6 months preg w/ twins- SPD, rectocele, diastasis, scoliosis

Submitted by roseredhoofbeats on September 5, 2012 - 10:55am
Body: 

So! I'm kind of falling apart here. I'm 24, have a four year old daughter, and am 26 weeks pregnant with twin boys. This is my fourth pregnancy (two miscarriages after my daughter was born).

I have a mild spinal curvature that wasn't deemed serious enough to treat when I was a teenager, through my thoracic spine starting at about T6 and it stacks unevenly all the way down to my sacrum. I've *never* had any kind of butt, even when I was quite active and muscled and had great hips, and I think the way the scoliosis affects my lumbar curvature is partially why. I was a horseback rider for years, and always leaned to the right. When I'm sitting I tend to slump to my right side as well unless I'm consciously thinking about it. It hasn't ever bothered me when I'm not pregnant, but I get horrible back pain as my uterus gets heavier and pulls things out of place. I get this huge knot right where the spinal curvature starts. My tailbone's also been broken three times and bends inward at a pretty sharp angle, and I have a compression fracture from when I fell off a horse and landed smack on my butt.

My daughter's labor and birth wasn't bad. I did have a very long pushing stage, but I didn't tear badly and once I got her past my bladder (thanks for forgetting to cath me for over 6 hours, that really helped) she was born easily. I had two tiny tears. No problems postpartum or anything.

I developed a severe diastasis with my daughter- I am very slender, 5'6" and 115-120 pounds pre-pregnant, and a size 2 with a 24" waist/36" hips (very pear shaped), and I carry very high and all the way out in front. I fixed it easily postpartum with modified Tupler and it wasn't a problem until I got pregnant three times in one year (m/c at 10 weeks, then 8 weeks, and then my current pregnancy, all about 4 months apart) and with having twins, I started showing VERY early and had quite a ridge from about 8 weeks. Having awful morning sickness and heaving over 10 times a day and being constipated from the Zofran did *not* help. Things got a little better in the second trimester, I started doing Tupler exercises for pregnancy and got a splint. But around 16-18 weeks it just sort of exploded no matter what, which I'm under the impression is not uncommon in twin moms who were already narrow waisted. I'm getting really bothersome rib pain, as I'm carrying VERY high (I can wear my pre-pregnancy pants no problem, just under my belly) and am obviously quite large with two in there. My hips hurt when I lay on my side, lying on my back makes me very short of breath and gets uncomfortable very quickly.

But around 20 weeks, I started getting really bad SPD/SI pain, along with sciatica. Went to a great physical therapist who specializes in pregnancy and she adjusted my pelvis so it was lined up properly, and taped my back up to help support the muscles so they would stay more even. That was AMAZING and significantly reduced the pain in the joints, but my pubic muscles are still very sore and almost feel bruised all the time. I'm expressly forbidden from doing anything that separates my knees or opens my pelvis too wide, since that worsens the SPD and increases the risk of getting it misaligned again (in addition to being MIND BLOWINGLY PAINFUL). So squats and lunges are out. We didn't think this would be a big deal because hey, I've got a pretty strong pelvic floor, right? Well...

In addition to all this loveliness, I've developed a rectocele. I discovered it when I was trying to have a BM the other night, and was trying to splint through my vagina (something I've had to do frequently with the Zofran, though normally I have to reach back quite far and sort of press things out) and realized I couldn't get my fingers in my vagina. Freaked out for a minute I'd somehow had some kind of catastrophic cervical prolapse, until I realized that the bulge was stool, and was trapped in the space between my vagina and perineum. Got that dealt with, broke out my hand mirror, and when I bear down I can kiiind of see something (I'm not really getting a good angle, here) and hit Google. Called my nurse-midwife who said I was probably right, but no, there's nothing they can do while I'm pregnant and they'll see if I need surgery after the birth. Gee thanks (I am not in love with this practice but the OB she works for is the head of labor and delivery at my hospital and so he's my best bet for a vaginal twin delivery. He has a good reputation for natural birth, I know someone who had vaginal triplets with him.)

ANYWAY. I'm feeling quite discouraged and very broken. I didn't have any problems at all after the birth of my daughter except for the diastasis and that seemed easy enough. But I'm just in a LOT of pain, every single day, sex is completely impossible, I'm having a hard time sleeping, and I feel completely unprepared to give birth like this. How will I be able to walk and move around in labor when it's so hard to walk right now? How will I be able to push if my abs and pelvic floor are so weak? What is the risk with an assisted delivery (either a breech extraction of twin B, or a forceps/vacuum extraction? I never thought I'd have *this* much trouble with childbearing. I'm scared that I'll tear straight through and have to get surgery and what the recovery from that will be like, if I'll be able to have more children vaginally, what it will do to my sex life.

