Risk for pubic symphysis separation

[noahsmommy]

I recently found out that I am risk for separating my pubic symphysis. Has anyone had this happened to them during delivery? If you knew the risk before, would you have had a c-section instead? How was the recovery? I'm assuming without an epidural, that it must be very painful when it separates. Are there any delivery position that may lessen the risk of separation? (It sounds awful, and very looooong!) My rehab doctor suggested that I discuss the possibility of having a c-section instead of a vaginal birth with my OB.

This news has just thrown my DH and I a bit off. My first delivery was very quick and everything was fine. 6 hours of labor, only 30 min of pushing, and I had my little 6#, 5 oz. DS. We naturally assumed we would just go down a simliar path, if not even a faster delivery, since things a looser, etc... IYKWIM. I really do not want a c-section, but then again, I know I would regret not having one if I did separate.

The rehab doctor I saw is highly recommended, and I do respect her experience, however, there wasn't much she could do for me at this point besides recommend rest, try to keep my legs close together as much as possible and wear a custom fitted maternity belt. (There were things she could do, but they would be endangering the baby.) Is there anything else that I could do?

Any information you can give me, or even your opinions would be most helpful.


Ann

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[o_mom]

Here is one website with info:

http://www.plus-size-pregnancy.org/pubicpain.htm

While an epidural may seem like a good idea, it is actually associated with much greater damage as you cannot feel anything. It is very important to avoid a traditional birthing position (back, semi-sitting, stirrups) and really listen to your body. A Bradley class may be helpful in achieving this. Talk to your OB in depth about delivery position. Most will say any position is fine, but really want you on your back in stirrups for delivery.

[noahsmommy]

Thank you for the mentioning the website. I did find it earlier, and thought I'd see if I could get some additional feedback. I guess I will see what happens on Friday after discussing it with my OB.




Ann

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[o_mom]

You may want to google "Symphysis Pubis Dysfunction" as that is whar it is called in the UK. (It is relativly unknown here)

[Momof3Labs]

I separated my pelvis when I delivered DS2 a few months ago (drug-free vaginal birth). I'm at work right now so can't write as much as I'd like, but I'll try to remember to come back to this thread tonight.

One thing - we may have another child, and I would absolutely go for a vaginal delivery again, even though I am at risk for another separation. Major abdominal surgery with risks to baby and me, versus a separation that is painful but that I can recover from? I'll take the separation and associated recovery, honestly.

I am curious - why are you being told that you are at risk for a separation? They are quite rare. Have you seen a chiropractor? If not, you need to find one! Here's one link for you:

http://www.icpa4kids.org/research/articles/pregnancy/Pelvic_Pain.htm

[noahsmommy]

Thank you so much for mentioning that you would still go through with another VB even after what you went through the first time! I really needed to hear that I have friends that have had c-sections with no complications, but I'm not really too keen on major abdominal surgery, with the knowledge that I have the ability to have a straightforward VB experience.

The physical rehab doctor that I consulted with this week, has had lots of experience with women who have separated their pelvis from VB. My OB, actually, had pubic symphysistitis with her second child, so she was the one who recommended the consult. Now, my OB did tell me that there was no reason I couldn't have a VB. My DD is still head down, so I guess that's good news. But after the consult, I left really concerned. The way I understood it from the rehab doc, the ligment connecting the 2 joints is stretched out/loose, and the manipulations of VB (in the standard position) can make them separate. It's all a matter of degree and how much. She did say that there are women who don't separate, but there can be such pain and recovery afterwards that she's had many women tell her that they wished that they had a c-section instead. 6 weeks for a c-section vs the avg of 4-6 months for a separated pelvis. Basically my rehab doc was subtly suggesting that a c-section is a much better option than the recovery of a separated pelvis. She ended the conversation with the suggestion that I discuss it in detail with my OB.

