I need information on a separated pubic bone from pregnancy. How long is the recovery period? What is the general risk of reinjury? What is the risk of reinjury if a woman becomes pregnant again? If one does become pregnant again, should a C-section be performed?

H.K.

The symphysis pubis, or pubic bone, consists of two separate bones that form an arch and are connected in the middle by cartilage. It is located at the bottom of the abdomen, above the vagina. Sometimes during pregnancy the cartilage holding the two halves of the pubic bone together is torn. This is very painful and makes walking difficult. Unfortunately, a separated symphysis, as this is called, is difficult to treat; unlike a broken arm or leg, it cannot be put in a cast. Bedrest is the only treatment, although special girdles can help stabilize the entire pelvis and decrease discomfort.

It can take anywhere from several weeks to a few months for a separated symphysis to heal. The recurrence with subsequent pregnancies is fairly high. Cesarean sections do not prevent a separated symphysis, as the separation occurs long before labor even starts.

A separated symphysis actually increases the size of the pelvic outlet and makes one able to deliver a larger baby vaginally. Many years ago, before good anesthesia and safe operations, the symphysis would be cut deliberately if a woman was unable to push out a baby. This still occurs today in some less-developed parts of the world, where an operation such as a cesarean section means almost inevitable death of the mother.