Today, Katie McGee, PT,  DPT, a physical therapist specializing in pelvic floor health for the childbearing year.  From time to time on Connecting the Dots, they will be sharing information and resources that will be valuable to educators and the families they work with in a new series called The Body in Birth.  If you have pelvic health questions, please let me know and I will work with Katie to get your questions answered.  I am grateful that the topic of pelvic floor health during pregnancy and postpartum is being discussed, as many people suffer in silence and without helpful resources. You can find all the posts in this series here. - Sharon Muza,  Community Manager, Connecting the Dots

Introduction

Childbirth educators serve a unique role in helping pregnant people understand their bodies and the physical challenges of growing a baby. Unfortunately, one common challenge is joint pain. In particular, pelvic joint pain affects 16 to 25% of pregnancies, with onset anywhere from the first to third trimester (Kanakaris, 2011). This article will give you answers to the seven most common questions childbirth educators get about pain in the pubic symphysis—the joint at the very front of the pelvis that expands as pregnancy progresses.  

1. What does pubic symphysis pain feel like?

Sometimes pubic symphysis pain can feel like a slight pinch or ache. Other times it hurts so much someone will not want to walk. In certain cases, the pain will not be over the pubic symphysis, but in the creases of the groins or along the inner thighs. Occasionally, pain is only felt on one side of the body. Pubic symphysis joint pain is commonly provoked by moving the legs apart, such as getting in and out of a car, climbing out of bed, rolling in bed, or going up and down stairs. Standing up from prolonged sitting, particularly on a soft couch, is another known trigger.

2. Do I need to tell my midwife or doctor about my pain?

Yes! Any time a childbirth student has notable pain, they should be directed to a knowledgeable medical provider for diagnosis. The medical term for problematic pubic symphysis pain is symphysis pubis dysfunction (SPD).

3. Is pubic symphysis pain treatable?

Yes! There are a number of at-home treatment options including rest, bracing, and following self-help tips. Many people with pubic symphysis joint pain in pregnancy also benefit from physical therapy, massage therapy, acupuncture, or chiropractic care. Here’s a list of self-help tips you can share with your students. 

Walking: Walk with shorter steps to decrease pubic symphysis irritation. When carrying items, wear them in a backpack or hold them close to the chest to avoid uneven loading of the pelvis causing pain.  

Sleep: Keep a pillow between the legs that spans from the knees to the ankles (not just between the knees). 

Rolling over in bed: To go from one side to the other, (1) bend knees to 90 degrees, (2) tense the belly gently for stability (sometimes doing a Kegel helps too!), and (3) roll with knees, hips, and shoulders in line like a log. Avoid flopping side to side in bed or letting the spine twist. 

Dressing: Sit down on the edge of the bed or on a chair to get dressed. Standing on one leg can irritate the pubic symphysis. 

Stairs: Face the railing and try going up stairs stepping to the side. Alternatively, take the steps one at a time to avoid a large movement with the pelvis. 

Car: When getting in a car, turn their back to the seat and aim their bottom in. Once seated, keep the knees close together as they slowly turn to face forward. Getting out is the same process in reverse. Keeping the knees close together helps prevent the pubic symphysis from feeling pulled on. 

Sitting: Rest as evenly as possible on their sit bones. Consider putting a pillow behind the back for support. Avoid slumping or leaning on one sit bone more than the other. Sitting on a large exercise ball (about 65 cm) may offer relief of pain. Avoid sitting cross legged on the floor. 

Sexual activities: Aim to keep the knees together as much as possible. This may require some creativity for positioning (think spooning or using a chair). 

4. Are support belts a good idea? 

Most, but not all, people with SPD feel less pain and have an easier time walking while wearing a support belt. One of the most common support belts for SPD treatment is the Serola Sacroiliac Belt. Another common support belt is the Upsie Belly. Many support belts can be purchased using a Health Savings Account (HSA) or Flexible Health Savings (FSA). Some people use a support belt just when they need more support, such as for a walk around the neighborhood. Other people wear the belt 23 hours per day, just taking it off to shower. Many people take them off for sitting. Sometimes people find that they need help from a physical therapist or chiropractor to adjust the pubic bones before splinting them with a brace. 

5. What should I expect during birth?

It is safe to labor with pain in the pubic symphysis joints, and this pain does not change the physiological process of birth. However, many birthing people find it helpful to adjust their positioning in labor and delivery to manage discomfort in the pubic symphysis joint. While going through contractions, positions that take weight off the pelvis may feel better. These positions include resting the upper body on an exercise ball, slow dance, being in a tub or pool, and sidelying. During pushing, hands and knees and sidelying are frequently more comfortable positions. Common positions to avoid if possible include one or both knees to chest, lunging, and climbing stairs. 

6. What should I expect after I give birth? 

Right after birth, the pubic symphysis pain may suddenly go away or it may feel worse from the physical rigors of labor. The first few days postpartum are often the most challenging, and a walker or wheelchair may be needed temporarily. Wearing a support belt is often helpful. If SPD is treated, most people get back to an active lifestyle by three to four months postpartum. 

7. What about a future pregnancy?

Joint pain that occurs during one pregnancy is worse during a subsequent pregnancy, unless the underlying risk factors are addressed (Kanakaris, 2011). Early use of interventions to manage pain, such as a support belt or targeted exercise, can lead to a more satisfying pregnancy experience overall. On occasion, a person who experienced a traumatic pubic symphysis injury during birth will choose an elective Cesarean for the following birth. A Cesarean is not required in these cases, but it can help the birthing person to feel more in control and to avoid a triggering experience.   

Conclusion

Childbirth educators can be a resource for class members who are dealing with symphysis pubic dysfunction and are uncertain about what they can and should be doing and what to expect during pregnancy,  labor, birth and postpartum.  Educators can help provide information to direct families to support for this painful condition.

Resources

Websites 

Baby Centre 

UK’s National Health Service

Finding a pregnancy physical therapist

Pelvic Rehab

American Physical Therapy Associations

Global Pelvic Health Alliance

Kanakaris, N. K., Roberts, C. S., & Giannoudis, P. V. (2011). Pregnancy-related pelvic girdle pain: an update. BMC Medicine, 9(15). https://doi.org/10.1186/1741-7015-9-15

About Katie McGee

Katie McGee, PT, DPT, (she/her + they/them), specializes in helping pregnant and postpartum people overcome pain and pelvic health conditions. Her approach includes thoughtful listening, targeted exercise, and hands-on techniques. Katie regularly coordinates with clients' healthcare team and doulas for optimal outcomes. Home visits are available throughout the greater Puget Sound region. You can reach Katie through her website.

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