woman felt she should just get on with it and stop complaining.
Is that not a recurring theme in a lot of women's health issues ? In my practice as a midwife I hope I will no longer allow this to happen.
For more information please contact:
The British S.P.D. Support Group (Formerly known as The British D.S.P.
Support Group) Providing Information and Support to Women with Pelvic
Dysfunctions.
British S.P.D. Support Group
Room 2, Mont Hamel House
2 Chapel Place
RAMSGATE, Kent CT11 9RY
tel: (01843) 587356; fax: (01843) 587523
email: info@spd-uk.org
The British DSP Support Group Website
(http://www.spd-uk.org)
See also: our Discussions on SPD from our UK Midwives and Consumers Email Group.
LW updated February 4, 2005