How will having SPD affect my labour?

Alison Bourne

Physiotherapist and women's health expert.

If you're prepared, and get good advice and support, symphysis pubis dysfunction (SPD) shouldn't cause you problems during labour.

You're unlikely to be offered an induction or a caesarean section purely because you have SPD. Some evidence suggests that severe pelvic pain may last longer after a caesarean than if you have your baby vaginally.

The pubic symphysis part of your pelvis naturally separates during labour. You probably won't have any problems as a result of this, but you can try these positions to stay comfortable in labour:
  • Kneel or stand, with support, to prevent strain on your pelvis. Lean on your partner, over a pile of pillows, a tilted bed end or a birth ball.
  • Position yourself on all fours, so the weight is on your hands and knees. This may also help your labour to progress.
  • If you are tired, lie on your side, with your midwife or partner supporting your upper leg.

Squatting positions may be uncomfortable, unless you can keep your back straight. If your back is straight, it locks out your pelvis, which helps to protect it and allows you to separate your legs. Hospitals and birth centres usually have birthing stools you can sit on to achieve an upright squat.

Using a birth pool may ease your pain and help you to stay upright. The water supports the weight of your body, and its warmth acts as a pain-reliever.

Your midwife will need to be sure that you can get in and out of the pool safely and promptly, if needed. Many pools have steps and rails, which severe SPD makes hard to negotiate.

Practise different positions and movements with your birth partner before labour starts. Ask your midwife if she can arrange a practice session, and write the positions you preferred in your birth plan.

Note down how far apart you can comfortably move your legs, depending on what position you are in. If your back is slumped or you are lying flat on your back, your pelvis becomes unlocked. This means that separating your legs even a little may be very uncomfortable.

Your midwife and birth partner should make sure that you don't widen your legs beyond a gait that's comfortable. It's particularly important if you have an epidural, as you won't be able to feel your pelvic pain. This may cause you to irritate or over-stress your joints without realising it.

You won't need an epidural because of your SPD. But if you want one, having SPD won't stop you.

If you need continuous electronic fetal monitoring during labour, your doctor or midwife will work with you to find a comfortable position that allows them to monitor your baby's heartbeat.

Your maternity notes should mention that you have SPD. Midwives and obstetricians need to be aware of the help you will need if you need an assisted birth. If your legs are lifted and placed in stirrups, it can put a strain on your pelvis, so you shouldn't spend long in these positions. Don't rest your legs on the midwife's hips, as it may injure your pelvis.

If you do need to get into these positions, rotate your hips outwards as you bend both legs, so your knees move apart and your heels come together, rather than just moving your legs apart.

Bear in mind that labour is unpredictable. You may find that a different position from the one written in your birth plan turns out to be more comfortable. Be reassured that it's very rare for the position you adopt in labour to be the cause of problems in the weeks following the birth.

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