QuestionI guess you could say that this is a 2 question question. I am 33 weeks pregnant due 1/21/07. I have been placed on disability from work and other activities (such as walking for long periods and sitting) since Oct. 15 for the reason of symphyseal seperation. What is this and should I be worried? I was told that it may have been caused by the birth of my last child (I have 2 other children)since he was over 9 pounds and because I had an excess amount of amniotic fluid with him causing my pelvic floor muscles to give out so early in this pregnancy. I have been in some extreme pain since the beginning of Oct. particularly if I raise up one leg at a time to put on under garments and pants. Sleeping is nearly impossible. I was also told that the baby is currently breech. Is this normal at this time in my pregnancy? Every answer I have read from this site about breech is that if the baby isn't properly turned by 36 weeks then I would be scheduled for a c-section around my 38th week. Is there anyway that I can get the baby to turn by then? The thought of having a c-section scares me.
AnswerWhat you describe is often called Symphysis Pubis Dysfunction, or SPD, and it is indeed very, very painful. It is caused by the joint in the front of your pelvis stretching too far. It doesn't really "separate", although they use that terminology; it's more like a sprain. I myself suffered with this during my last pregnancy, starting at 18 weeks. Nobody is really sure what causes it, beyond the fact that relaxin does open up this joint for delivery, and the joint sometimes comes apart prematurely or does not close properly. There is a great article on SPD here:
http://www.plus-size-pregnancy.org/pubicpain.htm
You'll want to be very careful in your movements until you deliver. When you stand up, always stand straight up, squarely on both legs. When you need to reach the floor, squat, again keeping your weight evenly distributed. The squat itself should not hurt the symphysis joint and will help relieve any lower back pain you may be having. Sit straight in any chairs; do not cross your legs, do not lean to the side or back. If you're watching tv or reading, sit cross-legged on the floor, with a pillow under your bottom if you need it. Stay off the couch, or only sit on the very edge with both feet on the floor. When you get dressed, sit on the edge of the bed to put on pants and shoes. If you live in an icy area, be extra careful; if you slip, even a little, you will feel a lot of pain, even if you don't actually fall. When you get in the car, sit down first and then swing your legs around; do the same in reverse when you get out. Everything you do should focus on keeping your weight evenly distributed between your hips. This will help minimize your pain.
I highly recommend you see a chiropractor. Although the adjustments may not make the pain disappear entirely, they may be the difference between being in pain and being able to function, and being in so much pain that you are bedridden. Also, a chiropractor experienced in the Webster technique may be able to turn your breech baby. Check with your local chiropractors and ask specifically whether they are experienced at working with pregnant women, whether they are familiar with SPD, and whether they can perform the Webster technique. You will also likely have better results from classic drop-table chiropractic than from the newer "activator" style of chiropractic alone, so ask about that as well.
At 33 weeks, you have plenty of time still for your baby to turn from breech to head-down. Check out this website on optimal positioning:
http://www.spinningbabies.com
One exercise in particular that I recommend will help both with your baby's position and with your pubic pain. This is the pelvic rock, also known outside of pregnancy as a cat stretch. On hands and knees, you slowly arch your lower back as high as it will go, tucking your pelvis in, then drop your lower back to the floor and arch your pelvis out. Do 40 of these in a row, taking about 2-4 seconds for each repetition. Then rest on your belly for 10-15 minutes (this is a good time to practice your Kegels and restrengthen your pelvic floor) to give your baby a chance to move. If you do not have a LoveSac or something similar (http://www.lovesac.com -- I love this while pregnant!), try a large pile of pillows to support you. Do these exercises at least three times every day.
Sleeping at night with SPD can be a nightmare. My midwife suggested a body wrap pillow to me which was a godsend. You can buy them for $50-75, or for about $20 you can make your own if you have a machine. I made mine about 11 feet long and stuffed it with 6 bags or so of polyfill. It was like my own little nest to sleep in, it supported my legs, hips and belly, and allowed me to sleep in relative comfort up until delivery. You can also use this pillow for resting on your tummy (see above), and for resting in various positions during labor.
Fortunately, once you get to delivery, your SPD should not be an issue. Make sure you do not end up in bed, laboring and/or pushing in the classic lithotomy position (on your back, legs pulled back, or even semi-reclined with your legs pulled back). This position WILL injure your symphysis joint and could make pushing impossible to bear. You will want to deliver either squatting or on hands and knees. I delivered my last baby leaning over the side of a birthing tub, so a variant of hands and knees. The key is to keep your knees as close together as possible, so as not to place any unnecessary strain on that joint. The joint will move to allow the baby to pass through, but you don't want it to move any more than it has to. Don't let your doctor push you into delivering in bed; this position exists solely for the convenience of the doctor, and is the absolute worst position for any mother to have to deliver in.
If your baby is still breech, you do not have to schedule a c-section at 38 weeks. You always have the option of waiting until you go into labor to do a c-section. This will allow your baby to choose his own birthday and ensure that your baby will not be born prematurely and potentially have breathing difficulties (if your baby is meant to be born at 42 weeks, and you take him at 38 weeks, you are causing him to be a month premature). Your second option is to find a provider who will perform a breech delivery. If your baby is in the frank breech position (buttocks presenting, both feet up), the American College of Obstetricians and Gynecologists (ACOG) actually recommends attempting a vaginal birth rather than automatically electing a c-section.
