SPD stands for symphysis pubis dysfunction, a condition where the joint at the front of your pelvis becomes painfully loose or unstable during pregnancy. It’s one of the most common sources of pelvic pain in pregnancy, and while the severity ranges widely, it can make everyday movements like walking, climbing stairs, or rolling over in bed genuinely difficult.
You may also hear it called pelvic girdle pain, or PGP, which is a broader term that includes pain at the back of the pelvis as well. SPD specifically refers to the symphysis pubis, the narrow joint where the two halves of your pelvis meet at the front, just above the pubic bone.
Why It Happens
During pregnancy, your body produces a hormone called relaxin that loosens muscles, joints, and ligaments throughout your pelvis, back, and abdomen. This loosening is deliberate: it prepares your body for labor by making the pelvis more flexible. Relaxin levels peak around 12 to 14 weeks of pregnancy, at the end of the first trimester, though the effects build throughout pregnancy as your baby grows heavier.
The problem is that relaxin doesn’t target one joint at a time. It loosens your entire pelvic structure, which can leave the symphysis pubis joint with more movement than it can handle comfortably. The increasing weight of pregnancy puts more strain on this already-loosened joint, and the result is pain, instability, or both. Relaxin can also weaken your pelvic floor muscles, sometimes affecting bladder control and posture at the same time.
What SPD Feels Like
SPD pain varies a lot from person to person. For some women it’s a mild ache at the front of the pelvis. For others it’s sharp, shooting pain that comes from the front or back of the pelvis without warning. The sensation can feel like tingling, burning, stabbing, or deep throbbing in the pelvic region. In more severe cases, steady pain radiates outward into the lower abdomen, back, groin, perineum, and thighs.
What makes SPD particularly frustrating is the list of movements that trigger or worsen it. Nearly every basic daily activity can set it off:
- Walking, especially for longer distances
- Climbing or descending stairs
- Getting in and out of bed or rolling over at night
- Getting in and out of a car
- Standing on one leg, even briefly (like when pulling on pants)
- Spreading your legs apart, such as stepping over something
- Bending forward or sitting up straight for extended periods
- Twisting motions, like reaching behind you
The pain often worsens as the day goes on, particularly after periods of standing or walking. Nighttime can be especially rough, because shifting positions in bed forces your pelvis to move in ways that stress the joint.
How It’s Diagnosed
There’s no single test for SPD. Diagnosis is based primarily on your description of where the pain is, what makes it worse, and a physical exam. Your provider will typically press on the symphysis pubis area and may ask you to perform movements like standing on one leg or walking to see how your pelvis responds. Imaging is rarely needed but can be used in severe cases to check how much the joint has separated.
One reason SPD can be underdiagnosed is the wide variability in how it’s defined. Estimates of how many pregnant women experience pelvic girdle pain range from 4% to 84%, a gap that reflects inconsistent diagnostic criteria across studies rather than genuine uncertainty about whether it’s common. In practical terms, it’s one of the most frequent complaints in the second and third trimesters.
Managing the Pain
SPD can’t be “cured” during pregnancy because the underlying cause, hormonal loosening plus the weight of your growing baby, is ongoing. But there are effective ways to reduce how much it interferes with your life.
Pelvic Support Belts
A pelvic support belt wraps snugly around your hips to compress and stabilize the joint. Research on pregnant women in their third trimester found that using a support belt led to meaningful reductions in both back and pelvic pain scores. They’re inexpensive, available without a prescription, and one of the first things typically recommended. The belt works best when worn during activities that trigger pain, like walking or standing for long periods, rather than all day.
Movement Strategies
Small changes to how you move can make a surprising difference. The general principle is to keep your legs together and avoid asymmetrical movements. When getting out of bed, roll onto your side and swing both legs off the edge together rather than twisting. When getting into a car, sit down first and then swivel both legs in at the same time. Take stairs one step at a time rather than alternating legs. Avoid squats, lunges, and any exercise that requires standing on one leg.
Gentle exercises that strengthen the muscles around your pelvis, particularly pelvic floor exercises and core stability work, can help compensate for the loosened ligaments. A physical therapist who specializes in pregnancy or pelvic health can design a routine specific to your pain pattern. Swimming and water-based exercise are often well tolerated because the buoyancy removes weight from the joint.
Sleep Positioning
Nighttime pain is one of the most common complaints with SPD. Placing a pillow between your knees while lying on your side keeps your pelvis in a more neutral position and reduces strain on the symphysis pubis. A full-length body pillow can also help by preventing you from rolling into positions that pull the joint apart overnight.
SPD During Labor and Delivery
SPD does not prevent vaginal delivery, but it does affect which positions are comfortable and safe during labor. The key limitation is how far apart your legs can comfortably spread. Positions that require wide leg separation, like traditional stirrup positioning, can significantly worsen the pain and in rare cases cause further separation of the joint.
It’s worth discussing your SPD with your birth team before labor begins. Knowing your comfortable range of leg separation ahead of time allows your providers to plan positions that work for both delivery and your pelvis. Side-lying positions, hands-and-knees, and upright kneeling are commonly used alternatives that put less stress on the joint. An epidural can mask SPD pain during labor, which is helpful for comfort but also means you and your team need to be careful not to push your legs beyond their safe range when you can’t feel the warning signals.
Recovery After Birth
For most women, SPD improves significantly once the baby is born. The mechanical stress on the joint drops immediately, and relaxin levels gradually return to their pre-pregnancy baseline. The standard six-week postpartum checkup is typically when you’ll be cleared for normal activity, but full recovery of the pelvic floor muscles and associated connective tissue takes longer, usually four to six months.
Some women notice lingering pain or instability beyond six weeks, particularly if the separation was severe or if they had SPD in a previous pregnancy. Postpartum physical therapy focused on pelvic floor rehabilitation and core strengthening can speed recovery and address any persistent symptoms. In rare cases where the joint separated significantly, recovery may take longer, but the vast majority of women return to full, pain-free function without any lasting effects.