Symphysis pain gone!

Contrary to what I'd expected, which was worsening pelvic pain up until the time of birth, it instead seems to have subsided entirely. This seems nothing short of miraculous to me, considering how much pain I was in just a few weeks ago. The acupuncture seems to have set off the initial healing reaction, helped along by an activator adjustment by my new chiropractor. I can't recommend these two things highly enough, and you can go to this site to find out whether there are any acupuncturists offering sliding-scale fees in your area.

The things that helped me most during the actual flare-up were an ice pack to the area, and also doing the exercise described in the previous post which involves putting your fist or a flat pillow between your knees and squeezing it for a count of five. That one sounds counterintuitive, but I found it to give me an almost instantaneous measure of relief, especially if I did it a few times before standing up from a sitting position (which previously really exacerbated the pain). It resulted in kind of a "good hurt" during the exercise, like a good deep stretch, and then the area felt better afterward.

I was able to go to a conference last week on support techniques for natural birth, and was fortunate enough to hear the Bagnells, a husband-and-wife chiropractor team, speak on their techniques for pregnancy adjustments and resolution of fetal malpresentation. While my chiropractor doesn't specifically practice the Bagnell technique, she is very hands-on with pelvic adjustments, and hearing the Bagnells speak made me glad that I was able to find effective interventions for my symphysis pain so early on. One interesting point they made was that any time a pregnant woman experiences severe round ligament pain, especially early on, one should suspect pubic bone malposition. As you may recall, I started with round ligament pain in the first trimester, and interestingly, so did my coworker who also developed pubic bone pain (and actually referred me to my current chiropractor). A misalignment there is associated with a much higher incidence of malpresented babies, including breech, posterior, and transverse presentations, which is not anything that I am interested in!

A good site for those who want to learn more about the interaction between maternal tissues and fetal position, and how that affects the duration and ease of labor, is Spinning Babies.

Another good resource for understanding the physiology of pregnancy and birth and beyond, and what you can do to maximize it, is Elizabeth Noble's Essential Exercises for the Childbearing Year. I got mine used off Amazon for $0.01, bringing my total to $4 with shipping--an investment that is well worth it.

Symphysis pubis pain

I mentioned in an earlier post that around 22 weeks, I started suffering from pain in the front of my pubic bone, or symphysis pubic dysfunction (SPD). This is the best online resource I've found so far, which includes a good explanation of the physiology of SPD, frequently asked questions, medical and alternative relief options, and considerations for birth.

This article details the use of a support belt and stabilizing exercises to treat SPD. I recently obtained a maternity support belt (a lot like this one) and wear it when working or walking for long periods, and I think it's somewhat helpful. I don't wear it all the time, because I want my muscles to have to work to maintain their own stability as well, but a 12-hour shift is a lot to ask out of anyone's back and pelvis and so the extra support is nice. The subjects were given the following instructions with regard to exercise and lifestyle:

Abdominals: "Sitting with your feet resting on the floor, gently pull in your lower abdominal muscles abdominal muscles as if you are hugging your baby. Hold for 5 seconds. Repeat 5 times, continuing to breathe normally."

Pelvic floor: "Sitting tall, squeeze to close around your openings. Lift and hold for 5 seconds. Repeat 5 times. Breathe normally throughout."

Gluteus maximus: "Sitting or standing, squeeze buttocks together. Hold for 5 seconds. Repeat 5 times."

Latissimus dorsi: "Sit on a chair in front of a table or a closed door. Grasp door handle or table with both hands and pull toward you. Hold for 5 seconds. Repeat 5 times."

Hip adductors: "Sitting down, put your fist or a rolled towel between your knees. Squeeze knees together. Hold for 5 seconds. Repeat 5 times."

Self-help Management

The aim is to reduce stress on the joint.

It is essential that you tighten the muscles of your pelvic floor and lower abdomen before and during the following activities.

When getting into bed:

* Sit on the edge of the bed, keep knees close together, then lie down on your side, lifting both your legs up sideways. Reverse this to get out of bed.

* Do not attempt to pull yourself up from lying on your back.

When rolling over in bed:

* Keep knees together.

* Do not roll with your knees apart.

When getting up from a chair:

* Keep knees close together, put your hands on your knees, and lean nose over toes to stand up.

When sitting down:

* Do the reverse to sit down.

* Ensure that you feel the chair at the back of your legs first.

When getting into a car:

* Sit down first and then swing legs in, keeping knees together.

When walking:

* Take smaller steps.

When using stairs:

* Step up sideways one step at a time.

* Avoid stairs if possible.

Remember to:

* Sleep with a flat pillow between the legs.

* Take rest breaks.

* Move within the limit of pain.

Avoid:

* Sitting on soft sofas and chairs.

* Walking as an exercise.

* Active stretching.

