SPD in Pregnancy: How to Prep for Birth When Your Pubic Bone Hurts

You roll over in bed, and a sharp pain shoots across the front of your pubic bone. Or it catches you stepping into your jeans, climbing the stairs, or swinging one leg into the car. If that sounds like your pregnancy right now, you might have SPD, and you're far from alone. Underneath the pain there's usually a bigger worry, too: if this hurts now, what is going to happen when I'm in labor? Let's talk about both.

What is SPD, and why does my pubic bone hurt in pregnancy?

SPD stands for symphysis pubis dysfunction. It's pain at the pubic symphysis, the joint at the very front of your pelvis where your two pubic bones meet. Most providers now call it pelvic girdle pain, or PGP, which also covers the sacroiliac (SI) joints at the back of the pelvis, and it affects about 1 in 5 pregnant people [1].

It tends to flare with the moves that load one leg at a time or spread your knees apart [1]:

• Standing on one leg, like putting on pants or taking the stairs

• Moving your knees apart, like getting in and out of the car or the bath

• Rolling over in bed, which is often the worst one at night

• Walking far, or walking on uneven ground

Some people also feel a clicking or grinding at the front of the pelvis [1]. And here's the most important part: as painful as it can be for you, SPD does not harm your baby [1].

If your pain sits more in your groin or inner thigh, my post on groin pain in women walks through the other usual causes.

Is it really just relaxin loosening my joints?

You've probably heard this one already: pregnancy hormones, especially relaxin, loosen your ligaments, so your pelvis gets unstable and starts to hurt. It's repeated everywhere, and it sounds so tidy. When researchers in Denmark actually measured relaxin in 455 pregnant women with clearly defined pelvic joint pain and 455 matched women without it, they found no difference in relaxin levels between the two groups [4].

Hormones clearly do change connective tissue in pregnancy, and the research on this is still mixed, so I'm not telling you hormones play no part. I'm telling you the simple "it's just relaxin" story is not what the data shows, and I'd rather not hand you an explanation that doesn't hold up.

It matters practically, too. If SPD were only about hormones, there would be nothing to do but wait for your baby to arrive, and that's not what I see in my practice. What I see is how your pelvis is being loaded, which side flares, and how the muscles around the joint are guarding, and those are things we can actually change.

What actually helps SPD during pregnancy?

The good news is that small changes to how you move add up quickly. These are the ones I teach first:

• Keep your knees together for the one-sided moves. Roll over in bed with your knees together, sit down first and then swing both legs into the car together, and put your pants on sitting down [1].

• Change positions often. Try not to sit or stand in one spot for more than about 30 minutes [1].

• Set up your sleep. Sleep on your less painful side, with a pillow between your knees and one under your bump [1].

• Skip the lopsided loads when you can. Carrying a toddler on one hip, crossing your legs, wide stances, and sitting on the floor tend to aggravate it [1].

• Keep moving in a way that feels okay. A large Cochrane review of 34 trials and 5,121 pregnant women found that exercise improved function and reduced sick leave, and that a mix of hands-on therapy, exercise, and education reduced pain and disability [3]. The evidence isn't high quality yet, but it does point the same way [3].

• Try a support belt, if it helps you. The physical therapy guideline for pelvic girdle pain in pregnancy found mixed evidence for belts, so think of one as a tool to try, not a cure [5].

In my practice, I start by watching how you stand on one leg, which side flares, and how your hip and inner thigh muscles are working, because the plan for you depends on what's driving your pain. That hands-on, individual approach is what the physical therapy guideline supports, rather than a generic handout [5]. If you're wondering whether it's even safe to start PT while you're pregnant, my post on pelvic floor therapy during pregnancy covers it. The short version: SPD is not something you have to just put up with until your baby comes [1].

Can I still have a vaginal birth with SPD?

Yes. Most people with SPD can have a vaginal birth, and a C-section is not normally needed because of it [1]. There's no evidence that a C-section helps pelvic girdle pain [2].

All of your pain relief options, an epidural included, are still on the table [1]. The most helpful thing you can do is tell your labor team about your SPD ahead of time, so they can support your legs and help you change positions as you go [1].

How do I prep my birth plan for SPD?

This is the part I love helping with, because a little planning now can make labor so much kinder to your pelvis.

1. Find your pain-free gap. As you get close to your due date, lie on your back with your knees bent (or sit on the edge of a chair), let your knees open slowly, and stop where it starts to hurt. Measure the distance between your knees [6][7]. Some people cut a piece of string to that length so it's easy to show their team.

2. Start practicing labor and birth positions now. Many people with SPD find lying on their back uncomfortable. Standing, kneeling, all fours, leaning forward, and lying on your side are often much easier, so try them out now and write down the ones that feel good [2]. In my practice we go through positions that can be used for rest and recovery during pregnancy when SPD flares, and can also make labor and delivery go more smoothly.