If you wouldn't mind, could you tell me some more details when you get a chance. I had an epidural with my first (I had very severe back pain at 4 cm, and couldn't handle it until the relief of the epidural at 8cm). I was planning to have an epi with this one, but maybe I shouldn't. Though, I really cannot tolerate pain. And with how it feels just trying to open up for an exam at the OB's (sorry if TMI) I just cannot imagine tolerating the pain being 100 times worse during labor.

I didn't get the impression from either doctor that separation was rare, and they both seemed to be very familiar with SPS. I did google info on it, and there were lots of references to chiropractors in the information, but it seemed in reference to babies that were in odd positions and the importance of getting them to be in the right position.

I will definetely check out your link! Sorry for the long winded reply, btw!

Ann

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[Momof3Labs]

I'll type as much as I can (still at work, waiting on something).

I had pain in my pubic symphysis during my pregnancy with Colin, but it went away after he was born. Not debilitating, but it hurt to walk, sit, lay down - very hard to get comfortable. With my second pregnancy, the pain came back earlier. I found that if I stayed away from lifting anything over 10-15lbs and sitting much, I could keep it to a low roar. The lifting is critical - one lift of DS1 and I would feel it for a couple of days. Then I started to see a chiropractor, and after one or two adjustments, the pain was all but gone (unless I lifted something over my limit or had to sit for an extended period).

When Logan dropped at 37w, the pain started again. He dropped again about 3 days before he was born, and I was miserable. Spent most of my time either standing or laying on my left side - sitting was almost out of the question at that point. But I had high hopes that it would once again go away following Logan's birth.

The birth was beautiful. Just what I wanted. No IV, no drugs, no epidural. And he was positioned well so he came out easily with 20 minutes of pushing (Colin was 2.5hrs of pushing and still a high forceps delivery - he was facing the wrong way). My midwife and doula paid a lot of attention to Logan's position so that he wouldn't rotate and be harder to push out.

The morning after he was born, I felt great. I was moving around well and in good spirits. Then around noon, I started to get sore. It got worse and worse, and by evening, I could barely move out of bed. By the day of discharge, I couldn't walk without substantial assistance and, honestly, the pain was *bad*. And this is coming from someone who just birthed a baby without pain meds. An x-ray confirmed a 1.5cm separation in my pubic symphysis.

I ended up staying an additional four days in the hospital. I had 2-3 days where I could barely walk. By the time I went home, I could walk slowly without assistance, and my pain levels were manageable. Stairs were VERY difficult for a week or more. I rested in bed for about 2 weeks after getting home, and took it easy for another couple of weeks (minimized stairs and lifting). At 3 weeks post-partum, I returned to my chiropractor, and feel that his adjustments helped me heal much faster. I then started to see a physical therapist but feel like that helped me to a limited extent - many of her exercises aggravated some lower back and knee problems that I have, and I just wasn't up for more problems at that point.

I'm now 4 months post-partum and feel 95% or so healed (I've felt this way for probably 2.5 months). I still see a chiropractor as needed, and am more careful about sitting, lifting, etc. So I guess that I'm still recovering, but it isn't like I've been in significant pain for 4 months, kwim?

I'm surprised that both of your docs have told you that separation happens often. That isn't what I've been told. My midwife (30 years of experience) has seen it a couple of times. My mom's GYN (also an OB) has seen it twice or so (25+ years of practice). And I'm annoyed that the specialist told you there wasn't much that could be done and that you should have a c-section - because there is a lot that you CAN do to minimize any injury before or during childbirth. Never mind the risks to your baby of an elective c-section (at least a pelvis separation won't affect your baby at all).

Besides finding a good chiropractor, I'd also suggest getting a doula who can help you with pain management and staying in the right positions while laboring. It will be even more important to stay upright since laying on your back can cause the baby to rotate, which makes for a more difficult delivery (and harder on your pelvis). I believe that the site someone shared above talks about this, and www.spinningbabies.com talks about proper positioning (which is a lot more than head down) too.

OK, gotta run. LMK if you have more questions.