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).

Pubis Pain aka “Lightning Crotch” or Pelvic Pain During Pregnancy: Part 2

Part 2 - Managing pubic symphysis dysfunction through exercise

Not sure what pubic symphysis dysfunction is or the causes? Check out Part 1 for more information!

The most important thing to know is that each mama is unique in her needs. For that reason, it is important to see a chiropractor or physical therapist with additional training in pregnancy and postpartum to find out what your specific needs are. With that being said, there are some general guidelines. Y’all know by now that I love mamas to stay active during pregnancy but there are some exercises that are best modified or temporarily taken out when you have SPD.

The ‘Don’ts’ of exercising with pubic symphysis pain (exercises to avoid with lightning crotch):

• Don’t over-stretch

  • Yes, it is possible to over-stretch, especially during pregnancy when relaxin and progesterone are helping muscles and ligaments relax in order to prepare for birth. If you are doing yoga or pilates, it’s a great idea to not push mobility at the end of any pose as this can increase your risk fo stretching too much and destabilizing the pelvis

• Limit single leg movements for a few weeks (2-3 weeks) and slowly add them back in your routine to see if you can manage the load. If not, that’s OK…you can take them back out. If they do not increase or cause pain, it’s a great idea to add them back!

  • This includes taking out lunges, bulgarian split squats, pistol squats, warrior pose, assault bike, and step ups as all of these exercises are one-leg dominant and can increase shearing on the pelvis.

  • Here’s the catch…some mamas actually benefit from single leg movements with a little modification. If you notice that deep lunges cause pain, you can modify it! First, try to change the position of your feet by bringing them closer together. You may notice that by bringing your feet closer together decreases your pain but still lets you use those muscles. This is great! You can strengthen this area and then try to increase the distance between your feet as you get more comfortable. The next thing you can change is the depth or how far down you go into the lunge. If a full lunge causes pain, try to lunge at half depth or a quarter of the depth. If you are able to do these without pain, that’s great - you should continue to do them! Our goal is never to exclude the movements you love but to work with them to see what can work with your body at this time.

• Use caution with traditional “core” exercises 

• Traditional core exercises like sit-ups and crunches focus on activating one or two muscles independently of the core system (diaphragm, pelvic floor and all abdominal and back musculature). Working these muscles can actually pull on the pubic rami and increase pain. Core exercises like the plank are advanced and require full pelvic/core stability and joint centration (the pelvic floor and diaphragm should be aligned). It is common for mamas to compensate during this movement as their natural gravity shifts and this compensation can lead to increased pelvic and low back instability.

• Watch deep squats or sumo squats

  • I love deep squats because the bottom of a squat is when the pelvic floor is most relaxed (hello benefits in labor) BUT that stretch can be too much with pelvic pain. If you notice pain with deep squats OR after deep squats, it’s okay to take them out.

• Adductor stretch or adductor machines 

  • The adductors are connected to both the inner thigh and the pelvis and can definitely play a role in pelvic pain. Like most everything, it is best to figure out if the adductors need relaxed or strengthened. If you are constantly stretching and they don’t feel better, they may actually need strengthened! Vice versa, if you’ve been working hard to strengthen the adductors but they continue to be sore, you may need to calm the signal from the brain to down regulate this pain. The best way to know this is to see a professional who can guide you in what your body currently needs.

• Fast/explosive movements 

  • We want to continue moving during pregnancy but fast and explosive movements require the musculature around the pelvis to respond quickly and when there is pain this reaction is often slower. It is easier to compensate and not utilize the appropriate muscles to create the force to stabilize.

Exercises that may improve pubic symphysis pain

• Focus on posture and pelvic alignment

  • As you stand and walk your diaphragm should be aligned with your pelvic floor — this is a neutral spine. If you drop into too much anterior or posterior pelvic tilt this can increase pain/pressure on the pubic region. So one easy exercise to stand in front of a mirror and focus on finding that neutral spine.

• BREATHE

  • As we inhale, our pelvic floor gently descends and relaxes and as we exhale it gently lifts and contracts. This is a normal progression with diaphragmatic breathing that naturally helps to activate the deep abdominal muscles and stabilize the pelvic region with the breath

• Balance strength and mobility

  • All movements should be slow and intentional to start to focus on maintaining task-specific pressure (that’s the amount of support/brace/natural tension you need to create to stabilize the body). This intention trickles down to balancing strength and mobility so we aren’t over-stretching or strengthening a muscle that does not have its full range of motion.

• Work the glutes and adductors in synergy through movement

  • Banded monster walks

  • Glute bridges with band around knees and yoga ball or block in-between knees

  • High Bear or low bear: with bands around knees and yoga ball or block in-between knees —> if you are able to do this and looking to advance the movement without doing a bear crawl, you can simply lift and hold one arm or one leg at a time

  • Hip Hinge or banded good mornings

  • 90/90 or Shin box flow: this is a movement where slow and intentional movements are best

• Work all of the core together

  • Box squats: i mentioned earlier that deep squats may not be beneficial but shortening the range of motion to the point before there is pain can be extremely helpful in pelvic pain and keeping pelvic mobility with core stability

  • Side bridge

  • Bird dog with pelvic floor focus and focus on breathing and elongating spine

  • Dead bug with focus on crossover

Part 3: Labor and Delivery considerations for pubic pain

Mama, if you are struggling with pubic symphysis pain or any pelvic pain, I understand the frustration, anger and fear that comes along with it. I believe that no woman should have to suffer through pregnancy or postpartum in pain. Call 331-307-7110 to schedule an appointment today or book online. Not ready yet? That’s OK, schedule a free 15-Minute Healthy Mama strategy session today to discuss your options.