START WITH AN ASSESSMENT

Place the mom in a supine (face up) tilted up posture (see Figure 1). Have the mom find her ASIS on each side (see Figure 2). Note any asymmetry and tenderness. The helper should verify the findings (see Figure 3). Then have the patient find her pubic symphysis, if she can. She may not be able to reach it. In any case the helper should palpate the pubic symphysis by starting at the ASIS on each side and sweeping the palpating fingers underneath the abdomen until they reach the midline. If there is any sensitivity or pain then the pubic symphysis is likely misaligned, especially if asymmetry at the ASIS is noted (see Figure 4).

Figure 1   SUPINE POSITION 
This is usually the most comfortable position for Mom, instead of flat on her back.
Figure 2 THE MOM FINDS HER ANTERIOR SUPERIOR ILIAC SPINE (ASIS) ON EACH SIDE 
Have the mom put her fingers on her ASIS on each side and note any asymmetry in height and posteriority. This mom’s left ASIS is superior and posterior relative to the right side.

Figure 3 THE HELPER VERIFIES THE POSITIONS OF THE ASIS ON EACH SIDE. 
The helper’s thumbs are on the ASIS on each side to verify that the left ASIS is superior (higher) and posterior (further back) compared to the right side.

Figure 4 THE MOM CONTACTS HER PUBIC SYMPHYSIS, ANTERIOR SURFACE 
This mom has significant pain at the pubic symphysis. Note the posterior, or backward, position of her left hand.

Figure 5 THE MOM CONTACTS HER PUBIC SYMPHYSIS ON THE SUPERIOR (HIGHER) SURFACE 
The superior displacement of the hip bone is the most painful and debilitating of the displacement patterns.

Figure 6 THE HELPER’S HANDS ON THE ANTERIOR PUBIC SYMPHSIS 
The helper’s hands palpate (feel or touch) the anterior surface of the pubic bones. Sometimes the mom is so big she cannot feel her own pubic bones. The helper should do this and note misalignment and pain. Reduction of misalignment and pain are the goals.

Figure 7  THE HELPER’S HANDS ON THE SUPERIOR PUBIC BONES 
The helper’s fingers palpate the top of the pubic bones evaluating the misalignment pattern. Note the hand on the patients left side is more superior.

The maneuvers are focused on reducing or eliminating pain at the pubic symphysis by realigning the pubic bones. If there is tenderness and pain, you need to note the posterior or backward side of the two bones and then a higher or more superior ASIS of the pair. Have the mom contact the top of her pubic bones (see Figure 5). The helper might have to verify the misalignment pattern (see Figure 6).