Symphysis pubis dysfunction (SPD) is a problem with the pelvis. Your pelvis is mainly formed of two pubic bones that curve round to make a cradle shape. The pubic bones meet at the front of your pelvis, at a firm joint called the symphysis pubis.
The joint's connection is made strong by a dense network of tough tissues (ligaments). During pregnancy, swelling and pain can make the symphysis pubis joint less stable, causing SPD.
Doctors and physiotherapists classify any type of pelvic pain during pregnancy as pelvic girdle pain (PGP).
SPD is one type of pelvic girdle pain. Diastasis symphysis pubis (DSP) is another type of pelvic girdle pain, which is related to SPD. DSP happens when the gap in the symphysis pubis joint widens too far. DSP is rare, and can only be diagnosed by an X-ray, ultrasound scan or MRI scan.
What are the symptoms of SPD?
Pain in the pubic area and groin are the most common symptoms, though you may also notice:
Back pain, pain at the back of your pelvis or hip pain.
Pain, along with a grinding or clicking sensation in your pubic area.
Pain down the inside of your thighs or between your legs.
Pain that's made worse by parting your legs, walking, going up or downstairs or moving around in bed.
Pain that's worse at night and stops you from sleeping well. Getting up to go to the toilet in the middle of the night can be especially painful.
SPD can occur at any time during your pregnancy or after giving birth. You may notice it for the first time during the middle of your pregnancy.
What causes SPD?
During pregnancy, your body produces a hormone called relaxin, which softens your ligaments to help your baby pass through your pelvis. This means that the joints in your pelvis naturally become more lax.
However, this flexibility doesn't necessarily cause painful problems of SPD. Usually, your nerves and muscles are able to adapt and compensate for the greater flexibility in your joints. This means your body should cope well with the changes to your posture as your baby grows.
SPD is thought to happen when your body doesn't adapt so well to the stretchier, looser ligaments caused by relaxin. SPD can be triggered by:
the joints in your pelvis moving unevenly
changes to the way your muscles work to support your pelvic girdle joints
one pelvic joint not working properly and causing knock-on pain in the other joints of your pelvis
These problems mean that your pelvis is not as stable as it should be, and this is what causes SPD. Physiotherapy is the best way to treat SPD, because it's about the relationship between your muscles and bones, rather than how lax your joints are. You're more likely to develop SPD if:
you had pelvic girdle pain or pelvic joint pain before you became pregnant
you've had a previous injury to your pelvis
you've had pelvic girdle pain in a previous pregnancy
you have a high BMI and were overweight before you became pregnant
hypermobility in all your joints
How is SPD diagnosed?
Your doctor or midwife should refer you to a women’s health physiotherapist. Your physiotherapist will test the stability, movement and pain in your pelvic joints and muscles.
How is SPD treated?
SPD is managed in the same way as other pelvic girdle pain. Treatment includes:
Exercises to strengthen your spinal, tummy, pelvic girdle, hip and pelvic floor muscles. These will improve the stability of your pelvis and back. You may need gentle, hands-on treatment of your hip, back or pelvis to correct stiffness or imbalance. Water gymnastics can sometimes help.
Your physiotherapist should advise you on how to make daily activities less painful and on how to make the birth of your baby easier. Your midwife should help you to write a birth plan that takes into account your SPD symptoms.
Acupuncture may help reduce pain and is safe during pregnancy. Make sure your practitioner is trained and experienced in working with pregnant women.
Other manual therapies, such as osteopathy may help. See a registered practitioner who is experienced in treating pregnant women.
A pelvic support belt may give relief, particularly when you're exercising or active.
What can I do to ease the pain of SPD?
Be as active as you can, but don't push yourself so far that it hurts.
Stick to the pelvic floor and tummy exercises that your physiotherapist recommends.
Ask for and accept offers of help with daily chores.
Plan ahead so that you reduce the activities that cause you problems. You could use a rucksack to carry things around, both indoors and out.
Take care to part your legs no further than your pain-free range, particularly when getting in and out of the car, bed or bath. If you are lying down, pull up your knees as far as you can to make it easier to part your legs. If you are sitting, try arching your back and sticking your chest out before parting or moving your legs.
Always associated pregnancy with a voracious appetite for everything from pepperoni pizza to ice cream and pickles? Pregnancy is indeed that one special time of your adult life when gaining weight is applauded and eating every two hours is encouraged (lucky you!). But just as you begin stocking your refrigerator with healthy foods (and yes, sometimes those not-so-healthy cookies you’re craving), loss of appetite — plus its common sidekick, morning sickness — strikes, turning your nose at the sight and smell of your favorite foods.
