Number 3 was born with hip dysplasia. Of course as I’m sitting in a delivery bed with my feet up in stirrups, shaking violently from the adrenaline of shoving a baby out of my body, waiting for the afterbirth to be delivered, nobody called it that. What I heard the neonatologist say from across the room was, “huh…look how floppy she is.” The nursery nurse agreed.
I started hollering from my bed that somebody needed to turn around and speak to me and explain what was going on. The nurse and neonatologist turned around slowly, clearly uncomfortable with the view before them. The neonatologist said, “She looks good, except her hips are loose. You’ll want to have the pediatrician check them,” and left quickly. Since the pediatrician wouldn’t be by the hospital until the morning, I got no further explanation for the rest of the day.
I had never heard of “loose” hips, and I was pretty sure I was too hormonal in the first 24 hours postpartum to Google it and take the chance that I’d see some horrific diagnosis. I’d been in labor for 18 hours and was completely wiped out, so I spent the rest of that first day sleeping, nursing, and worrying. In retrospect, I probably should’ve spent more time sleeping than worrying.
First, let me explain Hip Dysplasia
Number 3’s hips stayed “loose” for the first few well-baby visits, so the pediatrician recommended an ultrasound which confirmed a diagnosis of hip dysplasia. The Mayo Clinic explains hip dysplasia as “the medical term for a hip socket that doesn’t fully cover the ball portion of the upper thighbone. This allows the hip joint to become partially or completely dislocated. Most people with hip dysplasia are born with the condition.”
Hips are ball and socket joints. When a baby is born with hip dysplasia, it means her hip socket is not deep enough and not formed around the ball enough to hold that ball joint in place. Number 3’s “loose” or “floppy” hips were caused by the ball of her hip joint moving out of its proper position when the doctor rotated her legs.
What caused her Hip Dysplasia
The pediatrician told me that because Number 3 was the third baby, a girl, and had been in breech presentation (sideways with her head on my left and her feet on the right) before the OB/GYN turned her prior to induction, she was more likely to have malformed hips. For the most part, this was confirmed by the Mayo Clinic website, a resource I trust for regular-people-speak explanations of medical conditions.
According to the Mayo Clinic, other risk factors include being a large baby, being a first pregnancy, or being a baby born in a family with a history of hip dysplasia. None of those additional risk factors applied to Number 3, but there we were nonetheless.
Off to the Orthopedist
We were sent to an orthopedic specialist in our children’s hospital. The pediatrician told me we would be going for the orthopedist to explain the treatment and discuss maybe having her in a “harness.” Naturally, I went home and Googled, “harness for hip dysplasia.” What I saw was a lot of discussion about a doctor named Pavlik and a really old diagram of what looked like a torture device for babies—straps everywhere from the shoulders to the chest to the legs to the feet. I did not look forward to hearing if the orthopedist wanted to tie my baby up in one of those. Even the information on the International Hip Dysplasia Institute’s website wasn’t tremendously cheerful, although it turned out to be completely accurate.
I was not prepared
I dressed Number 3 up super cute for the appointment with the orthopedist. She was only two months old, and was just starting to fill out those 0-3 month clothes. She was born in the summertime, so I had her in one of those little dress onesies with a skirt over the bottom half of the onesie.
We met with the orthopedist who was very kind. He examined Number 3 and explained to me how her hip joints did not look right on the ultrasound.
Suddenly, his assistant pulled what looked like a folded-up navy blue dog leash out of her big, white coat pocket. He says, “She’ll show you how to use the Pavlik, it’s got a 99% success rate of no future problems if you do it right. Be sure to follow the instructions.” And walked out of the room. The assistant looked at me sort of apologetically and asked if I was ready. Of course not. I didn’t even know what we were doing anymore! I had come to discuss treatment plans, not START treatment!
The Pavlik–our cure and our curse
Despite my silent protest, the assistant unfurled this complicated-looking mass of straps which were actually sort of velvety. She told me to put Number 3 on the exam table, and she started ripping open Velcro sections of the straps. She started at the top, hooking Number 3’s shoulders into sort of a suspender look. It looked kind of like a weird sports bra with the shoulder straps leading to a thick strap that went all the way around Number 3’s ribcage. She could not lie flat on the table anymore, having a quarter-inch-thick and two inches wide strap pushing her back off the table. She started screaming.
Then the assistant pushed her legs up into a frog-like position, and hooked straps from the chest strap to two straps that went around each calf—one under the knee and one above the ankle. There was a stirrup going under each foot that connected back to the calf straps on the other side and then ran up to connect to the strap at her back. Now that she was hooked in, her legs were suspended in the air, bent and splayed out. But they weren’t far enough out that either of them touched the table. Those leg straps were holding the weight of her legs suspended in the air and started rubbing against her little bare thighs.
We were instructed to leave it on 24 hours per day, removing it only for bathtime once per week. We’d follow up in six weeks. SIX WEEKS! She’d only been alive for eight weeks, and now they want six weeks in this contraption!?