I know that a c-section is not nessecarily better for pelvic floor issues (then I could have a rectocele AND a cystocele!) and trust me, I'm very motivated to avoid one. I am unfortunately stuck at the hospital- it isn't legal for midwives to attend twin births at home where I live, and I'm going to the best one in my area- it's WHO Baby Friendly, it's got good breastfeeding rates, decent (for America) c-section rates, and my husband works there, so I have the best insurance coverage. Like I said, I'm not wild about the practice, but I'm not sure any other MFM doctor would be any better in terms of bedside manner. He's very flexible in terms of the usual trappings of a natural hospital birth and since he's the department head, I don't have to worry about a nurse giving me any crap about it. Pretty much all of the questions I've asked, about possible fetal malformations or preterm labor or anything, I get a blown off "we're not really worried about that right now..." or a basic soundbyte answer that could have come off the American Pregnancy Association website. He was completely ignorant that you could use physical therapy for a diastasis and I had to argue with him to get a splint covered. Wow, four years of undergrad and med school and six years of residency and that maternal-fetal medicine fellowship weren't wasted on you, were they?

Anyway! Sorry about the novel... my concerns/questions are.

1. Are there ANY exercises for the rectocele that I can also do with the SPD? Some kind of supported squat that will strengthen the pelvic floor without pulling on the pelvic bones? Anything? Should I even be trying to fix this while pregnant, or is it a case of spitting in the wind?

2. What are the implications for delivery with a rectocele and the risks with an assisted delivery?

3. What can I do for the pelvic pain, especially the muscular pain I'm feeling?

4. What are the best positions for sitting and lying down for all my various problems? Semi-reclining with pillows propping me up on the bed or on the couch seems to be the only way I can sleep right now.

Thank you so much for any help you can give me!

Forum:

fab

September 5, 2012 - 7:23pm

Welcome RoseRedHB

The basis of Wholewoman work is posture. If you go into the "Frequently Asked Questions" tab on this site’s home page you will find a description of wholewoman posture. The important aspect is to work on maintaining or regaining your lumbar curve as far as is possible with the injuries you have sustained and the weight of your pregnancy and maybe it is something that needs to wait a little till after labour, but see what you can do.

The fact that you had a successful labour with your little girl is a very encouraging landmark for your next labour with your dear twins. However, twins is twins; a whole new experience on its own with its own particular difficulties which you so well describe.

You have gone to particular trouble to make sure that you and your twins get the best care possible. That is a major plus. That your doctor doesn’t want to talk about any abnormalities or preterm labour, you can be pretty sure is because he has seen nothing to worry him in this regard, but being a scientist and experienced in the vagaries of life doesn’t want to rule the possibility out when there is always the chance of the unexpected. They don’t wish to be cruel or to alarm you unduly. It’s a difficult balance.
Although every mother does worry until she finally gets to that stage where she resigns herself to the inevitable which you would have done with your first little girl. The old Scarlet O’Hara trick: “I’ll worry about that tomorrow”. You, with two miscarriages, would be naturally even more alert to these fears, so examine your instincts and place this worry if you can in the real or unreal basket and act accordingly. And remember if in real doubt assume the worst and insist you get it checked anyway.

I don’t know how much reading you have been able to manage on this site or forum but if you type “Tupler”, and “rectocele and labour” in the search box on the top left here on the forum's page you will see a number of previous posts where these things have been discussed.

I don’t know much about Zofran for morning sickness. The old remedy was to be taken a cup of tea into bed in the morning “before your feet meet the floor”. It usually passes in the first few months, the fact it hasn’t maybe some other ladies will come in later and make suggestions on this, for of course you’ve hit the nail on the head. Constipation is what you don’t want.

Best wishes, Fab

wheayting

September 7, 2012 - 10:39am

I'm by no means an expert on any of what you're dealing with, but I do have scoliosis, two pregnancies (large babies, not twins) with diastasis recti and the second time I had pubis symphasis (SPD). I was advised by my physio to wrap my hips during pregnancy but I found it didn't really help much. In the back of my mind I was thinking if my hips were preparing to spread apart that much maybe there was a good reason. What helped the most was staying off my feet and not lifting. If I lifted my older child or did a grocery shopping trip I was in tremendous pain. During labor, I labored sitting up as that's just what I felt like doing, I got up to go to the bathroom and walked around and it didn't bother me much. Afterwards it was extremely painful, I could get out of bed and walk a few steps to a wheelchair and that was it for a few days. It took a long time to get better, probably 4 months before I started feeling ok. In the PP period I wrapped my hips and it helped a lot.

