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3 May 2000 : Column 88WH

Diastasis Symphysis Pubis

12.30 pm

Dr. Stephen Ladyman (South Thanet): This is my first experience of Westminster Hall. I was a strong supporter of the experiment when it started, but I did not realise that it would be as difficult to be drawn out of the hat as it is to get six winning numbers on a Saturday night in the national lottery. This is my first opportunity to open a debate here, and I am delighted that it is to be a debate on the subject of diastasis symphysis pubis. I have discovered that if one wants to attract the interest of colleagues and journalists in a debate, it is a good idea to have a title that nobody understands; I have had dozens of calls from people who wanted me to explain it to them.

If my persistence in seeking the debate has paid off, it has been nothing like the persistence of my constituent Mrs. Angie Lambert, who suffered chronic pain during and subsequent to her pregnancies in 1992 and 1994. She received no adequate support to deal with that pain, no explanation of it and no suitable treatment, but she would not accept that it was the norm and that pregnant women must put up with it. She was told that pregnant women must face that sort of pain and had to grin and bear it, and that it went with the job of having children.

Mrs. Lambert began to research the subject and came across an article entitled "Mind the gap" by Margaret Polden, then the superintendent obstetric physiotherapist at Hammersmith hospital. When Mrs. Lambert read the article she realised that she had been suffering from one of a group of conditions called symphysis pubis dysfunction, or SPD. In particular, she was suffering from the condition known as diastasis symphysis pubis, or DSP. She found that there was no organisation to provide care for that condition, or advice about its treatment. Having been encouraged to do so by Mrs. Polden, she set up the British DSP support group, which has subsequently been renamed the British SPD support group. So far as I am aware, it is the world's only support group for the condition. It is based in my constituency in an office in Ramsgate.

The group is responsible for raising awareness of the condition, among other things. As part of that process, and for the benefit of all the parliamentary colleagues who have, I hope, switched on monitors around the Palace of Westminster to find out what diastasis symphysis pubis means, I will briefly describe the condition.

There are three major bones in the pelvic girdle. The one at the centre is called the sacrum, to which the backbone is attached at the base of the spine. To the side are two curved bones, which join the sacrum at the back and curve forward and are jointed at the front. The joint at the front is called the symphysis pubis; the bones are held together by ligaments, and the gap in the joint would usually measure around 4 mm to 5 mm. The ligaments soften as a result of the hormones produced during pregnancy, and the joint moves apart slightly, possibly by another 2 mm to 3 mm, to facilitate the delivery of the baby. A gap of 9 mm would be considered normal during pregnancy, but if that gap gets too large or if after birth the ligaments do not toughen up and the gap does not close down again, problems arise. The condition known as diastasis symphysis pubis occurs when the gap has grown beyond 10 mm.

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The consequences of the condition are chronic back pain, shooting pains in the legs, suprapubic pain, sacroiliac or lumbar pain, radiating pains to the buttocks, groin and legs, and tenderness. The woman will often walk with a waddling gait because she cannot walk normally. She will find it difficult to walk with normal long strides and will have difficulty in moving her legs. She will be unable to get in and out of a car, turn over in bed and climb the stairs. She will find it difficult to do the shopping and normal household activities. Sexual intercourse becomes difficult, and the woman often experiences loss of self-esteem and depression. Many women find that the quality of their lives is severely affected by SPD.

Many women cannot lift their babies out of their cots to cuddle them, which can be distressing for a mother with a newborn baby. A woman will find it difficult to sit on the carpet and play with her new baby, which is one of the pleasures of close bonding. She will feel cheated out of that experience and will consequently often face depression. Her marriage may be affected, and family relationships often suffer. Her sex life and social life can be affected. Women who intend to return to work can find employment difficult, and obvious financial problems result. Depression, resentment, anger, lack of self-esteem, frustration and lack of confidence are all common.

On top of that, the medical profession finds it difficult to recognise the condition and to provide appropriate levels of support, because awareness of the condition is not high. The woman will therefore often find that nobody believes in her. She is almost told to go away and pull herself together, with the words, "This is normal--it's just a bit of backache, which will disappear. Take a couple of aspirins." In fact, the condition is anything but normal. Once it has been recognised, it can be managed very well and treated, but it is seldom recognised.

