Dad's Page
We are aware that there is a need for more information and support for dad's whose partners are suffering from Pelvic Girdle Pain(PGP)/Symphysis Pubis Dysfunction(SPD). To say the least they are often left bewildered, confused and unsure about how best to help/support their partners.
We would like to have here also, a few personal accounts about how Dad's coped and what advice they would give to others in a similar situation so of this has affected you and you would like to share your experiences please get in touch with us by emailing info@pelvicinstability.org.uk Thankyou
Frequently Asked Questions
What is Pelvic Girdle Pain?
Pelvic Girdle Pain was previously known as Symphysis Pubis Dysfunction or SPD and these names are still commonly used. It is a condition which causes pain and mobility problems and is most often associated with pregnancy. The symptoms vary widely from mild occassional discomfort when walking to severe, debilitating symptoms which leave the women affected requiring crutches or a wheelchair.
How does it affect the women?
The symptoms, which can also vary quite significantly from day to day include:
- Pain in one or more joints of the pelvis, often affecting the pubic bone at the front or one or both sacro iliac joints at the back
- Pain in the lower back, hip joints or inner thighs.
- Pain in the groin or across the lower abdomen
- Pain and difficulty with walking
- Waddling gait
- Pain or difficulty moving their legs apart
- Difficulty with activities which involve standing on one leg such as dressing and climbing stairs
- Difficulties with activities of daily living including getting in and out of a car/turning over in bed and getting in and out of a bath
- Difficulties with household activities such as hoovering, lifting and carrying small children and pushing shopping trolleys.
- Clicking or grinding in the pelvic joints which may be heard or felt.
- It is not uncommon for people with pelvic girdle pain to also experience problems with leaking urine when they laugh, cough or sneeze (stress urinary incontinence)
- stiffness in the upper back
- knee pain or pain in other areas can sometimes be a side effect of pelvis problems
- Difficulty getting started walking especially after sleep
- Feeling like the hip is out of place or has to pop into place before walking
It is important that your partner's symptoms are properly assessed by a health professional, usually in the first instance your partner's GP, midwife or Obstetrician, not only to organise referral to a physiotherapist for further management and treatment but to enable other causes of pelvic pain in pregnancy to be ruled out.
As well as the physical symptoms listed above there are understandably often also associated emotional or psychological symptoms. If symptoms are being experienced after the baby is born or if you have young children already your partner may feel guilty that she is unable to fulfill her role as a mother and do the normal day to day things that the majority of mum's take for granted like bathing the baby and taking the kids to the playpark. She may feel frustrated at the loss of some or all of her independence and feel isolated and alone. You may feel angry and frustrated that what was supposed to be a joyous occassion has not turned out as planned and you may worry about what the future holds. Remember you are not alone with this problem. Early identification of the condition and appropriate treatment can reduce pain, increase mobility and lead to quicker recovery times.
What can I do to help?
Sit down with your partner and find out how pelvic girdle pain(PGP)/Symphysis Pubis Dysfunction(SPD) is affecting her day to day life. Find out what things in particular are causing her difficulty and figure out practical ways of making things easier. This may involve taking on the school run, asking friends or family to help with shopping or having children after school, asking neighbours for help with hanging out the washing, getting paid help with cleaning or organising extra childcare. Everyone is affected differently but problems which are commonly reported are lifting and carrying small children, pushing supermarket trolleys, household activities such as hoovering, bending down to pick things off the floor and getting in and out of cars. Shopping online is a good option if this is available in your area. Pushing heavy supermarket trolleys and carrying baskets of wet washing are to be avoided.Good regular communication is essential as symptoms also change and develop. Have a look at our practical advice and occupational therapy pages for more information.
What treatment is available?
The first step is to ask your partner's midwife or GP for a referral to a physiotherapist with experience in treating Pelvic Girdle Pain(PGP)/Symphysis Pubis Dysfunction(SPD). Depending on where you live this may either be an Obstetric Physiotherapist at the local maternity unit or a women's health physiotherapist who runs clinics at your local GP surgery/health centre.
