Conditions & Advice: During Pregnancy & After
Osteopathic Treatment can support you throughout your pregnancy & afer
Symphysis Pubis Dysfunction (SPD)
SPD stands for Symphysis Pubis Dysfunction. It is a musculoskeletal complaint that may affect women during pregnancy. It doesn't indicate any harm to the baby which is still safely held within the protective confines of the uterus.
The Symphysis Pubis is the joint at the front of the pelvis between the two pubic bones. Normally this joint is held together by strong ligaments. The pregnancy hormones allow these ligaments to relax to enable the baby to pass more easily through the birth canal. In SPD the joint can become unstable and painful.
The most common complaint is pain at the front of the pelvis brought on by activity such as walking, climbing stairs or changing position at night. The pain can also radiate into the buttocks and low back or down the thighs. Movement can become difficult and in the most severe cases walking can be almost impossible. The onset of SPD can happen at any time during pregnancy, but usually starts after the first trimester. For some women it is a temporary discomfort, for others it is more severe. As the baby grows the pressure on the joint can sometimes increase and cause further discomfort. Sometimes a shift in the position of the baby in the womb can make a big difference. SPD usually settles down steadily after the birth of your baby.
If you suspect you may have SPD it is important to discuss it with your midwife. She can offer advice and help you plan for the birth. SPD doesn't mean you will need a caesarean, nor that the birth will be difficult.
There are a number of self help measures that are useful:
- Sometimes a simple pregnancy tubigrip is sufficient, but a ‘sacro iliac' support belt is a better option. Your midwife or osteopath will be able to help. If your SPD is very severe you may have to resort to using crutches.
- When rising from sitting or getting into a car try to keep your knees together. Try to avoid lifting or pushing heavy loads. Take small steps and don't rush.
- Don't overdo it: this could make matters worse. Regular rests are important. This can be tricky if you also have a toddler, so accept all the help that is offered.
- Sitting often relieves the pain, but sofas are not the best place to relax in pregnancy. Instead use a firmer, higher chair and keep your feet flat on the ground or raised on a stool. Don't cross your legs or tuck your knees to one side.
- In bed sleep with a rolled towel or pillow between your knees, this will keep the pelvis level. When you need to turn over, you could try moving via your tummy rather than your back. However in late pregnancy this is nearly impossible!
- As for exercise: swimming is often comfortable whilst in the water, but is not really advised with SPD. Breast-stroke in particular can increase levels of discomfort. Take extreme care with stretching exercises like yoga. The wide legged positions in particular are not advisable.
Finally, a visit to your osteopath can help to relieve discomfort and can help the baby find a more comfortable position to rest in the womb and thus relieve pressure.
Fetal Position & Birth
Delivering a baby is a natural process that has been going on forever. So why are almost 26.2% of babies delivered by caesarean section and a further 12.4% delivered by forceps or ventouse? (Figures from ONS maternity statistics 2013/14 for England). Part of the reason is fear of litigation by hospitals, part of it is due to women having babies later in life and part of it is due to modern lifestyles – working up to the last minute, too much time spent sitting, stress etc. However, there is a lot you can do to help yourself to have a normal childbirth.
The baby tends to lie facing the placenta, which is normally on the back wall of the womb. This naturally places the baby so that s/he is back to front. They will normally lie head down, which is more comfortable. You can encourage this optimal position by lying on your left side in the later stages of pregnancy, so that both you and the baby are supported by the bed. You can put a thin pillow under your tummy to make it more comfortable.
If the baby is not in the best position, there are several possible explanations. Perhaps the womb itself is an unusual shape or is flopped over or twisted. Your pelvis might not be the ideal shape. Or maybe the pelvis is out of position due to leg length difference or a fall onto the bottom. Your osteopath can check your pelvis for you. The placenta may be attached to the front, or low down in the womb. The baby may have the cord wrapped round his/her neck and can't move for fear of strangling himself. If there are twins, they will squeeze themselves in as best they can. If you can feel kicks pushing outwards your baby is probably back to back. If you can feel it nodding just under your ribcage, it is probably breech.