What was I supposed to do now?
By this point, Number 3 is losing her mind crying, and I just cried right along with her. I wasn’t sure how to hold her to make her more comfortable—and also to keep the straps from catching my two-months post-partum belly, which was still fairly prominent. I walked out of the hospital to the parking lot Googling how to use a Pavlik in a carseat. The front leg straps of the harness would be pulled weird by the bottom straps of the carseat, and the carseat would push her legs together because they don’t make infant seats that wide. Turns out, you just cram them in the carseat. The Pavlik straps get pulled weird by the carseat straps. The legs can’t maintain their spread-out position, and the straps pull against that. The baby screams more. You keep car rides short.
Life with the Pavlik was a steep learning curve
Much like the carseat issue, we ran into many precarious situations with our new Pavlik harness. The first was figuring out how to nurse my screaming, and now very tired, baby when we got home. When I tried to hold her in the typical cradle position, the harness forced her legs to dangle uncomfortably—and I couldn’t get my arm around both legs without pushing one the wrong way. I ended up having her nurse sitting upright, straddling my thigh. She didn’t like it. There was no snuggling. But it worked.
Eventually, we figured out other positions that worked for nursing, even finding that side-lying was possible when I put my leg between hers to support the top leg.
One of the biggest solutions we had to work around was how to keep the straps from rubbing raw spots. The solution: leg warmers and socks. Pants are not practical in the Pavlik because you can’t effectively pull them down all day to change diapers. Leg warmers covered her legs, and socks covered her feet, keeping all her delicate skin protected from getting rubbed by the straps. We could easily access her onesie snaps and change her diapers as needed.
We also kept a bib on her most of the time to protect the harness from spit-up.
Sleeping was miserable
Number 3 was just over two months old when we got the Pavlik, so she still did not sleep through the night. She could not lie flat on her back because of all the straps and pressure, and she screamed anytime anyone put her flat on her back. We are not big fans of letting infants cry anything out.
We tried having her in a Rock-N-Play (before the recalls happened), which worked sometimes. She could sit in a swing for short naps during the day as long as we rolled a blanket and propped her little feet up with it. But overnights were terrible.
Overnight, I found the only way for both of us to sleep through the bulk of the night was to just co-sleep. I’m a big fan of the American Academy of Pediatricians and their safety recommendations. But the Academy wasn’t trying to go back to a full-time job without sleep.
I’d hold my arm under her neck to keep the back strap from pushing her back up, and sleep with a leg at a 90 degree angle to support her legs with my thigh. I’m confident it was not the safest way to sleep. But it was what we did. My body learned to ignore its discomfort every night, and it worked enough to survive.
People were rude
It is a well-known fact that people feel called upon to comment on you and/or your children whenever in public. Strangers, relatives, friends, everybody’s got an opinion. Some people know to keep those opinions to themselves unless you’re close friends. Many do not.
When you walk out in public with a baby in a crazy harness, people get especially obnoxious. No, our baby’s legs weren’t broken. This isn’t a cast, it’s a harness to help her hips. It’s not torture to make her wear it, it’s medically necessary. No, it’s not hurting her. Yes, she has to wear it all the time.
We tried whenever possible to turn it into a learning opportunity. An opportunity to educate the opinionated person. But more importantly, an opportunity to show our older kids how to respond with kindness and gentleness when people butt into business that is not their own. Surprisingly, it turned out to be good practice for the comments we got when we discovered that we had gotten pregnant with a fourth baby shortly after switching only to nights with the Pavlik! (See my post on that adventure here!)
It got better sooner than we’d anticipated
We got better at hooking the straps up after about a week, no longer having to refer to the diagram. We worked out the bugs with supporting her legs so she could rest comfortably. We started to sleep again. We dealt with ignorant people making rude comments.
And finally the 6 week appointment came. She had another ultrasound to show the cartilage growth and hardening, and she was improving! We were able to switch to only having to wear the Pavlik at night. What a huge difference that made! We still had to sleep in a weird position overnight, but she was finally able to nap normally during the day. She was also able to kick her legs freely, enjoying extending them all the way.
Long-term outcome has been amazing!
She was slightly delayed in her gross motor movements, but the doctors had warned us that was a possibility since we’d kept her movements and muscle growth inhibited for such a long time. By the 9 month mark, she had completely caught up.
When we were released from treatment, the doctor was tremendously pleased with how her hips had improved. He proclaimed her “better” and said she would not have any hip issues as a result of this dysplasia for the remainder of her life. He said she would learn to walk, run, and dance like any typical child. And he was right. Now, years later, she is the cutest little dancer in her dance class. She runs, plays, kicks balls, everything typical children her age do without any hesitation.
Hip dysplasia was no cakewalk, and the Pavlik feels like torture, but it was the greatest gift we could give our daughter. Because of early diagnosis and treatment, she now gets to live without the negative consequences of hip dysplasia. We are eternally thankful for that.
Have you had an experience with hip dysplasia or the Pavlik? I’d love to hear about any differences in your experience below!