The approach to treating Pelvic Girdle Pain has changed quite significantly over the last few years as more research evidence has come to light . This has demonstrated that in women with pelvic girdle pain/symphysis pubis dysfunction there is often an underlying mechanical problem rather than the condition being purely caused by the pregnancy hormones as was previously thought to be the case.
In some women there are differences in the amount of movement between the joints of the pelvis or alterations in the way that the muscles of the low back/pelvis/hip function to support the pelvis.
Women have found that "hands on treatment" during pregnancy to get stiff or stuck joints moving again and to release tight overactive muscles followed by exercises to get all the muscles in the lowback/pelvic/hip area working properly again can be very effective.
New Guidelines
Guidelines were published in 2007 by the Association of Chartered Physiotherapists in Women's Health and can be accessed by clicking here.
These guidelines are still fairly new and we are aware that not all physiotherapists are familiar/confident as yet with the recommended techniques. The traditional advice was to offer a support belt and if necessary crutches along with some advice regarding abdominal and pelvic floor exercises, however an individualised treatment and exercise programme is now recommended as women develop pelvic girdle pain for very different reasons.
We are developing contacts throughout the UK of practioners who are recommended for treating pelvic girdle pain so please contact us if you would like to recommend a practioner or if your partner requires assistance in finding one.
What other help is available?
Potentially lots but knowing how to access it is important.
If day to day activities such as bathing, dressing and cooking are causing difficulties a home assessment by an Occupational Therapist can be extremely helpful. There is often a high demand on their services and if there is going to be a delay it can be very useful to as to speak to them directly. Some items such as grabbers for picking things off the floor are relatively inexpensive and can be ordered through your local pharmacist. Your local Red Cross may also be able to help.
Organisation such as Home Start which operate throughout the UK can provide support and Shopmobility Schemes can make trips out to the shops possible again. Social services can provide a care package and home helps to assist with shopping, cooking etc but this does vary from area to area.
Will the baby be affected?
There are no reports of pelvic girdle pain affecting the baby.
What about the birth?
It is important that your partner makes the team looking after her aware of the fact that she has pelvic girdle pain(PGP)/Symphysis Pubis Dysfunction(SPD) and that this is recorded clearly in her maternity records. It would also be worthwhile getting her to write a simple birth plan with information about pelvic girdle pain affects her. If she has pain moving her legs apart then she should ask the midwife or physiotherapist looking after to measure her pain free gap which is the distance she can move her legs apart without pain whilst lying on her back with her knees bent. This should also be recorded in her notes. Your partners midwife or physiotherapist can also advise on suitable positions for labour and birth and on positions to be avoided. Have a look at the ACPWH guidelines for further information on suitable birthing positions.
Will a C-Section be needed?
Most women with pelvic girdle pain will not need a C-Section for this reason alone but it is hardly surprising that many women request one given the often terrifying reports of giving birth with pelvic girdle pain in the popular press and women's magazines. At the other extreme many women are told that their birth will be much more straightforward as their ligaments are "already so stretchy" and although many women with pelvic girdle pain do have very straightforward births for others it is not quite so straightforward as there does appear to be a tendency for some of these babies to lie in an OP position which can prolong labour and sometimes lead to intervention. (This is our own personal opinion based on our own experiences and those of others and and we are not aware of any research in this area.) Your partner's midwife can advise on optimal foetal positioning to get the baby into the best possible position for birth. For a small number of women with severe pelvic girdle pain and whose mobility is very restricted, elective C-section may be the best option but it is a decision to be made after a full discussion with your Obstetrician about the risks/benefits of the procedure.
How soon will it get better afterwards?
Research studies have shown that the majority of women (approximately 93%) recover within the first three months after giving birth. However a small precentage can, if the condition is untreated, continue to have symptoms which can persist for a prolonged period of time. We would recommend that any women experiencing symptoms after their baby is born to ask for referral to an apropriately trained physiotherapist and not simply "wait and see" if their symptoms settle down. In the research studies it was often women who has serious pain during pregnancy and pain for a longer period of time who were more likely to have ongoing pain after delivery and these studies looked at women who had no treatment for their condition.
What about future pregnancies?