Gaining enough pregnancy weight is the major signal that you’re eating enough to support your baby’s needs. Depending on your pre-pregnancy weight, most normal-weight women should aim to tack on between 25 and 35 pounds. During the first trimester, when morning sickness (known to many as all-day sickness) is at its worst, it’s common to only gain one to four pounds (or sometimes even lose weight). That’s okay. At this point your fetus is so tiny, it has fewer nutritional requirements — so as long as you’re taking your prenatal vitamin, you and baby-to-be should be covered.
After the first trimester, gaining about one pound per week is advised. If your appetite is still nowhere to be found by early in your second trimester, or if you aren't meeting the recommended weight gain in your third trimester, consult your doctor for a diet plan.
Still worried? Don’t be. You’re going to have easy days and difficult days — the big picture is what’s important. The good news is that most women find they can manage appetite loss with a few tricks. Here’s how to manage this particular pregnancy symptom.
Loss of Appetite in the First Trimester
What causes loss of appetite in the first trimester?
Loss of appetite often comes hand-in-hand with nausea during pregnancy, which affects about 75 percent of pregnant women (when you’re bent over a toilet on the regular, it’s no wonder your appetite is a bit shy these days). Morning sickness may be your body’s instinctual way of protecting the fetus from potentially harmful foods — explaining some of those food aversions women commonly experience.
Increasing hormones (including estrogen and the pregnancy hormone hCG — the ones responsible for making you cry at that car commercial) also play a role in increasing nausea and your sensitivity to smell while decreasing your appetite. You may even have a metallic taste in your mouth.
How can I meet my nutritional needs in the first trimester if I've lost my appetite?
Here are some tips for how to get the pregnancy nutrients you and baby-to-be if you're not very hungry early on.
Drink up. Ensuring you consume enough liquids is more important than a aiming for a certain caloric intake. Though it really depends on the mom-to-be and her lifestyle, try to aim for around eight to 10 8-ounce glasses a day from all sources, including fruits and vegetables. Warm water with lemon or ginger, ginger ale or ginger tea can be good substitutes for plain water if you're nauseous (always check in with your doctor before sipping any herbal tea or other drink, however, as some are off-limits during pregnancy).
Don’t overdo it. Eat six small meals a day (your body will probably let off hunger signals every two hours), which will satisfy your small appetite — instead of force-feeding yourself larger portions of food.
Eat lightly. For the moments during the day when your appetite makes a brief appearance, consume as much protein and complex carbs as you can, which will keep your blood sugar stable and keep you fuller for a bit longer. Fruits such as bananas may also be easier to stomach; pair with a spoonful of yogurt for added calcium and protein. And whole grain or plain crackers are almost always your friend.
Avoid strong-smelling foods. That includes spicy and fatty dishes — which may mean skipping fast food staples like burgers, fries and chicken nuggets and opting for something like a salad with grilled chicken or salmon if you can stomach it instead.
Use your good taste. Sure, variety is usually the spice of a good nutritional life. But if you find spinach makes you queasy while you can stomach kale, by all means eat the kale. You’ll get back to the spinach soon enough.
Change the temperature. Many women prefer their foods and drinks chilled when they're pregnant, while others like it hot. If you fit one of those categories, adjust your diet accordingly if that works.
Take your vitamin. Make taking your prenatal vitamin as routine as brushing your teeth. Ideally, start taking the vitamin at least a month before conception, or at a minimum, at the time of conception. This will help fill in temporary nutritional gaps.
Get additional help. To help combat nausea, talk to your doctor about taking a special prenatal vitamin with extra B6 or the FDA-approved Diclegis, which contains a combination of vitamin B and antihistamine (these may help decrease nausea and increase your appetite).
When you're pregnant, it can be hard to tell whether you're running a fever or just running a little hot. Like most expectant moms, you may be feeling flushed or extra toasty, and you may even experience the occasional hot flash, thanks to hormonal swings and your baby-to-be radiating heat as she grows.
Here's what you need to know about fevers during pregnancy — including what's considered a fever in expectant women, what medicine you can take and the importance of checking in with your doctor to minimize any potential risks that a fever might pose to you and your growing baby.
What Temperature Is Considered a Fever for Pregnant Women and What Are the Symptoms of Fever in Pregnancy?
