QuestionHi, I'm 5 weeks pregnant my regular doctor has advice me that I'm a high risk pregnancy, I haven't been seen by any doctor as of yet because of my condition, nobody wants to see me, and the only appointment I been assign is for June 1. Can you please explain to me what are the risk that I have, because of the fracture bone that I have. I had this fracture when I had my first baby in 2003. I'm really desperate to get a answer, please.
Thanks
AnswerIf you truly sustained a pelvic bone fracture at any point in time, you may be in for a necessary c-section. However, it sounds like you have a widened pubic symphysis joint, also known as Symphysis Pubis Dysfunction or SPD. The pubic symphysis joint is a place in the front of your pelvis where there is a natural break in the bone, joined by about 1-3mm of heavy ligaments. During pregnancy, the hormone relaxin is produced to loosen up this joint (this is the same hormone that makes your feet get bigger and your joints feel loose all over). This normally serves a good purpose; when this joint becomes flexible, your pelvis is able to bend and flex during delivery, more easily accommodating the baby's head and shoulders, just like the baby's head molds to move through your pelvis.
However, the extra loosening also makes the joint more susceptible to sprains and strains, leading to SPD. This can occur if you are pushing in the lithotomy position, which is lying in bed with your legs held up. This position in particular puts inordinate stress on the pubic symphysis joint, causing extra damage in susceptible women.
It is likely that this joint damage will cause you some pain during this pregnancy. For a lengthy explanation of why this happens and tips for dealing with it, check out this website:
http://www.plus-size-pregnancy.org/pubicpain.htm
In particular, from my past experience with SPD, I recommend lifestyle changes (making sure you keep your weight balanced across your pelvis at all times) and chiropractic care.
When it comes to delivery, your main concern should be to stay out of bed. If you deliver instead on your hands and knees, you will eliminate the strain on that joint because your legs can be together instead of pulled apart. The lithotomy position exists solely for the convenience of doctors; it has absolutely no advantages for the mother, so don't let yourself be bullied into it! I myself delivered in a modified hands-and-knees position, leaning over the side of a tub, after a pregnancy with SPD so severe I could barely walk some days. If you are in a hospital, you can raise the back of the bed all the way and lean against it for support. As long as you keep your knees close together, you will reduce or eliminate the risk of further damage to your pubic symphysis joint.
Other than that, this should not cause any significant problems with your pregnancy that would label you as high-risk. If you are still being labeled as high-risk after your next visit, you should seek out a second opinion.
