Pubic Symphysis Pain during Labor and Delivery

“Please tell me I'm not the only one who has had pain like this, and that you can have the birth of your dreams when you feel like you can't even walk sometimes.”

“I have horrible pubic symphysis pain and I’m scared about labor.”

“Will birth make my pubic pain last forever?”

***Not sure what pubic symphysis pain is? Head over here to see what exactly it is and why it happens. Trying to navigate lightning crotch in pregnancy? Find out different exercises you can consider to help you get on your way to feeling better.***

Can I give birth if I have pubic symphysis pain in pregnancy?

First things first, only YOU can decide if you feel comfortable giving birth with pubic symphysis pain. My goal isn’t to persuade you one way or the other but to give you facts and support rather than fear… which is probably all that you are hearing.

Pelvic pain generally doesn’t limit birth options. During labor, our pelvis is designed to open and expand. Some women notice that once they are in labor and these natural changes are occurring their pubic pain goes away because the ligaments have done exactly what they need to do- stretch and open. Having pubic pain during pregnancy does not guarantee having pubic pain during labor. 

Labor and Delivery Considerations with Pubic Symphysis Pain / Lightning Crotch

One way to help relieve pubic symphysis pain during labor is to move. Ideally, you can move in whatever position you feel comfortable. This is a great time to listen to your body and baby—if you feel like walking, walk. If you feel like lying on your side, do it. There isn’t one position that is best so find what works best for you at that moment. 

There are positions that research has shown you may not find comfortable if you have pubic pain. Those include:

• Squatting: especially with your knees wide. Some mamas are able to squat if their knees are closer together

• Side-lying or half laying back with hips spread wider than 45 degrees

• Lithotomy: this is when a mama is on her back with her feet in stirrups pushing

There are also positions you may find more comfortable in labor:

• Side lying with hips spread less than 45 degrees: you have two options for this one…you can place a pillow between your knees for support or you can prop your top foot up on an object while keeping your lower knee level

• Semi reclined with knees on pillows

• Quadruped (all-fours)

  • You can modify this position by having your knees closer together and your feet further apart

  • For added comfort, someone trained in Rebozo can also help sway the hips to relax the muscles around the pelvis

• Upright kneeling

Cliff notes: Find a position that works for you and try to keep your knees closer together than your feet.

Is there anything I can do to help pubic pain if I have an epidural or give birth on my back?

If you lie on your back without support, your sacrum (the large bone between your spine and tailbone) can’t move and open. Our bodies are amazing and will steal that movement that it needs from somewhere else, generally being the pubic symphysis which can create more pain. If you have chosen to use an epidural or give birth on your back, you still have options! One of the easiest things you can do is roll hand towels (or partly rolled towels) up and place them on either side of your sacrum.

You can also place a pillow under your low back (follow the natural curve of your spine) to help promote extension. This is helpful because it allows the low back and hips a little more space to move and open. 

One key part that we often forget during labor is what the foot is doing. It’s common for mamas to have their feet in stirrups or a person holding their leg up during labor. Fun fact: when you bring your toes towards your head, you actually activate the pelvic floor which is great for exercise but not so great during labor when we want the pelvic floor to relax and lengthen. To help relax the pelvic floor, try to keep your feet flat on the bed. 

Cliff notes: Place a rolled up hand towel on the sides of your sacrum, have a pillow under your low back and keep your feet flat on the table.

If I have pubic symphysis pain during pregnancy, will I have it forever?

The majority of mamas (62.5%) will have spontaneous recovery of pain within one month after delivery. At 4-6 months postpartum, that goes up to 75% of mamas not being in pain. At the end of 6 months 92% are fully recovered. If you are part of the 8% who still have pain at 6 months postpartum, you still have options. Heck, even if you have pain one month after delivery, you still have options! I’d highly recommend finding someone in your area trained in pelvic floor rehab. They can evaluate the muscles, bones, joints and how everything is working. From there they can give you specific exercises based on YOUR needs to help you recover faster. 

One thing I want you to understand is how your mind is related to pain. There was an interesting study that showed the greatest predictor of pregnancy-related pelvic pain post delivery is the belief that you will continue to have pain. Your pelvic isn’t unstable. You are not broken. Working on calming the nervous system and having a positive outlook can help relieve your pain.

If I had lightning crotch with one child, will I get it again with the next?

I wish I could give you a better answer, but it’s basically a flip of the coin. Research has shown that 41-77% of mamas will experience the pelvic pain again with another pregnancy. One of the best things you can do is find someone trained in pelvic floor rehab postpartum or during your next pregnancy so they can help you get the care you deserve. 

Resources:

1. Howell, E. 2012. Pregnancy-related symphysis pubis dysfunction management and postpartum rehabilitation: two case reports. J Can Chiropr Assoc. 56(2): 102-111.
2. Leadbetter R.E., Mawer D., Lindow S.W. 2006. The development of a scoring systems for symphysis pubis dysfunction. J of Obstet and Gynac. 26(1) 20-23.

3. Prather H., Spitznagle T., and Dugan S. 2007. Recognizing and treating pelvic pain and pelvic floor dysfunction. Phys Med Rehabil Clin N Am. 18: 477-496.

4. Hastings-Tolsma M, et al. 2007. Getting through birth in one piece: protecting the perineum. MCN Am J Maternal Child Nurs. 32(3):158-64

5. Boissonnault JS. 2002. Modifying labor and delivery positions for women with preexisting spine and pelvic ring dysfunction. J of Sec of Women’s Health. 26(2).