I saw a patient yesterday who was having her third labour induced at 36 weeks by a colleague because of severe and persistent pain. She had a difficult first labour complicated by induction, epidural, intravenous oxytocin and forceps delivery. It was a prolonged affair (more than 12 hours in the active phase). Her pain started at 20 weeks and had been unrelenting throughout pregnancy. Clinical examination revealed bilateral lower abdominal tenderness. The clinical diagnosis was “SPD” or symphysis pubis dysfunction.
Many of these women sustain soft tissue injuries during their first labours. These include injuries to pelvic nerves. These nerves re-grow in a complex and chaotic fashion over the next five years so that if any subsequent pregnancy occurs then the weight of the pregnant uterus may cause significant pain.
The extent of the pain may vary with the prior injury, the interval, and, the autonomic “gain” of the woman on any given day i.e. how sensitive she is to pain. Stress, alcohol, tobacco, drugs may all amplify the pain at any time. Treatment is TENS and simple analgesia. There are many strands of evidence to support these observations. Obstetricians do not all recognise these injuries.