I've started sleeping with a flat pillow between my knees, and I try to use the body mechanics suggestions whenever I can. I've heard conflicting things about whether walking is contraindicated as an exercise, and it's free and healthy, so I haven't given that up yet. I am planning to start to implement the exercises.

However, I was perhaps most interested in this article from the British Medical Journal, which reports a greater decrease in pelvic pain in subjects who underwent acupuncture than those who underwent interventions involving exercise, support belts, or both.

I'm figuring I can't go wrong with all three. This morning I had my first acupuncture appointment with a delightful acupuncturist in Frederick, Maryland, who has made a name for herself offering treatments on a sliding scale from $15-35 per session. This was my first experience with acupuncture and I was very pleased. A couple of the needles stung a little as they went in, but on the whole I was very comfortable during the approximately 20-30 minute treatment. My pelvis has felt sort of achy and sore all day, and it's hard to say if that's left over from yesterday or if it's a sign that things are resettling themselves, but time will tell. I'm placing a lot of hope in this, because otherwise it's going to be a long next four months...

24 weeks

15 weeks, 18 weeks, 20 weeks, and 24 weeks

Every time we take a picture, I look at it and think how big my belly has gotten, and how I can't imagine it getting any bigger. Then, by the time we take the next picture, I think the same thing about that picture, and look back a little wistfully at how tiny I look to myself in the previous picture. It's crazy and you'd think I'd be used to it by now, but the thought process is remarkably similar each time.

First, the good news: I'm measuring perfectly at 24 cm for 24 weeks. (Which strongly dispels the likelihood of twins, despite what my round girth might suggest.) The baby is delightfully active and literally feels bigger and stronger every day. The heartbeat sounds great, my blood pressure is good, and by every other objective measure of pregnancy, I'm doing very well. The number on the scale is a lot to wrap my mind around, but we're eating incredibly well and I take at least a 30-minute walk most days, along with a variety of prenatal exercises, so I'm doing my best to let my body be my guide on that front.

On a less-pleasant level: the hormonal discomforts of pregnancy (morning sickness, etc) have all too quickly been replaced by the mechanical ones, as I mentioned in my last post. My symphysis pubis pain can literally bring me to tears, especially if I've been working all day, and I'm going to do a separate post on the efforts I'm making to correct that. Bending over has become rather a challenge, and I have a job that requires me to do that many times in a 12-hour period. Changing positions requires ever more (and noisier) efforts, and I had a recent tearful episode remembering what a wonderful, active summer we had last year and mourning the fact that I will most likely not be doing all of my grocery shopping by folding bike this summer, nor will I be doing any 7-mile hikes in the Shenandoah mountains. (Matt is wonderful about comforting me through such times, however, and pointed out, "We'll just plan to have a really active fall!") I'm also getting up probably 3-4 times a night to pee (during the day, I go at least once an hour). My mom says I've had a tiny bladder since I was a baby, and pregnancy has certainly brought out that condition. Also being crowded out of the way: my lungs and my stomach.

Otherwise, though, we're happy and thankful. We're getting more and more excited about the birth, and talk all the time about what it will be like when the baby gets here. We went to an excellent cloth diaper information session put on by a locally owned Web-based business, Abby's Lane, which we were completely impressed with. We've decided that we'll most likely go with prefolds, pins, and wool covers to start with. We'd originally thought we might go with an all-in-one, but she convinced us that these are often not a good fit for newborns and we want something that we can start with and that will then grow with the baby, as opposed to changing systems midstream. It's also much more economical and seems like a better fit for our lifestyle and philosophies. We've also been incredibly blessed by Freecycle and hand-me-downs from friends, so that we feel like we have a good stock of what we'll need to at least get started. Which is good; now that the weather is warm, it's starting to feel like summer and this baby are just around the corner.

At least, that's what I keep telling myself, when four more months of pelvic pain and a waddling gait and going to the bathroom 20 times a day starts to sound like a very long time...

22 weeks

There's not a whole lot to report these days, except that the baby and I are both getting bigger all the time! In the space of a week or two, the baby's movements have changed from subtle fluttering movements to strong, identifiable gestures that are easily felt (and sometimes seen) from the outside. The baby seems to have at least three predictable periods of high activity: when I first wake up, between about 2 and 4 pm, and again just before I go to bed.

Otherwise, I've started seeing a chiropractor trained in Webster technique for general achiness in my lower back and pelvis. I've always had very lax joints and the hormonal influences of pregnancy have only exacerbated that. In particular, I've started experiencing symphysis pain. Measures like sleeping with the support of several pillows helps, but doesn't totally eradicate the problem.

Besides that, though, I'm happy to finally be free of systemic effects like nausea, heartburn, and overwhelming fatigue. When I'm sitting down, I hardly feel pregnant :) Once I try to stand up, though, I quickly remember that I am--changing positions, from getting up from the couch, to just rolling from side to side in bed, is beginning to get more challenging...