As the Member of Parliament for the constituency in which the support group is based, I have had many telephone calls from men throughout the country who have said, "My partner has had this condition for months. My life has been made a misery because of the difficulty that she has been having. Nobody told her what she was suffering from or what to do about it. We have just found out about it by accident. Somebody has introduced us to the support group, and we are now getting help. What are you doing as the MP to make people aware of the condition?" One thing that I hope will come out of today's debate is that people will become aware of the condition and the Department will start to follow that up.

There are slightly more than 700,000 pregnancies each year in the UK. About one woman in 250, or close to 3,000 women will probably suffer from SPD in one form or another. Of those 3,000 women, only 45 per cent.--or 1,300 women--are ever put in touch with the SPD support group. It is the only group that supports such women, so one must assume that 1,700 other women who suffer from the condition are never given appropriate counsel.

Doctors still are not taught about DSP and SPD. During training, they receive only a basic knowledge of ligament pain and are not given specific details about the condition. Many hospital trusts have no specialists who can spot it, and many women suffer for months without

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it being recognised. Once you know that you have the condition, your lifestyle can be assessed and you can be given advice to help you manage the pain and the condition and to bring about comfort, if not a cure.

Mr. Deputy Speaker (Mr. John McWilliam): Order. The hon. Gentleman is using the word "you". When he uses it, he refers to me, and, in the circumstances, I am physiologically incapable of having the condition.

Dr. Ladyman : My great apologies, Mr. Deputy Speaker, but I am sure that you will now be able to counsel appropriately constituents who come to you with this problem.

Once the condition is recognised, an individual can be counselled to address the matter. Postural advice is especially important. Osteopathy and chiropractic treatment can bring a great deal of relief, as can the Alexander technique. Generally, a plan can be put in place to manage the condition and the pain associated with it. The first step is for doctors to recognise the condition and for the woman to be put in touch with people who can help and advise her.

I have various questions that I want my hon. Friend the Under-Secretary to address. I know that she has addressed the first, which is an issue that gives weight to the support group's view that nobody is taking the condition seriously. The group wrote to Her Majesty the Queen some months ago, to bring the matter to her attention, and Her Majesty wrote back to say that she would bring it to the attention of the Secretary of State. The Secretary of State did not respond. The group wrote directly to the Secretary of State, but he still did not respond. It wrote to me and asked me to obtain a reply from the Secretary of State. I wrote to him, and, lo, no response came. The letter still has not received a reply. I understand that my hon. Friend the Under-Secretary has managed to track down that correspondence, and she assured me that there will be a response. However, I am sure that she will understand that that has added to the feeling that nobody really cares about the condition.

Why are doctors still not being taught about the two conditions? What steps can the Government take, presumably through the Royal College of Obstetricians and Gynaecologists, to ensure that such study is included in doctors' training? We would like the Under-Secretary to consider making osteopathy and chiropractic treatment available on the national health service to women who have been identified as having the condition. The Department of Health should consider an awareness campaign, not only within the medical profession but in clinics that women attend for check-ups. Consequently, if a woman should start to experience such chronic pain, before or after her baby is born, she will at least know that there is a group that can advise her. Alternatively, she can ask her general practitioner whether he has considered that she might have SPD or DSP, and ask him to put her in touch with the support group. It is likely that the condition is often made worse by midwives using a technique called lithotomy, whereby a woman gives birth with her feet in stirrups or on the hip of the midwife. The support group believes that midwives should give serious consideration to the use of that position, given the possibility that women might suffer from SPD or DSP following the birth.