This is a very individual decision and one that only you and your partner can make. Research indicates that having pelvic girdle pain in one pregnancy does mean that it is more likely to recur in a future pregnancy. However, as the reasons why it occurs are very different depending on the individual it would be worthwhile in the first instance asking for advice from the health professionals who treated your partner previously and who know her full history. They can give advice on fitness and exercises before conceiving and some physiotherapists offer a pre conception appointment. Other factors to consider are the care of your older child/ren and how your partner would cope should her pelvic girdle pain symptoms recur. Lifting and carrying small children is a frequently reported difficulty and for this reasom some health professionals advocate waiting until older children get past the lifting stage before trying for another baby. It would also be advisable to wait until any symptoms from one pregnancy have settled before conceiving another child.
Further general information for expectant and new fathers can be accessed on the Dad Info website.
A Dad's Account of PGP
An honest account of my/our experience with SPD/PGP
My name is Nick, long suffering husband of Rhonda (only joking)! We have two great children, Jack 3, and Katie 6 months. I would like to share my experiences (two) with you, perhaps more for the benefit of the Dads out there – that have been through, going through or about to embark on life with SPD/PGP.
Rhonda has suffered with this condition in both of her pregnancies each time it developed mid-term and she deteriorated quickly. The first time she started with a support belt then crutches and then a wheelchair. When the symptoms developed in our second pregnancy she was prepared with physio exercises, a grabber, carrier bags in the car to swivel into the car and a support belt. Later on she used the crutches and attended a twice weekly appointment with a great Osteopath, who helped relieve her symptoms and she would feel much better for a few days – which was great! Although we were always fighting against an ever increasing supply of hormones.
She described the pain as “it feels like I have smashed between the legs and hips by a baseball bat”.
During our first pregnancy, Rhonda’s condition deteriorated after week 22, I was working 12 hour days and coming home to do the cooking, cleaning, washing, food shopping, which I am not moaning about, it was a pleasure to be able to do even the littlest thing to try to get Rhonda to smile. During the second was the same as the above but I would feed, bath and put Jack to bed every night when Rhonda was at her most incapacitated
We have a great relationship and communicate very well, but it is really now whilst writing this about SPD that I realise how low Rhonda had become.
We were lucky that on both occasions Rhonda’s Consultants (different ones) had heard of SPD, the first time he just said – no worries I will book you in, and the second time round we fought (well Rhonda insisted) that she be given a C-Section date for 2 weeks before her due date. She was very scary at this point and her desperation for the pregnancy to be over was formidable. With not having any family living closer than 350 miles from us, this also helped me in arranging my paternity leave and extra leave from work – to have a date (if all went to plan) which it did.
The difference in Rhonda’s experiences are that first time round, she didn’t proper physio support or understanding or given information about the condition. After the first C-Section the maternity ward staff were not understanding, saying she would not be allowed home until she had a shower and was walking around. She could barely shift position in her bed what with the pain and post op wound. As you can imagine, I was pretty angry when I was in visiting but being new parents we both focused on Jack and getting all that under our belt asap. In the end (thank God) Rhonda had the presence and strong will to say enough is enough and discharged herself. At least at home I was there 24/7 to help her to the loo and wait on her hand and foot etc etc, this definitely helped.
Second time round, we were on our guard and although we gave birth in a different County some of the staff were ignorant and had no idea what the condition was about – at one point we had two nurses disagreeing with each other over how Rhonda should be cared for. One was trying to force her out of bed to have a shower (the next day) and the other was insisting that her catheter had to remain a further 24hours and that she was not allowed to move out of her bed.
We did not let this spoil the magic of Jack meeting his baby sister for the first time, a moment I will never forget.
Now onto little Katie, yes even after all the pain and suffering Rhonda and I decided to try for another…..we lost a baby in November 2007 but in March 2008 the pregnancy test was a clear blue as they say!
