36½ weeks along:
I can now actually say I’m due ‘next week’. That is too bazaar. I’m still preparing myself for going longer, even though my measurements have been consistent to being due July 23. So, yes, I say next week, but I also know that it’s just an “estimated” due date.
After doing some research, it’s been revealed to me that my supposed pulled muscle in my groin that occurred in May actually has a name and wasn’t a pulled muscle at all! haha As most are aware, the pelvis maneuvers itself naturally during pregnancy in order to allow the baby to pass through. The gap between the two pubic bones at the symphysis pubis joint situated at the front of the pelvis will increase from a non-pregnant 4-5mm to a pregnant 6-7mm, not usually exceeding 9mm. This is due to the fact that ligaments which ‘tie’ the joint become slightly slacker under the influence of the pregnancy hormones relaxin and progesterone. An abnormal gap is considered to be 1cm or more, sometimes with the two bones being slightly out of alignment. This is called Symphysis Pubis Dysfunction.
Symphysis Pubis Dysfunction in pregnancy can result because of hormones, misalignment of the pelvis, or an interaction of the two (I believe what happened to me was the combination of the two). If the pelvis gets out of alignment, the bones don’t line up correctly in front, and this puts a lot of extra pressure on that pubic symphysis cartilage. Diastasis of Symphysis Pubis is the name for the problem in its most severe form (where the pubic symphysis actually separates severely or tears).
Symptoms of Symphysis Pubis Dysfunction include (all of which I’ve been experiencing with varying intensity) pain felt low down over the symphysis pubis joint, which can be painful to the touch; pain may also be felt in the hips, groin and lower abdomen and can radiate down the inner thighs; pain increase with walking and all weight bearing activities particularly lifting one leg like climbing stairs, movement in bed, getting in and out of the car, etc. Sometimes a “clicking” can be heard and felt and feel as though the bones are grinding together and opening the legs is difficult and painful.
Unfortunately, it was not extremely surprising to find that many in the medical community do not take the pubic pain/SPD seriously (especially the obstetric community). Often the pubic pain is attributed to the ‘normal aches and pains of pregnancy’ and is brushed off as no big deal. They often believe that no real physical therapy or treatment is possible while pregnant and that it is just a matter of waiting it out. It seems that seeing a chiropractor is the most effective way to treat the problem and alleviate the symptoms versus the alternative of drugs, surgery or nothing at all.
Because of this issue, I’ve had to prepare and consider the area concerning labor. Thankfully, many were already in our consideration because we’ve been planning a homebirth. God is so good!
Position is the greatest consideration and praise God, He’s been preparing me for this already. I shouldn’t give birth on my back because many cases of pubic symphysis injury occur in this position (among many other things which we’d already determined I would avoid this position) or semi-sitting because 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. Stirrups should also be avoided. This widens the gap between the legs and strains the pubic symphysis. The ideal positions include standing, kneeling, and all fours in particular (which I’d been planning for – as well as squatting but this should be avoided with SPD because it does puts strain on the pubic symphysis and increases the risks of it separating severely or tearing).
Searching for a provider that is comfortable using these positions throughout labor is important because though some doctors will ‘permit’ women to use alternative positions, they’ll only allow it until just before baby’s head crowns, and then wants 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 preventing pubic symphysis damage, so the search for a doctor or midwife that is willing to ‘let’ a woman be in whatever position feels best to her for birth is a necessity. Side-lying is a good alternative to the back 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. Thankfully my Physician cares more about my life and safety than even I do! 😉
Arching the back has been found to be most helpful because this helps the baby move under the pubic arch and be born rapidly. Other women with pubic pain have reported that arching the back during pushing was helpful too. Use the position your body tells you to!
Labor interventions often cause pubic symphysis strain/damage as well and should be avoided. These interventions include:
- the use of forceps or vacuum extractor (may necessitate opening the legs wider than the pubic symphysis can safely tolerate – among other things),
- pulling knees back too far (puts a great deal of strain on the pubic symphysis joint),
- putting legs on attendant’s hips (again strains the pubic symphysis joint),
- minimize or avoid vaginal exams (positions for vaginal exams tend to strain the pubic symphysis joint. As few vaginal exams as possible -most are not necessary anyhow- should be done so there is less frequent strain, and use as small a leg gap as possible if a vaginal exam must be done),
- avoid induction (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 labor. 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 (this often is associated with more severe damage. If you get the epidural, your less likely to tell if damage is imminent -once 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. Avoiding an epidural also lowers 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 coaches use that in labor to remind nurses and other attendants of the widest position that is wise. Only use a ‘narrow gap’ -if vaginal exams are truly necessary or if any stitching is needed afterwards, be sure to remind the providers to use a ‘narrow gap’ only),
- research and understand the signs of a baby malposition (baby malpositions may be more common in women with misaligned pelvises and pubic pain, and this can cause a more painful, difficult labor. Understanding the issues and knowing the symptoms may be very important in avoiding such a labor. Understand how to prevent malposition or turn a malposition during labor – There are things that can be done to help avoid a malpositioned baby or even to help turn one during labor. Educate yourself more about this so that you can be proactive about prevention at home and pass on the info to your provider).
Again, I share my experiences to help someone else who may come to this in the future! Be blessed!