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Those are key points, but I would like my hon. Friend the Under-Secretary to consider a further point, on which she does not need to take immediate action, but which she should start to think about--the future funding of the support group. It has been funded for three years on a generous lottery grant, which the group was thrilled to receive. However, that funding runs out next year. Prior to the lottery grant, grants were made available through the Department of Health for the group's work. We must consider what will happen if there is no renewal of the lottery grant, because the group provides a vital service to women suffering from the condition. Will the Under-Secretary also consider whether the Department might fund a lecturer to tour medical colleges and hospital trusts to raise awareness of the condition. It is a debilitating condition for many hundreds--probably thousands--of women. It can absolutely ruin what should be the greatest experience of a woman's life: having a baby and looking after that child in its first months. Not only can the condition destroy that experience for many women, it can destroy their family and social life. We must start taking it much more seriously. I congratulate Mrs. Lambert and her excellent team in my constituency for their work. I wish to encourage my hon. Friend the Minister to pick up the baton carried by that group of people and ensure that the Department of Health carries it forward.

12.45 pm

The Parliamentary Under-Secretary of State for Health (Yvette Cooper ): I congratulate my hon. Friend the Member for South Thanet (Dr. Ladyman) on securing this debate on diastasis symphysis pubis and on the care with which he is representing his constituents' interests in such matters. He gave a powerful description of the problem and of the health, emotional and social consequences of the condition. As my hon. Friend described, diastasis symphysis pubis--DSP--and the more common condition, symphysis pubis dysfunction--SPD--are conditions that occur in pregnancy and affect the front joint of the pelvis, which can cause considerable pain. It can take some time for that pain to relieve completely after the birth, and physiotherapy is often helpful in managing the condition. My hon. Friend has made very clear the extent to which DSP and SPD are misunderstood, can remain undiagnosed and cause considerable misery and distress for sufferers and their families.

SDP and DSP are characterised by pain over the symphysis pubis joint. They can cause considerable pain in the hips, groin, lower abdomen and inner thighs. The extent and the severity of the condition vary from woman to woman, but there is no doubt that it can have a significant impact on the physical and emotional well-being of sufferers. I assure my hon. Friend that I take seriously and have listened carefully to the points that he raised about the condition. I want to deal now with some of matters to which he referred, and I shall later follow up some of his other points in my Department.

I agree that raising awareness of the condition is important. SDP and DSP may be difficult to diagnose and raising the issue more widely will make more health professionals aware of the symptoms and better placed to respond speedily and appropriately. I share my hon.

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Friend's concern and that of his constituents to see services for women who suffer from such conditions continuing to develop and improve.

We are aware of the concerns of various patients' groups. I wish to take this opportunity to apologise to my hon. Friend's constituent, Mrs. Lambert. We cannot find her original correspondence in the Department of Health. I apologise for the delay in replying to my hon. Friend's letter, a copy of which we have. After receiving his letter, to which he attached the correspondence from Mrs. Lambert and the support group, we have asked the Royal College of Obstetricians and Gynaecologists to consider the issue further and, if necessary, to reinforce its advice to members.

I understand that the college's scientific advisory committee has put the issue on the agenda of the meeting to be held on 16 June and I am sure that any guidance forthcoming from the college will help the medical profession better to recognise those women who are in need of specialist care. We are also aware of concerns about the low level of interest and awareness of DSP among health professionals, particularly general practitioners, and the wide variation in referral habits. We recognise that the pain and disability accompanying DSP and SPD can be minimised through early diagnosis and appropriate management, as my hon. Friend described. It is clear that such conditions will require expert knowledge.

It is encouraging to note that a small, but steadily increasing, number of health professionals are developing an interest in DSP and SPD. For some GPs, that has led to developing competence in diagnosis, changing and adjusting treatment and providing support and advice. A number of midwives are also taking an interest in DSP and SPD, and specialist obstetric physiotherapists are making a valuable contribution to the development of expertise in treatment. Much can be learned from their experiences. It is unlikely that individual health professionals will see more than one or two cases of DSP a year, if that--though they may see considerably more cases of SPD--so it is vital that they receive help to enable them to identify more easily women who present with symptoms.

The Government have done much to promote and disseminate good practice that has been built up in maternity care, and in health services generally. The national health service learning network, for example, has been designed to help the NHS to modernise and to boost the spread of good practice in service delivery and management. The network combines the best of bottom-up learning from the service with practical help and know-how from national initiatives. We must see how we can use the learning network to disseminate best practice further in such areas as DSP and SPD.