Now I hear you say ‘You wanted another…………?’ and my answer is yes. I blame myself and it is another lesson for you guys out there, either at the beginning of the road or already on the road in pregnancy. I opened my big mouth early on in the relationship way before little Jack was even a twinkle in my eye, and said ‘oh yeah, I’d love a big family, 4 or 5 kids would be great”! Now Rhonda remembered that and I think she thought that no matter what, I wanted more kids. After the bad time we went through and the hassle we had, I was quite happy with one and didn’t have plans to go through it all again, even thought Rhonda seemed to fully recover after 8 months. We then felt that it was the right time to have another baby and heard that everyone who had SPD in a pregnancy always had it in the 2nd and 3rd etc etc. we hoped we would be the lucky ones that it didn’t happen to, or it wouldn’t be as bad.
It was as bad but only in the fact that we had moved away from friends and family and were on our own, it made it very hard. I had started a new Job and people were quick to say oh dear and nod their heads offering what help they could. Although Rhonda really didn’t like to ask for help, or ‘put people out’ which always frustrated me.
Rhonda was very pro active and was in touch with the Physio almost immediately only to be told she hadn’t really healed correctly from the previous pregnancy, the last health service had let us down badly. Thank goodness the new one knew about SPD. She started physio, swimming and keeping positive and lost a stone in weight in preparation.
As soon as the symptoms came back, her Consultant put us in touch with an osteopath, I am 100% sure that he stopped the SPD being as bad as last time. Rhonda went twice a week and he did what he did brilliantly, taking away the lactic acid build up. This enabled Rhonda to walk with a better posture, but eventually he said he had done all he could and would continue after the birth. Rhonda still has her ‘bad’ days where she can hardly move out of bed and shuffles about groaning but considering she has not only a new baby to care for but a very active 3 year old who is into everything, she is doing a superb job.
In conclusion, to any one treading this path the following may help:-
*Disabled handles in the loo, this helps when lowering oneself down onto the loo. From any good DIY shop.
*A raised disabled toilet seat, this helps as the distance to drop/lower her down is greatly shortened.
*Silk sheets or no clothes in bed as this helps to move around in bed much easier as twisting with clothes getting caught up can be a hindrance. – Not for me though!
*A couple of good plastic bags for the car seat, this helps as the friction in twisting round, is very much reduced and the lady can sit and then turn and swivel into the car much more easily. I held Rhonda’s legs as she did this and put them in the car for her. (Obviously they were still attached to her)!!!
*Plenty of chocolate and biscuits - you try stopping a hormonal pregnant SPD suffer from having these!!
*Foot rubs go down well and lots of compliments.
*Communication is a big factor in making sure you both know how the other feels.
*Make sure your Doctor and Midwife know that you have SPD and are understanding especially during examinations. There are some very terrible stories of some suffers being bedridden for years after being forced to give birth ‘naturally’ bullied by so called professionals who have no understanding of the condition.
*Speak to as many ‘experienced’ people a possible, listen to their hints for an easier life. Just know that someone else is going through this does help.
*Make sure that the people telling you about SPD, have actually had a wife etc who suffered with SPD and are not just telling you about some one they knew and how bad it was, as a race we are very good at telling bad news much better than good. So take it with a pinch of salt unless you know that person has had hands on experience.
*Be there to listen to the moaning of your loved one, (having chocolate and tissues handy is a great idea).
*What affected me most of all was that I was constantly on the go, working full time and then full on with jobs when I got home, there was never a break for me. I was very tired all the time and coping with Rhonda’s emotions and frustration was hard work. Second time round was the biggest challenge as we had a little toddler to care for also, that required lots of attention. I am not moaning, but just being honest from my point of view, as Rhonda has said many times, people seem to forget that it is the husband/partner that also goes through a lot of stress and heartache. Especially seeing your loved one struggling, in severe pain and disabled during a time that should be special and exciting for you both.
There a few things that can really annoy, irritate and anger an SPD sufferer , they are: -
1. Medical staff that not only haven’t heard of SPD, but are not interested in it either!
2 For fellow Dads – Read up on the PINS website so you can fully understand the condition, the cause and the effects. Remain positive and believe that this will only be short-term and once the hormones have calmed down after the birth, things will get easier. It will add comfort to your partner that they know that you understand what is happening to them.
Wishing you all the very best.
Nick
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