Crippled by my baby
One in a hundred women endure agonising pain during their pregnancy. Larissa Nolan tells her story of suffering SPD and her battle to give birth naturally despite the agony
I would wake in the night with the pain of it: my teeth ground together, my fists clenched up so tightly that my nails dug into my palms. I'd hope a good deal of the night had passed, because when it woke you, sleep was no longer an option.
I was seven months pregnant with my first child -- who turned out to be a joyfully healthy baby boy, Jean-Luc, now 15 months old -- and suffering from a severe form of a pregnancy-related complication called symphysis pubis dysfunction or SPD.
Crippled from the waist down, on two crutches during my waking hours , I was in the most pain I had ever endured in my life.
It was as if my right leg had been torn off at the hip and roughly sewn back on -- it was completely useless to me, but could still cause the relentless pain.
Yet even though very little is known about the disorder, SPD affects one in five women, and one in a hundred cases will result in the kind of disability I experienced.
It is understood to be caused by a combination of pregnancy hormones, the growing weight of the baby, increased movement in the pelvic sacroiliac joints -- up to 12 times more movement -- and the changing gait of the pregnant woman.
Any of the three pelvic joints -- the two sacroiliac joints and the symphysis pubis -- can slip out of alignment, and this asymmetry causes pain. Those with a previous pelvic injury or with a weakened bone in the pelvis are more likely to suffer. Trouble is, sometimes -- like in my case -- you are not aware of an underlying problem.
I feared I would not be able to give birth to my baby naturally, that I would never walk again and that the disorder could go on and I would never be able to fully look after my own child.
My SPD started as a seemingly minor problem. But, in a matter of a few short days, I was crippled and in agony.
I had enjoyed a blissful seven months of pregnancy, during which I avoided all the other usual difficulties.
I was confident about the impending birth, until one day I noticed that I was walking with a slight limp.
It looked as though one leg was slightly shorter than the other, I assumed, never having experienced pregnancy, that it was all part of the nine-month deal.
I had heard people talk of the pregnancy gait, listened to the old wives' tales of how it was just the baby sitting on a nerve, or could even be a form of sciatica.
In fact, the penguin-like walk was one of the classic early warning signs of SPD.
If I had been aware of the condition, I could have limited the damage with early physiotherapy, but I only made it worse. My pelvis was already misaligned by a few inches. Soon my right leg would not work at all, and I got crutches from the physio department of my hospital, the Coombe in Dublin.
The physio there told me that I was most likely suffering from SPD, and said that at this stage, I had very little choice but to wait it out.
X-rays are not an option for expectant women, nor are anti-inflammatory treatments. I could do nothing until the birth was over.
But this stressed me out more. What happened if it didn't get better -- if it got worse? How could I give birth?
It felt as if my body was on a deadline to get better in time.
With the news that I would have to wait it out, months of immobility stretched out before me and seemed a lot to endure, and I hated the idea of looking so pathetic: pregnant and on crutches.
When I went to see my consultant, just one week since I had last seen him, his face dropped to see me on crutches so swiftly, and he prescribed the painkiller Tylex, to take the edge off.
I had now moved into a different category of patient, one that would be very likely to require a Caesarean section.
The pain can be so bad that some patients come into A&E with SPD and require injections of pethidine, a form of morphine, into the area.
I was terrified because at this stage, my right leg did not work any more -- even if I directed it to move, I couldn't do it.
But when I asked him if I would be left paralysed for life, he confidently assured me that this was not a possibility, which was a huge relief.
He did tell me, however, that my condition would most likely worsen, meaning I would not be able to give birth naturally.
I was relishing the prospect of giving birth to my baby, and knew also that one C-section usually means all subsequent pregnancies are advised to end in a section too.
I felt I was being robbed of my chance to give birth to a baby, something I always wanted to do. Also, a C-section would take a lot longer to recover from.
So I set about some intensive physiotherapy and booked in for 10 intensive sessions with the physiotherapist, the wonderful Hana Burrow, who got me on my feet again after the batch of back-to-back appointments.
Despite the fact that I was barely able to move even on two crutches, Hana was always positive and assured me we would eventually have success.
With intensive physio, it would improve -- the only question was when, she said.
With about a week to go, I satisfied my consultant that I could comfortably dodge surgery and go natural.
And, on October 27, 2009, I did just that. I was able to give birth to my own baby naturally, and I was so grateful and proud for this experience.
I was admitted to hospital on crutches and I walked out without needing them.
So there was a happy ending, even if I still walk with a slight limp. SPD has left a legacy. I will, in all likelihood, only have one child in my life -- sufferers of SPD are highly likely to get it again in subsequent pregnancies, but earlier and even more severely. Doctors say I had an injured sacroiliac joint, which was the joint affected in my case.
Correct advice includes minimising activity, using permitted painkillers, wearing a pelvic brace or using crutches/wheelchair if necessary.
It also includes receiving intensive manual physiotherapy along with practising muscle-strengthening exercises.
My baby nearly crippled me -- but with more awareness, prompt action and the right treatment, other women can avoid having to suffer the pain of SPD.
Sunday Indo Life Magazine