Understanding pregnant women's experiences of symphysis pubis dysfunction: the effect of pain
Background. Symphysis pubis dysfunction (SPD) is an abnormal stretching of the pubic joint in pregnancy, which causes distress and pain during and after pregnancy. Measures of its incidence varies widely, and most research has focused on identifying causes. Among healthcare professionals, there is evidence of low levels of awareness of SPD and a lack of sympathy toward women with it. Aim. To explore women's experiences of SPD during pregnancy and up to six weeks postpartum, with particular reference to pain. Method. A qualitative, phenomenological approach was used in conducting semi-structured interviews in a large maternity hospital in the north-west of England. A total of 28 women were interviewed during pregnancy and six weeks postpartum (51 interviews). Findings. The dominant theme to emerge was the women's experiences of pain. Pain was described in compelling language, and some women overdosed themselves on analgesics. Pain was sometimes accompanied by sounds that were audible to others. Living with SPD was problematic in every case, and recommended management for the relief of pain brought little benefit to the women. Most women found coping difficult, felt a burden to family and friends and in some instances feared for their mental health. Conclusions. SPD can have a devastating effect on women. Midwives and other healthcare professionals have a duty to take the condition seriously. More research is needed to ascertain cause, to identify more effective pain relief, and most importantly to raise awareness of SPD and increase information and support.
Key words: Pain, symphysis pubis dysfunction, coping strategies, isolation, helplessness, chronic pain, pelvic pain
Symphysis pubis dysfunction (SPD) may be defined as an abnormal stretching of the pubic joint during pregnancy (Wellock, 2002). It is a distressing and painful condition that affects women during pregnancy and the postpartum period. Signs and symptoms may include tenderness of the symphysis pubis, groin pain radiating to the inner thigh, increased pubic pain during normal activities such as walking, parting or lifting the legs, a waddling gait, and difficulty turning over in bed, abducting the legs or getting dressed. The normal physiological non-pregnant symphysis pubis gap measures from 4mm to 5mm. Separation of more than 5mm but less than 10mm may be termed SPD (Heyman and Lindquist, 1932), and can be confirmed by x-ray or ultrasound scan (Lindsay et al, 1988).
The measured incidence of SPD varies considerably, from 1:521 to 1:20 000 individuals (Boland, 1933; Lindsey et al, 1988). These figures are from studies conducted over a broad time span and in countries with different cultures, healthcare systems and methods of data collection. In addition, lack of clarity in the definition of SPD means that old statistics may be unreliable. Some previous quantitative research undertaken to diagnose the condition used invasive methods such as a triangular cardboard tube with metal markers that could be seen on x-ray strapped to the skin over the symphysis (Heyman and Lindquist, 1932). X-rays were performed early and later in pregnancy, but this is now known to be detrimental to the fetus (Wagner...