SPD/PGP - Advice and Information for Friends and Family
I have written this article to try and give some information to the family and friends of those who have been diagnosed with, or who are suffering from SPD. It is particularly written for the partner of the SPD sufferer, however much of the advice is applicable to anyone who knows someone with SPD.
I have found through my own experiences that there is information and support available for those who are directly affected by the condition and friends and family will often call up to ask how they are and what they can do. However often the loved ones of the person with SPD are struggling to come to terms with it themselves, to understand what it means and to find out how they can help. This guide is designed to offer help, information and support for those people who know someone with SPD and want to be able to help.
What is SPD/PGP?
SPD is now often referred to as PGP which stands for Pelvic Girdle Pain. This term was changed to fit with European Guidelines but many sufferers feel the term is too generic and doesn't adequately describe the condition or its implications. For this reason I will continue to refer to this condition as SPD throughout this article.
SPD stands for Symphysis Pubis Dysfunction. SPD is a very painful condition, causing pain in the groin area, hips, coccyx, thighs, lower back and surrounding areas. It is caused during pregnancy by the production of the hormone Relaxin within the body which softens the ligaments in the pelvis in order to make the baby's passage through your pelvis as easy as possible, it is not know why some women produce too much of this hormone but it causes the ligaments to soften too much, which allows for increased movement in the pelvis. This can lead to a great deal of pain and discomfort, resulting in some cases in limited mobility.
There is no way of knowing who will develop SPD during pregnancy and it can happen to anyone, however some factors do mean certain people have a greater risk of developing SPD. These are;
- Having had SPD in a previous pregnancy
- Having had previous trauma to the pelvic area
- Having increased joint mobility (ie. Hypermobility syndrome)
- Being overweight at the time of pregnancy
- Doing too much strenuous work during pregnancy, such as heavy lifting
The symptoms and severity of SPD can vary from person to person. Some people only get mild discomfort from time to time and are able to carry on a fairly normal life, as long as they take things easier, avoiding the things that cause the most pain (for example, doing the vacuuming). Others get far more severe pain and have difficulty walking. In these cases it is sometimes necessary to use crutches or even a wheelchair to help with the pain.
It is estimated that as many as 1 in 5 women experience some pelvic instability during pregnancy. Around 5-8% of these will experience more extreme pain and difficulties and in around 7% of cases, pain and instability can continue, post pregnancy.
The SPD symptoms can start at any time during or even after pregnancy, this can be as early as the first trimester but in some cases it doesn't start until labour or the first few weeks after having given birth. Regardless of when the symptoms start it is important to get it diagnosed as soon as possible so that the sufferer can get help with managing the pain and to prevent the condition continuing long term.
Some doctors still struggle to diagnose SPD and in cases, put it down to 'one of the aches and pains of pregnancy', if you suspect someone you know has SPD make sure they push for a proper diagnoses and a referral to a physiotherapist as this can make a big difference to the recovery if help is sought earlier on.
What can you do to help?
It can often be difficult to know exactly what to do to help when a person is suffering from SPD. It is important that you talk to them and let them know you are there to help. Often people are stubborn and want to carry on with everything themselves so be patient and let them know you are there to help and to ask if they need it.
SPD does not only affect a person physically. It can have an emotional affect also. Pregnancy should be a time of joy and happiness in a woman’s life and it can be a huge shock when the reality isn't like that. Make sure the person with SPD knows it isn't her fault, that it will not harm the baby, and that she has no reason to feel guilty.
Physical help
Generally any help will be appreciated and what is needed will vary depending on the severity of the SPD but here are some suggestions;
- Help with housework. Doing any housework will help but in particular vacuuming as this can be very difficult for an SPD sufferer, as the weight and movement involved can aggravate the condition. Ironing is also hard due to being unable to stand for any length of time as is stripping and the remaking of beds. Ask what she is struggling with and try to take over or assist with those tasks.
- Help with shopping. Offer to fetch the shopping or accompany them so you can push the trolley and manage the heavier items. If this isn't possible suggest getting the shopping ordered online and delivered, this is a service that most of the larger supermarket chains offer.
- Help with childcare. If she already has children take them off her hands for a while allowing her to rest. Try to do things with the children that she may be unable to do, like taking them to the park or out on a bike ride. SPD sufferers often feel guilty that they cannot do much with their children and feel because of that, they are missing out. Activities like this will also wear the children out, meaning they will be less exhausting when they get home.
- Help with cooking. Preparing meals that can be frozen mean that she will not need to stand for long periods in the kitchen and can still have nutritious meals.
- Helping with the baby. If she is still suffering after having had the baby, try to help out with things like nappy changing and bathing as bending down can be difficult. If bottle feeding, help prepare the feeds. Take baby to mum when they wake, to save her having to carry baby. Try to help her be as involved as possible in feeding and cuddling so she doesn't feel detached from the baby.
