Pubic Symphysis Separation & Pregnancy: Risks & Natural Delivery Options

Question
Hi Elayne,

I suffered from pubic symphysis separation after the birth of my daughter 2 years ago. She was only 2.7 kgs. I had no pain at all during the pregnancy. But after a normal delivery I could not walk, it was painful to move my legs. Took months of physio to recover.
I am now 28 weeks pregnant and have been feeling pubic bone pain since the first trimester.
Would you recommend I have a cesarean section to avoid further damage to my pubic bone? I would greatly appreciate your advice on the matter.
Regards,
Mai Tran

Answer
A cesarean section comes with a whole host of its own problems, and I would never recommend it for this particular situation.  A properly managed vaginal delivery will not cause you any further damage, and while you may be in severe pain during the third trimester, that pain will be 99% gone after delivery.  The key is to avoid giving birth with an epidural, or lying in bed on your back with your legs pulled back.  

You want to avoid the epidural primarily because it masks pain, and pain for you is a warning that you are about to do damage to your pelvis.  Without the pain signal, you can do great damage to that joint and have no clue what happened until it's already done.

The best position for you to give birth in is on your hands and knees.  In this position, your knees can be very close together, eliminating any torque on your pubic symphysis joint.  In addition, this position can increase the size of your pelvis by as much as 30% over lying in bed, meaning that the baby's head and shoulders won't put as much stress on your pelvis during the delivery.

My final recommendation would be to avoid coached pushing.  Wait until your body pushes on its own, uncontrollably, and push only with that urge.  This may mean you start pushing a little before you are 10 cm, or you may have to wait up to 2 hours after you are 10 cm.  But your body will know when it is ready to push, and if you can hold out until you just can't control it anymore, you will usually be able to push the baby out with minimal effort and less time.

Good luck!  I have dealt with severe SPD pain for two pregnancies now, and while it is hard to believe during the last trimester that everything will be okay in the end, the relief after delivery is incredible.