Some research

I finally got some time to do more research. I've learned quite a bit from the following links, such as conservative treatments are almost always recommended, bed rest is most important, be very careful in subsequent labours. They're mostly research articles. I have copied some stuff that I think important under the links, and highlighted the most important parts. I'm happy to know that caesarean is not a 'must' for my next baby. I'll wait and see.

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B7CRN-4P83D6T-1&_user=10&_coverDate=02%2F29%2F2008&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_searchStrId=1211152689&_rerunOrigin=google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=71b70f22af53e109ce4447ad94b79519
external pelvic fixation

rupture of the symphysis pubis in spontaneous labouris is caused by marked intensity of the uterine contractions plus marked rapidity of labour
Pregnants with lack of pelvic flexibility in the absence of other predisposing factors, are at increased risk for development of rupture.11 Furthermore multiparity, difficult forceps delivery, precipitous labour, congenital anomalies, rickets and tuberculosis may implicate symphysis pubis separation.

With a seperation of more than 4 cm must be checked for sacroiliac joint pathology. Below 2.5 cm of separations must be treated conservatively by restrictive pelvic binder and absolute bed rest on lateral decubitus position

conservative treatment with bed rest and binders for 3�4 weeks in separations greater than 2 cm

http://www.ncbi.nlm.nih.gov/pubmed/8184705

The incidence of symphysis pubis separation is reported to be between 1:600 and 1:3400 obstetric patients

Treatment should generally be conservative and symptomatic.

Recurrent separation of the symphysis pubis could occur during subsequent deliveries but generally is no worse than the first occurrence.

http://www.ncbi.nlm.nih.gov/pubmed/3701720?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_SingleItemSupl.Pubmed_Discovery_RA&linkpos=3&log$=relatedarticles&logdbfrom=pubmed

All the cases in our 11 patients suffering peripartum pubic rupture occurred after spontaneous vaginal deliveries. Maternal age, parity, clinical pelvimetry and fetal weight did not play a clear role in the development of symphysiolysis. Rapid descent of the presenting part in the second stage, however, was a common feature. Nonoperative treatment of pubic diastasis and expectant management of subsequent deliveries seem advisable.

http://www.childbirth.org/articles/pubis.html a collection of a few articles' abstracts

http://allnurses.com/ob-gyn-nursing/please-help-student-9974.html in 2001

problem isn't even mentioned in my Maternity nursing textbook

http://www.ncbi.nlm.nih.gov/pubmed/14510169?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_SingleItemSupl.Pubmed_Discovery_RA&linkpos=4&log$=relatedarticles&logdbfrom=pubmed

can be managed successfully with absolute bed rest

http://parenting.ivillage.com/pregnancy/pfirsttri/0,,midwife_3q0p,00.html

Trauma or obstetric interventions such as application of force to move the thighs or the use of forceps may also trigger separation.

Treatment is usually conservative, including bedrest, pelvic binders, the use of walkers and mild analgesics, which usually result in a complete recovery with four to six weeks.

The occurrence of a symphyseal separation should not significantly alter the management of subsequent pregnancies, and the same types of conservative therapy are recommended for any recurrence of symptoms. Recurrent separation of the symphysis pubis could occur during subsequent deliveries, but generally is no worse than the first occurrence.

Elizabeth Noble's book, "Essential Exercises for the Childbearing Year" (1996) also has some exercises to perform to strengthen the ligaments. Use of a binder or lightweight maternity girdle may help as well.

Avoid postures where you need to separate the thighs by more than a normal stride width. During the birth, you should pick the position for birth; don't let practitoiners force your legs back. Birthing on your side may be most comfortable.

http://www.ejbjs.org/cgi/content/extract/78/11/1746

To the best of our knowledge, this is the second reported case of disruption of the symphysis pubis during spontaneous vaginal delivery¹.

http://www.ejbjs.org/cgi/content/full/78/11/1746

The patient was fitted with a pelvic binder and was allowed to walk with a walker on the second day after the delivery

use of a pelvic binder and absolute bed rest for painful disruptions of more than one centimeter, and even external fixation of the pelvis

This case report demonstrates that a large (4.7-centimeter) separation of the symphysis pubis associated with vaginal delivery can be treated satisfactorily without operative stabilization or prolonged bed rest.