The Government continue to provide central funding to support maternity service liaison committees, which facilitate the sharing of information about good practice and local initiatives. The committees embody the type of patient-professional partnership that we want to flourish, giving service users the opportunity to work with health professionals to develop appropriate and responsive local services that put the patient at the heart of NHS services.

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The development of primary care groups will present an opportunity to explore new models of care delivery, and people with conditions such as DSP and SPD will be able to influence change as the new NHS unfolds. Service users and voluntary groups such as my hon. Friend's constituents' organisation will play a special role in that process.

My hon. Friend is right that people are better informed today, but they also expect better information. The case that he described of his constituent seeking more information about her condition is typical: people increasingly, and rightly, want to know about their illnesses and the services that they need to manage them. That is why the starting point for a modern care system in the NHS is as a provider of information as well as a provider of treatment. In maternity services as in any other aspect of health care, communication and information are key aspects of good quality and effective care. We welcome the development of self-help groups, and I pay tribute to the work of the DSP support group--the SPD support group, as it now is--and its valuable role in raising awareness and helping sufferers of this distressing condition. I shall look into my hon. Friend's points about raising awareness of the support group and about its long-term future.

Concern has been raised in some quarters that women may be denied access to elective caesareans as a preventive measure. I take that point seriously, because a fundamental principle of "Changing Childbirth" and the Government's approach to maternity services is that women should be free to choose the care that they feel is most suitable. The woman must be the focus of maternity care and feel that she is in control of what is happening and able to explore and discuss her wishes regarding the birth with those who care for her.

The Government are funding a national audit on caesarean sections by the Royal College of Obstetricians and Gynaecologists to develop standards and monitor the wide variations across the country in the number of caesarean sections carried out. We hope to learn lessons from that audit.

My hon. Friend mentioned other issues relating to maternity care, including the position in which women give birth. I shall respond by reflecting on the broader principles that guide our approach to maternity services.

We have made it clear that the ethos of women-centred care, with the emphasis on appropriate, effective and accessible care, must drive all maternity services. Since the publication of "Changing Childbirth" in 1993, Government policy has consistently and successfully promoted that ethos. We remain committed to those principles and to ensuring that women receive the clear and unbiased information that they need to make informed choices about their care.

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Huge advances have been made in changing women's experience during pregnancy and childbirth. Women are more actively involved in making decisions about the maternity services that they receive and no longer have to make do with what is decided for them by others. That clearly includes the position in which they give birth, which is even more important for women suffering from DSP or SPD. We expect midwives to discuss with women the most comfortable position for them. Giving birth with one's feet up in stirrups or lying flat on one's back is considered to be old-fashioned by modern midwifery and obstetric practice.

The overriding expectation of pregnant women, their partners and families and the health professionals who care for them is a safe pregnancy and delivery and a healthy mother and baby, but childbirth is about more than safety. Maternity services exist to support the whole family, not simply during pregnancy and childbirth, but after the birth too. That must include managing conditions such as the DSP and the SPD to which my hon. Friend referred.

My hon. Friend also mentioned the availability of osteopathy and chiropractic, and other additional support and treatment for women suffering from SPD. The decision to commission services is a local one and must carefully balance clinical priorities with cost-effectiveness as well as taking into account the local population's needs. We are examining the commissioning of alternative therapies, and osteopathy and chiropractic treatment must be considered in that context.

My hon. Friend raised some crucial issues in this morning's debate. He deserves credit for initiating it and for raising awareness of this subject. We know that we have a long way to go to improve maternity services and care for patients with all kinds of conditions; we must not be complacent about the care and support provided by any part of the NHS. I commend the work done by the support group mentioned by my hon. Friend. I hope that referral of the issues to the Royal College and the consideration that it will give to them will help to take this matter further. I shall also consider the additional issues raised by my hon. Friend about extending awareness and about the future of the support group.

I hope that my remarks emphasise the Government's on-going commitment to the principle of good-quality, women-centred maternity services and support for all the conditions that women may experience during pregnancy, labour and childbirth. The initiatives that I have described today can make a difference in improving awareness, prevention, treatment and swifter diagnosis and can spare many women the misery and discomfort of DSP and SPD.

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