When it comes to fever, the numbers on your thermometer indicate the severity of your symptoms. Generally, the rule is the same during pregnancy: A temperature of 100 or 101 degrees F is considered a fever. If your temperature reaches 101 degrees F, call your practitioner immediately, even if it's in the middle of the night. If you aren't experiencing any urgent cold or flu symptoms and your fever climbs to 100 degrees F, start bringing it down right away with acetaminophen (like Tylenol) and call your doctor that same day, or, if you took your temperature in the middle of the night, the next morning.
Otherwise, a low-grade fever or temp (one that's under 100 degrees F) usually isn't something to worry about when you're expecting. That said, it's also something you shouldn't ignore — so keep an eye on the thermometer to make sure the numbers don't start rising.
What Are the Causes of Fever During Pregnancy?
You can get a fever during pregnancy for the same reasons you get a fever when you're not expecting. In fact, you're probably more likely to suffer from common viral infections like the flu or colds while you're pregnant. That's because your immune system is suppressed in order to protect your fetus (which your body considers an outsider) from being rejected. Good news for your baby, not so good news for your sinuses.
Low-grade fevers may be the result of a benign viral infection like a cold, while higher fevers may be a symptom of the flu. Sometimes, a fever can be caused by a bacterial infection (like a urinary tract infection, kidney infection or strep throat, for example) that requires antibiotics. On that note, pregnant women should avoid eating raw meat, fish and unpasteurized cheese to avoid exposure to listeria bacteria during pregnancy, which can also cause a high fever.
How Long Can a Fever Last When You're Pregnant?
Fever in pregnancy can last as long as the underlying cause, such as the flu, but you should call your practitioner right away if it reaches 101 degrees F. And take steps to bring down your temperature the same day it climbs to 100 degrees F or higher.
What Can I Take for a Fever During Pregnancy?
While you're waiting to speak to your doctor, take acetaminophen (Tylenol) to reduce your fever. Avoid aspirin or ibuprofen (Advil or Motrin) when you're pregnant unless they're specifically recommended by your practitioner.
A few more tips to treat fever during pregnancy:
Take a tepid bath or shower
Drink plenty of water and other cold beverages to cool down and prevent dehydration
Keep clothing and covers light
What Can I Do to Prevent Fever During Pregnancy?
Avoid catching a cold or flu by washing your hands often, avoiding sick people and getting a flu shot. Catching the flu can not only induce fever, it can potentially lead to other complications — all the more reason to get the flu vaccine at the start of flu season (ideally in October) if you're pregnant or planning to get pregnant.
Can You Get a Fever in Early Pregnancy? When Else Can You Get a Fever During Pregnancy?
Yes, you can, and you can get a fever at any time during pregnancy. Research suggests that about one-third of pregnant women will get a fever at some point, and the majority deliver healthy babies.
But while it's possible to get a fever any time throughout your pregnancy, a high fever in the first weeks of pregnancy may be riskier than a flu later on. A study published in the journal Pediatrics associated fever, especially in the first trimester, with various birth defects — although experts caution that the fever’s source, severity, frequency and any treatment are all factors to consider when evaluating any risk. Still, it’s a good idea to have a trusty thermometer on hand (along with your practitioner’s number) to keep a very close eye on your temperature if you're feeling under the weather.
What Effects Can a Fever Have on My Pregnancy?
It's unlikely that a fever will have an effect on your pregnancy. A mild fever under 100 degrees F is generally no cause for concern and typically won't have any impact on your growing baby. But a higher fever can be more serious, which is why it's so important to give your practitioner a call and bring your temp down with acetaminophen as soon as you start to see those numbers go up.
While pregnant women and their babies are more likely to suffer from complications from an untreated high-grade fever, it's important to know that the fever itself may not be the cause; it could be an indication of an underlying condition, such as an infection or something else.
As your body gears up to support your growing baby, you produce more of the hormones oestrogen and progesterone.
A similar hormone surge happens to you before a period, so this tenderness is probably an exaggerated version of how your breasts feel then.
Your breasts may become so tender that your usual bra becomes really uncomfortable. You may not like having your breasts touched.
You may have noticed this tenderness from about three weeks or four weeks of your pregnancy, before you even did a pregnancy test.
Along with the effects of a hormone surge, your breasts are likely to be getting bigger. The fat layer in your breasts thickens, you grow more milk glands, and blood flow increases to them. These changes are preparing your breasts for feeding your baby.
