Family affair: Fiona Brown, who is a busy mum to toddlers Seth (3) and Zacharia (1)
The sound of my baby giggling brought tears to my eyes. Not of happiness, but of frustration.
Instead of holding my three-month-old daughter Amelia, I was forced to watch via a grainy baby monitor as I was laid-up in bed.
I’d just undergone surgery to repair a tear in my labrum — the ring of cartilage that cushions the hip joint and helps hold the ‘ball’ at the top of the thigh bone within the hip socket — because of damage caused in pregnancy, and I was under strict orders not to lift or hold Amelia for two months.
The surgery to stitch the tear together, and reattach the part of the labrum that had come away from the bone came three months after an emergency Caesarean, and so I had begrudgingly hired a nanny to care for my longed-for IVF baby.
A year on, I am still suffering muscular pain, as well as having physiotherapy. This pain is awful, but the psychological damage is almost worse. I was unable to breastfeed as I could not sit. I felt jealous watching another woman feed and comfort the baby I’d spent two years trying for, after struggling to conceive due to endometriosis.
I also felt intense guilt in seeing husband Andy, 36, go from 12-hour days as an assistant headteacher into long nights caring for Amelia.
But things needn’t have been this way. If my GP had acted when I had complained repeatedly of crippling pain in my left hip, the lasting joint damage may not have occurred because I would have known how to manage my movements.
Instead, I was left unable to stand, walk, sit or sleep.
My GP didn’t take me seriously, while the midwives at my NHS hospital referred me for a single antenatal group physiotherapy class — which I couldn’t attend as I was in too much pain.
During pregnancy, it’s normal to have hip discomfort or some kind of pelvic pain. The relaxin hormone released by the brain causes the ligaments between muscles to open and allow room for the baby to grow, and later pass through the birth canal.
But if your ligaments are too flexible, this puts pressure on the muscles and joints.
The weight of the growing baby, plus all the amniotic fluid and placenta, can cause strain on the pelvis as well as an exaggerated forward curve of the lower back. This changes the way you sit or stand and puts more stress on your pelvis.
Standard: During pregnancy, it’s normal to have hip discomfort or some kind of pelvic pain
Another common cause is pelvic girdle pain. The three pelvic joints work together, but if they move unevenly, it causes the pelvic girdle to become painful and less stable.
Usually, this pain reduces greatly once the baby arrives. My condition was different.
The ball at the top of my thigh bone wasn’t perfectly round, and a small, extra jutting piece of bone was wearing away at the cartilage each time I moved.
I was born with that problem, but it emerged only when I was 22 weeks pregnant. It got so bad that, by the end of my pregnancy, I was wheelchair-bound. Eight weeks after the birth, I was finally referred to a specialist. An MRI revealed the labrum cartilage had ripped and partially detached. Surgery was my only hope. I was devastated.
I am not alone. A study at Waikato Hospital in New Zealand in 2010 suggested that just under 10 per cent of pregnant women suffer a labral tear — many more go undiagnosed.
Fiona Brown, a mother-of-two from Essex, is one of them. Her tear occurred when she was pregnant with first son Seth in 2014, but it was three years before her diagnosis.
Fiona, 38, has osteoarthritis in her hips and lower back. Though no one knows if the tear caused it, a specialist told her the bone rubbing on bone could have been responsible. ‘When I was pregnant, they assumed it was pelvic girdle pain,’ says Fiona. ‘I made do with crutches and belly bands — maternity belts which support the back in pregnancy and alleviate back and hip pain.’
She mentioned it in post-natal appointments, to no avail. When pregnant with second son Zachariah, the pain — from eight weeks into her pregnancy — was continuous.
Fiona self-referred to an NHS physiotherapist, who insisted her GP order an MRI — this showed she had a tear. However, with two young children, surgery is out of the question, at least until they start school.
Face it: If ignored, a labral tear can lead to arthritis – and, in some cases, total joint replacement
‘I’ve not been left with many options,’ says Fiona. ‘I can’t take codeine because it makes me drowsy and unable to drive.’
Her current painkiller — naproxen, a non-steroidal anti-inflammatory — can cause stomach bleeding if used long-term. Fiona quit her job as a college lecturer as she cannot stand for long periods and runs business training from home for post-natal women (facebook.com/flbconfidenceclub).
She and husband Phil would love another baby, but at 35 he will have a vasectomy as Fiona’s body cannot endure another pregnancy.
Paul Jairaj, a consultant orthopaedic surgeon with Ramsay Healthcare Group, says: ‘If you do a repetitive activity and have an altered hip and pelvic position — which most women do in pregnancy — a labral tear can happen. The difficulty is proving that’s responsible for the symptoms.’
He is clear on why misdiagnosis is common: ‘When you tell a GP or midwife you have hip pain in pregnancy, they may say this is expected. I’ve seen mothers later and no one has made the link that it could be a tear. It’s usually physiotherapists who figure it out, and it can be too late.
‘A labral tear cannot heal by itself, though the pain can be reduced through physical therapy,’ he explains. ‘However, significant loss of articular cartilage — found inside the socket, while labrum is found at the edge of the socket — can occur alongside a labral tear.
‘If this is ignored it could lead to arthritis, and even the need for a total joint replacement.’
Andy and I have six embryos frozen, and though I long for another baby, I am scared to become pregnant again.
Sadly, Fiona and I are not unique — thousands of women could be suffering from this combination of debilitating hip damage and GPs’ ignorance.