Symphysis Pubis Dysfunction (SPD/PGP)
Medically reviewed by Dr. Lisa Okafor, MD, FACOG · Board-Certified OB-GYN
Content reviewed against published ACOG, NIH, NICE guidelines
Last reviewed:
Your health matters just as much as your baby's. If you are dealing with symphysis pubis dysfunction (spd/pgp), here is what you need to know.
The short answer
Symphysis pubis dysfunction (SPD), also called pelvic girdle pain (PGP), occurs when the joint at the front of the pelvis becomes too loose during pregnancy, causing pain, instability, and difficulty walking. It affects about 1 in 5 pregnant people to some degree. It is caused by the hormone relaxin and the weight of the growing baby.
Key takeaways
- Symphysis pubis dysfunction (SPD), also called pelvic girdle pain (PGP), occurs when the joint at the front of the pelvis becomes too loose during pregnancy, causing pain, instability, and difficulty walking. It affects about 1 in 5 pregnant people to some degree. It is caused by the hormone relaxin and the weight of the growing baby.
- Usually normal when: Mild to moderate pubic bone pain that worsens with certain activities
- Call your doctor if: Sudden severe pain in the pubic area with a popping sensation, which could indicate symphysis separation
- Varies by age — see the age-by-age breakdown below
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What Parents Should Know
According to ACOG, NIH, NICE guidelines, symphysis pubis dysfunction (SPD), also called pelvic girdle pain (PGP), occurs when the joint at the front of the pelvis becomes too loose during pregnancy, causing pain, instability, and difficulty walking. It affects about 1 in 5 pregnant people to some degree. It is caused by the hormone relaxin and the weight of the growing baby. At Second trimester, sPD may begin in the second trimester as relaxin loosens the pubic symphysis joint. Symptoms include pain at the front of the pelvis that may radiate to the groin, inner thighs, or lower back. Pain often worsens with walking, climbing stairs, getting in and out of bed, or standing on one leg. A pelvic support belt and physical therapy can help significantly. It is generally considered normal when mild to moderate pubic bone pain that worsens with certain activities. However, you should contact your pediatrician promptly if sudden severe pain in the pubic area with a popping sensation, which could indicate symphysis separation.
Normal vs. Concerning
By Age
What to expect by age
Second trimester
SPD may begin in the second trimester as relaxin loosens the pubic symphysis joint. Symptoms include pain at the front of the pelvis that may radiate to the groin, inner thighs, or lower back. Pain often worsens with walking, climbing stairs, getting in and out of bed, or standing on one leg. A pelvic support belt and physical therapy can help significantly.
Third trimester
SPD often worsens in the third trimester. Keeping your knees together when turning in bed, sitting down to get dressed, avoiding wide-legged positions, and using a pillow between your legs at night can help. A physiotherapist specializing in pregnancy can teach you techniques to manage daily activities with less pain.
Labor & delivery
Let your birth team know about your SPD so they can help you find comfortable positions during labor. Avoid pushing your legs too far apart. Water birth may be helpful as buoyancy reduces joint stress. SPD does not prevent vaginal delivery in most cases.
Postpartum
SPD usually improves within weeks to months after delivery as relaxin levels decrease. Postpartum physiotherapy can help speed recovery. In rare cases, the pubic symphysis separates significantly (diastasis symphysis pubis), which requires specialized care. Most people recover fully.
What to Tell Your Pediatrician
- Describe when you first noticed symphysis pubis dysfunction (spd/pgp) and how it has changed over time.
- Note your baby's current age and which age-specific patterns you are seeing.
- Mention if pelvic pain is severe enough to significantly limit mobility.
- Mention if you need crutches or a wheelchair due to pelvic pain.
- Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
- Bring a list of any questions or observations you want to discuss at the appointment.
What Should You Do?
When to take action
- Mild to moderate pubic bone pain that worsens with certain activities
- Pain when walking, climbing stairs, or getting out of bed
- Clicking or grinding sensation in the pelvic area
- Pain managed with position modifications and a support belt
- Pelvic pain is severe enough to significantly limit mobility
- You need crutches or a wheelchair due to pelvic pain
- Pain is not improving with recommended strategies
- Sudden severe pain in the pubic area with a popping sensation, which could indicate symphysis separation
- Inability to walk or bear weight on either leg
What You Can Do at Home
- Keep track of when you notice symphysis pubis dysfunction (spd/pgp) — noting the time of day, duration, and any triggers can help your pediatrician.
- Remember that mild to moderate pubic bone pain that worsens with certain activities — this is generally within the range of normal.