Every woman's experience is different. Your breasts may grow quickly in early pregnancy, or they may grow gradually as your pregnancy progresses. You may not even notice much difference in the size of your breasts until the end of your pregnancy.
When it does happen, though, the change in size can be quite dramatic, particularly if this is your first pregnancy. You will probably go up a couple of cup sizes by the time you have your baby. Don’t worry if this hasn’t happened by the end of pregnancy. Your breasts are likely to expand more once your newborn has arrived.
You may notice other changes, too. During sex you may feel a throbbing or tingling sensation in your breasts, as the blood rushes to them.
Are sore breasts in pregnancy common?
Yes, it is common to have sore breasts in pregnancy. Sensitive, tender and tingling breasts are among the earliest signs that you’re pregnant.
Having sore breasts is one of the top three things women complain about in early pregnancy, along with nausea and tiredness.
The soreness is likely to lessen after your first trimester. Once you’re in your second trimester, your surging hormone levels will settle down.
This won’t necessarily spell the end of painful breasts altogether, though. Breast pain and tenderness still affects almost half of women in the third trimester.
What can I do to ease the soreness in my breasts?
A supportive bra with wide shoulder straps will help to ease the soreness. Underwired bras are less comfortable for your changing breasts, so choose softer bras.
Have your bra fitted by a specialist in-store fitter. If this isn’t possible, measure under your breasts for size, and around the fullest part of your breast for the cup. Bear in mind that sizes vary according to style and brand.
Try to get fitted more than once during your pregnancy. You may need to change cup sizes as your breasts grow.
Wear a well-fitting bra while you exercise, to support your heavy breasts.
A maternity cotton sleep bra may help to ease soreness while you sleep.
Some women find it helps to run warm water over their breasts to ease soreness. Gently pat your breasts dry afterwards.
Learn how to cope with these other common pregnancy complaints:
nausea and vomiting
Bleeding during pregnancy is relatively common. However, bleeding from the vagina at any time in pregnancy can be a dangerous sign, and you should always contact your midwife or doctor immediately if it happens to you.
Bleeding is not often caused by something serious, but it’s very important to make sure and to find out the cause straight away.
Contact your doctor or midwife if you notice bleeding from your vagina at any time during your pregnancy.
In early pregnancy you might get some light bleeding, called ‘spotting’, when the fetus plants itself in the wall of your womb. This is also known as ‘implantation bleeding’ and often happens around the time that your first period after conception would have been due.
Causes of bleeding
During the first 12 weeks of pregnancy, vaginal bleeding can be a sign of miscarriage or ectopic pregnancy (when the fetus implants outside the womb, often in the fallopian tube). However, many women who bleed at this stage of pregnancy go on to have normal and successful pregnancies.
In the later stages of pregnancy, vaginal bleeding can have many different causes. Some of the most common are outlined below.
Changes in the cervix
The cells on the cervix often change in pregnancy and make it more likely to bleed, particularly after sex. These cell changes are harmless, and are called ‘cervical ectropion’. Vaginal infections can also cause a small amount of vaginal bleeding.
The most common sort of bleeding in late pregnancy is the small amount of blood mixed with mucus that is known as a ‘show’. This occurs when the plug of mucus that has sealed the cervix during pregnancy comes away. This is a sign that the cervix is changing and becoming ready for the first stage of labor to start. It may happen a few days before contractions start or during labor itself.
This is a serious condition in which the placenta starts to come away from the inside of the womb wall. Placental abruption usually causes stomach pain, even if there is no bleeding. If it happens close to the baby’s due date, your baby may be delivered early.
Placenta praevia, sometimes called a ‘low-lying placenta’, is when the placenta is attached in the lower part of the womb, near to or covering the cervix. This can block your baby’s path out of your body. The position of your placenta is recorded at your morphology scan.
If the placenta is near the cervix or covering it, the baby cannot get past it to be born vaginally, and a caesarean will be recommended.
Vasa praevia is a rare condition, occurring in about 1 in 3,000 to 1 in 6,000 births. It occurs when the blood vessels of the umbilical cord run through the membranes covering the cervix. Normally the blood vessels would be protected within the umbilical cord. When the membranes rupture and your waters break, these vessels may be torn and this can cause vaginal bleeding. The baby can lose a life-threatening amount of blood and die.
It is very difficult to diagnose vasa praevia, but it may occasionally be spotted before birth by an ultrasound scan. Vasa praevia should be suspected if there is bleeding and the baby’s heart rate changes suddenly after the rupture of the membranes. It is linked with placenta praevia.