alemama

September 13, 2012 - 7:18pm

1. Are there ANY exercises for the rectocele that I can also do with the SPD? Some kind of supported squat that will strengthen the pelvic floor without pulling on the pelvic bones? Anything? Should I even be trying to fix this while pregnant, or is it a case of spitting in the wind?

are you wrapping to support the SPD? Wearing a brace? They have them....and yes there are things you can do. And things you are going to want to do.
1. Get to know your back vaginal wall and perineum. Check it all out, make note of any scar tissue, rough spots, thin spots.
2. Cat Cow and pelvic rocks (you can do these on hands and knees or on your feet with your hands on your knees). Up to 100 each day (at one time if you can manage it).
3. No constipation at all. Avoid it!

2. What are the implications for delivery with a rectocele and the risks with an assisted delivery? No difference. The rectocele will be flattened out by the head (may bulge right before the head comes down- but no big deal).

3. What can I do for the pelvic pain, especially the muscular pain I'm feeling? Epsom salt soaks. Cold plunges. Massage and chiropractics. Acupuncture. Osteopathic doc may be a big help as well. Yoga. Stretching (especially lengthening the hamstrings).

4. What are the best positions for sitting and lying down for all my various problems? Semi-reclining with pillows propping me up on the bed or on the couch seems to be the only way I can sleep right now.
Left side lying with a body pillow. For me there was a magical distance to keep the knees apart that kept my pelvis happy.

Finally, know that my heart goes out to you. I know how painful the SPD can be, just how hard it is to be pregnant with small children to care for, how you always put yourself last in the line up.
I'm so glad you are here, asking how best to care for yourself. I know many people don't agree with me on this one (and you can take it or leave it of course), but I recommend you make a good bone broth and drink it daily. It really does support the body, the growth of the baby and the connective tissues. If you can't do that, please at least get plenty of magnesium and vitamin C and D. Maybe start taking cod liver oil.
Growing two humans is no joke. YOu have a big job to give them everything they need. And you are starting at a loss since you have been pregnant before. Your babies will take from you what they need- but if you don't have it to offer- they will miss out. Getting enough DHA will help you not have a brain fog (they will take it right from your brain). When people say *I'm eating for two* as an excuse for more cake, it's just silly. But you are *eating for three* and in my mind that means you gotta make EVERY BITE COUNT!!! Overload yourself with greens, fats and proteins. A multi vitamin is not going to cut it!

For you body, it may be that you are going to just have to ride this wave for the rest of the pregnancy. You can do it! It seems long when you are in it, but it will be over before you know it!

wholewomanUK

September 15, 2012 - 4:26pm

Hi roseredhoofbeats,
The previous posts sound great advice so not much more to add:

You've got a lot to cope with - and I also sympathise greatly with what you're going through. We're all vouching for you here! It sounds very painfl and uncomfortable, but fortunately many of the symptoms which have arisen during pregnancy will probably disappear once your babies are born. The prolapse issue can be addressed by the WW work. Thankfully you've found WW straight away! However I do really appreciate it's a very long time to be in pain and discomfort in the meantime.

I hope you're making sure you have maximising all opportunities for healthy relaxation, pampering and when at all possible - pleasure! Feeling as happy and calm as possible helps you through the tough times. So if you can, eg enlist the help of others, rest if you can when you're tired... identify the things that help you feel happier, healthier, calmer and try including them into your days... Every little helps... This will help you to cope better and feel better.

Morning sickness: you may find ginger helps, eg tea with chopped fresh ginger in, ginger biscuits... Some women find nibbling small quantities throught the day and avoiding large meals helped.

Sleepng: I'm wondering if sleeping lying flat may be better re prolapse, but that is not the only issue for you, so obviously you need to find what works best for you. Some women with prolapse find sleeping on a bed slightly higher at the feet end helps. Many pregnant women find sleeping with a pillow, some like the big long ones, to place one leg on or place close behind their backs etc, which makes then feel more comfortable.

WW exercise and posture are the appropriate exercises for you, although as you say you need to keep your legs and hips narrow. It's easy to avoid the wide hip/leg postures and confine yourself to narrow hip/leg postures. I don't knowif you've got the WW book and dvd/dvd's. If not, I think these would be really helpful references, resources and supports for you in the short and long term. You might find one of the Introductory bundles a good start. Meantime, do make good use of the videos and resources on this website.

Love and best wishes, xwholewomanuk