3. Write it in your birth plan. Ask that your legs are not moved wider than your pain-free gap, and that both legs are lifted and moved together for things like stitches or an assisted delivery [6][7]. This matters even more if you have an epidural, because the epidural takes away the pain that would normally warn you. AND write your alternate positions in your birth plan so nurses and supportive team members can help you try them as needed.

4. Plan your epidural positions, too. Lying on your side with your less painful leg supported on pillows or a peanut ball is especially useful if you have an epidural [2].

5. Ask about the birthing pool. Water can take weight off your joints [1].

6. Skip the feet-on-hips pushing. Pushing with your feet braced on your partner's or midwife's hips has sometimes reproduced SPD, so it's worth noting in your plan [6] and refer back to step 2, trying different labor and delivery positions in advance so you have options.

In a small number of births, your legs may need to go wider to deliver your baby safely, and that's okay. If it happens, just take extra care in the days after, and have a physical therapist check in with you.

In my practice, we can work through these positions together in your third trimester and get your SPD notes ready for your birth plan, so you walk into labor with a plan instead of a worry.

Does SPD go away after birth?

For most people, it gets better after the baby arrives, but about 1 in 10 still have pain afterward [1]. Build your walking back up slowly, and if you can, ask for a room close to the bathroom for those first few days [1].

SPD is also more likely to come back in a later pregnancy, so starting care early next time is a great idea [1]. If you're still sore once your baby is here, my post on what to expect from postpartum physical therapy walks through the next steps. And if your pain sits more at the back of your pelvis, my post on SI joint pain is a good next read.

When should I call my provider sooner?

Severe pain at the front of the pelvis after delivery that makes it very hard to walk, especially with trouble passing urine, deserves a prompt call to your doctor or midwife. A true separation of the pubic joint is rare, but it does happen, and it needs a different plan [8].

SPD FAQ

Is SPD the same as pelvic girdle pain? SPD is the older name for pain at the front joint of the pelvis. Most providers now use pelvic girdle pain, which also covers the joints at the back of the pelvis [1].

Will SPD hurt my baby? No. It can be very painful for you, but it does not harm your baby [1].

Can I have an epidural with SPD? Yes, all pain relief options are possible [1]. Write your pain-free gap into your birth plan so your legs aren't moved wider than that while you can't feel it [6][7].

When should I start physical therapy for SPD? As soon as the pain starts. Early care helps, and you don't have to wait it out until your baby arrives [1].

You can still have the birth you want

SPD is common, it's treatable, and it doesn't take the birth you're hoping for off the table. With a few changes now and a plan for labor, you can walk into that day feeling a lot more prepared, and I'd love to help you get there!

You can reach Protea Physical Therapy at (909) 265-3584, and I see patients here in Anaheim Hills, serving Orange County. You can read more about my pregnancy care, or if you'd like to talk it through first, book a free 15-minute discovery call.

This article is for education only and is not medical advice. Please talk with your doctor or midwife about your pain and your birth plan, and call them right away if your pain becomes severe or you have trouble walking or passing urine.

References

1. Royal College of Obstetricians and Gynaecologists. Pelvic girdle pain and pregnancy (patient information). https://www.rcog.org.uk/for-the-public/browse-our-patient-information/pelvic-girdle-pain-and-pregnancy/

2. HSE (Health Service Executive, Ireland). How pelvic girdle pain affects labour and birth. https://www2.hse.ie/conditions/pelvic-girdle-pain-pregnancy/how-it-affects-labour-and-birth

3. Liddle SD, Pennick V. Interventions for preventing and treating low-back and pelvic pain during pregnancy. Cochrane Database of Systematic Reviews. 2015;(9):CD001139. https://doi.org/10.1002/14651858.CD001139.pub4

4. Albert H, Godskesen M, Westergaard JG, Chard T, Gunn L. Circulating levels of relaxin are normal in pregnant women with pelvic pain. European Journal of Obstetrics & Gynecology and Reproductive Biology. 1997;74(1):19-22. https://pubmed.ncbi.nlm.nih.gov/9243195/

5. Clinton SC, Newell A, Downey PA, Ferreira K. Pelvic Girdle Pain in the Antepartum Population: Physical Therapy Clinical Practice Guidelines. Journal of Women's Health Physical Therapy. 2017;41(2):102-125. https://www.aptapelvichealth.org/info/cpg-pelvic-girdle-pain-in-the-antepartum-population

6. South Tees Hospitals NHS Foundation Trust. Pelvic girdle pain in pregnancy. https://www.southtees.nhs.uk/resources/pelvic-girdle-pain-in-pregnancy/

7. Northern Lincolnshire and Goole NHS Foundation Trust. Pelvic girdle pain (PGP). https://www.nlg.nhs.uk/resources/pelvic-girdle-pain-pgp/

8. Carlson K, Vadakekut ES. Postpartum Pubic Symphysis Diastasis. StatPearls. 2026. https://www.ncbi.nlm.nih.gov/books/NBK537043/