Your baby will move into a better position with a bit of help from you – unless it is impossible, such as when the cord is around the neck or the womb is an unusual shape. Pick a moment when the baby is active (sorry if that's 3am!):
- Give your baby room to move by standing leaning forward, with your feet wide apart – perhaps at the sink, or holding onto the banisters of the stairs. Let your lower back drop into a ‘swayback' position, relax your tummy muscles and rock backwards and forwards or side to side, keeping the knees slightly bent.
- Get down onto all fours, again with a swayback posture and relaxed tummy, and experiment with crawling, rocking back and forth and placing one knee onto a cushion, then the other and see which is more comfortable. Sometimes the baby will turn there and then, sometimes s/he does it while you sleep.
- During the day, avoid sitting with your knees higher than your hips. Lie rather than slouch on the sofa.
- Go for a swim – it'll give your back a rest and is perfect for helping the baby to change position.
- Find a local Active Birth Teacher to help you prepare for the birth.
- Ideally, give up work 6 weeks before your due date to allow yourself more time to exercise, relax and sit comfortably.
- Once you are in labour try to keep active and on your feet or knees, leaning forward with support from the furniture or your partner, so that gravity can help the baby to descend. Experiment with the positions described above to help your baby ease his/her position.
- If you have an epidural, try lying on your side (swapping over when the epidural is topped up) so that your sacrum (tailbone) can move out of the baby's way. Unfortunately this isn't always practical as the midwife may want to hook you up to various monitors, requiring you to lie on your back.
Caring for Yourself After Birth
The six week period following the birth of your baby is known as the post partum stage. Many changes happen to the mother during this period.
The placenta, producing the high levels of hormones that circulate through your body during pregnancy, is expelled from your womb following birth. The sudden cessation of the hormonal surge is a powerful physiological experience and ‘baby blues' may occur, usually experienced in the first week following birth. Accepting all the help that is offered can ease the strain, and try to make time for yourself as well as the baby.
Post-natal Depression (PND)
Post-natal depression (PND) is different from baby blues. It tends to kick in later – several weeks or months after the birth. Poor sleep that does not coincide with night time feeds, loss of appetite and a feeling of ‘can't be bothered' should be taken seriously. Your partner or friends and family know you well and may be better able to spot behaviour that is ‘just not like you'. Your Health Visitor will know what to look for and what questions to ask, but only if you admit to feeling low. Osteopaths believe that altered positioning and function of the pelvis following birth contributes to PND.
Changes to your pelvis
The pelvis undergoes huge changes both during pregnancy and delivery. Usually your body corrects itself, but stretched abdominal muscles, a sore perineum, tears, the pressure on the pelvic floor from prolonged pushing and the changes to bladder and uterus in the weeks following birth can all hinder this process, leading to pain and a feeling of instability. Births by Caesarean Section, the use of ventouse or forceps, episiotomy and epidural or spinal block can all have an effect on the comfort of the mother. Gentle activity and the use of warmth and massage can help low back ache, but if you notice ongoing pain or aches into your back, hips, knees or feet or if you would like a check up then see your osteopath for assessment.
Breast-feeding is great for your baby and for you - the hormones released during breast feeding help your body to return to its pre-pregnancy state - but can be hard work. Poor positioning can lead to sore nipples and aching shoulders, neck or upper back. Sit in a supportive chair with your back resting on pillows if necessary and use pillows to support your baby. Sometimes feeding whilst lying down can be a comfortable option. Stretch after feeding, gently extending your arms, moving your neck and wriggling your upper back. If you are bottle feeding, try to swap hands for each feed. Changing positions can help relieve postural tension and prevent the build up of pain. Feeding with either hand alternately also helps to keep the baby's neck fully mobile to each side.
Your diet is important too. If you are breast-feeding the amount of food you eat may need to be larger than usual. You will need to keep your fluid intake high as well. Following the birth you may continue to lose blood for a few weeks. The body's iron stores reduce in the latter part of pregnancy, so overall you may become anaemic. You probably feel tired and lethargic anyway from caring for the baby, but ask your GP for a blood test if you are concerned. As with PND, your nearest and dearest may spot the signs before you do. Floradix or Spa Tone tonics are good sources of iron for the post partum period. Tea and coffee inhibit iron uptake, whereas ascorbic acid (e.g. orange juice) helps the body to absorb iron.Back to top