- At Second trimester, focus on observation rather than intervention unless your pediatrician advises otherwise.
- Prioritize your own rest and nutrition. Accept help when offered, and do not hesitate to reach out to your healthcare provider.
- While monitoring at home, seek immediate care if sudden severe pain in the pubic area with a popping sensation, which could indicate symphysis separation.
Related Conditions
Hip Pain During Pregnancy
Hip pain affects many pregnant people, particularly in the second and third trimesters. It is caused by the hormone relaxin loosening hip joints, weight gain changing your gait, the growing belly shifting your center of gravity, and the pressure of side sleeping. It is usually treatable with stretching, support pillows, and gentle exercise.
Back Pain During Pregnancy
Back pain affects approximately 50-70% of pregnant people and is most common in the second and third trimesters. It is usually caused by the shifting center of gravity, weight gain, hormonal changes that loosen ligaments, and postural adjustments as the belly grows.
Pelvic Pressure and Heaviness in Pregnancy
Pelvic pressure is a common sensation in pregnancy, especially in the third trimester, caused by the growing baby's weight pressing on the pelvic floor, the baby descending into the pelvis (lightening), and hormonal loosening of pelvic joints. It is usually normal but should be evaluated if it occurs before 37 weeks.
Related Resources
Postpartum Recovery Guide
Week-by-week postpartum recovery timeline and warning signs.
Month-by-Month Development
Detailed monthly development guides from birth through 24 months.
When to Call the Doctor
General guide on when to call the pediatrician, visit urgent care, or go to the ER.
Frequently asked questions
Is symphysis pubis dysfunction (spd/pgp) normal?
When should I call the doctor about symphysis pubis dysfunction (spd/pgp)?
When is symphysis pubis dysfunction (spd/pgp) normal?
What causes symphysis pubis dysfunction (spd/pgp)?
What should I mention to my pediatrician about symphysis pubis dysfunction (spd/pgp)?
Is symphysis pubis dysfunction (spd/pgp) normal at Second trimester?
Is symphysis pubis dysfunction (spd/pgp) normal at Third trimester?
Should I go to the ER for symphysis pubis dysfunction (spd/pgp)?
Does symphysis pubis dysfunction (spd/pgp) go away on its own?
References
Doctor Visit Checklist
Bring this checklist to your next pediatrician visit to discuss Symphysis Pubis Dysfunction (SPD/PGP).
Things to mention
- Describe when you first noticed symphysis pubis dysfunction (spd/pgp) and how it has changed over time.
- Note your baby's current age and which age-specific patterns you are seeing.
- Mention if pelvic pain is severe enough to significantly limit mobility.
- Mention if you need crutches or a wheelchair due to pelvic pain.
- Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
- Bring a list of any questions or observations you want to discuss at the appointment.
Observations to share
- Pelvic pain is severe enough to significantly limit mobility
- You need crutches or a wheelchair due to pelvic pain
- Pain is not improving with recommended strategies
Urgent signs to report immediately
- Sudden severe pain in the pubic area with a popping sensation, which could indicate symphysis separation
- Inability to walk or bear weight on either leg
My notes
From ismybabyalright.com — free, evidence-based baby health guides
All content follows our editorial policy and is reviewed against published clinical guidelines.
2,705 evidence-based guides6 authoritative medical sources5 medical advisory board members
Related Resources
Bottom line
Most cases of symphysis pubis dysfunction (spd/pgp) are normal. Talk to your pediatrician if sudden severe pain in the pubic area with a popping sensation, which could indicate symphysis separation.
Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.
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Related Maternal Concerns
Hip Pain During Pregnancy
Hip pain affects many pregnant people, particularly in the second and third trimesters. It is caused by the hormone relaxin loosening hip joints, weight gain changing your gait, the growing belly shifting your center of gravity, and the pressure of side sleeping. It is usually treatable with stretching, support pillows, and gentle exercise.
Back Pain During Pregnancy
Back pain affects approximately 50-70% of pregnant people and is most common in the second and third trimesters. It is usually caused by the shifting center of gravity, weight gain, hormonal changes that loosen ligaments, and postural adjustments as the belly grows.
Pelvic Pressure and Heaviness in Pregnancy
Pelvic pressure is a common sensation in pregnancy, especially in the third trimester, caused by the growing baby's weight pressing on the pelvic floor, the baby descending into the pelvis (lightening), and hormonal loosening of pelvic joints. It is usually normal but should be evaluated if it occurs before 37 weeks.
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