Emotional help
As stated this can be an emotionally difficult time for someone with SPD, so try to be there for them, in particular;
- Listen but don't judge instead be there for her, allow her to vent her feelings of frustration. Do not force your own opinions on her, for example you may feel she should not consider having more children, that she is exaggerating the pain or that she should pull herself together, etc but please do not say this. Many SPD sufferers already feel guilt for what their family is going through and she will need support at a time like this.
- Take her out. SPD can make you feel very isolated and some women go on to develop prenatal or postnatal depression with SPD. Getting her out of the house, allowing her to get some fresh air and to socialise with other people can really help.
- Make sure you have someone to talk to yourself. This is a very difficult time for the whole family, especially for working fathers, who can find working the whole day to then come home and have to do housework, childcare and cooking too much to bear. Consider hiring a cleaner to lighten the load and accept any help offered by family or friends.
- If you are the sufferers’ partner then remember you are still that and not just her Carer. Sometimes, especially in severe cases, it is easy for your roles to become confused, if she needs you to assist her to the toilet, or with help to roll over in bed, then passion can be easily be forgotten. Make sure you make time for the both of you as a couple. Have a quiet evening with a nice meal and candles or go to the cinema together.
It is natural to worry about sex. Make sure you are open with each other and discuss it. In most cases women with SPD can still make love, although you will need to be gentle. Again openness and honesty is the key. You might need to try different positions until you find one that is comfortable, but try and make it fun. Remember she will also be frustrated by the lack of intimacy and might be worried about letting you down. Make sure she knows she is not under any pressure. If sex isn't possible you can still have lots of cuddles and there are other things you can do to feel close and intimate. Make sure she knows you still see her as an attractive woman, and not just a disabled mother or mother-to-be.
The Birth and After
As with any birth sit down together with your partner and discuss the birth plan. You are a couple and a team but try to be understanding of her wishes and requirements, even though you may have your own views, because it will be her that has to physically give birth to your baby. You are both bound to have additional anxieties about what effects SPD could have on the birth especially when it comes to pain relief, often women prefer a more natural birth whereas men believe they should use the pain relief when available. If needed you should raise these concerns with your Health Professional and remember nothing need be set in stone, Birth Plans can be changed right up to and during birth.
Depending on how disabilitating the SPD is, certain things may not be possible so it needs to be discussed in advance with the midwife, for example, your partner may want to use a birthing pool, but the midwife has to be sure she can get into and out of it easily, in case of any complications.
Before the birth you will need to measure your partners 'pain free gap'. Get your partner to lay down with her knees raised and ask her to let her legs fall open to where they are comfortable, before it gets painful. Measure this gap using a piece of string or a dressing gown cord; it can also help to cut duplicates to give to the midwife and a spare for you. You then need to make sure this distance is not exceeded during the labour; the string can help with this. It is particularly important for you to be aware of this if your partner has an epidural as she will not be aware of the pain.
Some midwives and doctors are not as experienced as others with SPD and your partner may not be in a position to argue so it is up to you to keep explaining her limitations and to stop them putting her into risky positions. It is especially important to be careful to avoid having her feet put into stirrups (the lithotomy position) and if this is really unavoidable then both her legs should be lifted together and supported carefully and should be in this position for as little time as possible.
Once the baby is born it is especially important the new mum is given her baby and encouraged to breastfeed. Because of the complications during the pregnancy women who have had SPD are more at risk of developing Post Natal Depression (PND) so it is important that mother and baby get time to bond. It is important to be aware of this but please try not to worry too much as this is not always the case and many women with SPD, me included, do not develop PND.
For some women the SPD can right itself immediately, for others it can take longer and in rare cases it doesn't go away, but this is the exception and there really is no need to worry until 6 months to a year after the birth. Even if the symptoms do appear to have gone away, the new mum should still continue to do any exercises prescribed by the Physiotherapist and take it easy for 6 months as the pregnancy hormones (including Relaxin) are still present in the body during that time.
Some women also find they get a small flare up at the time of their period and if this is the case then she should see her Doctor for pain medication and take it easy during this time.
A Final Word
As I mentioned before, you need to make sure you look after yourself or you will not be able to help your partner. Make sure you eat properly and get lots of rest. Friends and family always love to help out with a new baby, so accept offers of support, even if it’s just someone bringing a casserole round, helping with the housework, or taking the baby out for a couple of hours.
If your partner is particularly immobile there is help available for carers. Information is available on the dot gov site here.
Madmums is also a great way of getting support for both your partner and yourself. We don't discriminate and also welcome fathers, so if you need advice, or just someone to talk to, log on and let us know.
An article is available here which might help your partner. We also run a buddy scheme if she wants to talk to someone on a one-on-one basis who understands what she is going through.
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