Quick Answer: The best mattress for pregnancy with SPD is typically a medium-firm pocket-coil hybrid that keeps the pelvis level and eases hip pressure during side sleeping. The Royal College of Obstetricians and Gynaecologists notes pelvic girdle pain affects about 1 in 5 pregnant women, and a knee pillow often helps.
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In This Article
SPD, also called pelvic girdle pain (PGP), is one of the most common and most disruptive pregnancy complications. Research shows that approximately 45% of pregnant women experience pelvic girdle pain and/or pregnancy-related low back pain, with about 25% reporting serious pain and 8% experiencing severe disability. The pain is centred at the pubic symphysis, the joint at the front of the pelvis, and radiates to the hips, groin, and inner thighs.
What makes SPD particularly miserable is that it is worst at night. Turning in bed, getting up for the bathroom, and even lying still can trigger sharp, stabbing pain that interrupts sleep repeatedly. For a condition that already affects physical function during the day, losing restorative sleep compounds the problem significantly.
What SPD Is and Why It Worsens at Night
During pregnancy, the hormone relaxin loosens the ligaments that stabilize the pelvic joints. This is necessary, it allows the pelvis to widen for delivery. But in some women, the loosening is excessive or uneven, and the pubic symphysis becomes hypermobile. The result is pain with any activity that loads the joint asymmetrically: walking, climbing stairs, turning in bed, standing on one leg.
SPD worsens at night for several reasons:
Turning in bed loads the pelvis asymmetrically. Every turn involves shifting weight from one hip to the other, which requires the pelvis to rotate. In a stable pelvis, this is painless. In an SPD pelvis, where the pubic symphysis is hypermobile, this rotation creates shearing force across the joint, and the result is the sharp, stabbing pain that wakes you at 2 a.m.
Lying on your side compresses one hip. Side-sleeping, which is recommended during pregnancy, puts the full weight of your hip and the growing baby's weight onto a single contact point. If the mattress does not adequately redistribute this pressure, the compressed hip pushes the pelvis into an asymmetric position that stresses the symphysis.
Muscle relaxation during sleep reduces pelvic stability. During the day, your core and pelvic floor muscles provide some dynamic stabilization of the hypermobile joint. During sleep, muscle tone decreases, leaving the ligaments (which are already loose from relaxin) as the primary stabilizers. Any mattress that does not passively support pelvic alignment takes away the last line of defence.
SPD Is Not "Normal Pregnancy Discomfort"
SPD is frequently minimized as a normal part of pregnancy. It is not. While mild pelvic discomfort is common, the sharp pain, functional limitation, and sleep disruption of true SPD significantly affect quality of life and can persist postpartum. Research classifies it as a condition that "deserves serious attention from the clinical and research communities." If you have SPD, optimizing your sleep environment is a legitimate clinical intervention, not a luxury.
8 min read
Why Side-Sleeping Matters in Pregnancy
Starting in the second trimester and increasingly in the third, side-sleeping is the recommended sleep position for pregnancy. An individual patient data meta-analysis of nearly 1,800 women found that going to sleep in the supine position in late pregnancy was associated with a 144-gram reduction in birth weight and a three-fold increase in small-for-gestational-age risk. Public health campaigns now encourage women in the third trimester to settle to sleep on their side.
This creates a specific mattress challenge for women with SPD: the sleep position that is best for the baby (side-lying) is the position that puts the most pressure on the pelvic structures that are causing pain. The mattress must resolve this conflict by providing enough hip and shoulder compression to maintain pelvic alignment in the side-lying position, without the firmness that creates pressure points, and without the softness that allows the pelvis to sag.
The Pelvic Alignment Challenge
In side-sleeping, the pelvis is level when the mattress allows the hip to sink just enough that the spine remains straight from the head through the pelvis. If the mattress is too firm, the hip cannot sink, the spine curves laterally, and the pelvis tilts, creating shearing force on the symphysis. If the mattress is too soft, the hip sinks too deeply, the pelvis drops below the spine, and the symphysis is again loaded unevenly. Medium-firm, with adequate hip conforming, is the biomechanical sweet spot for SPD in side-sleeping.
The Clinical Evidence for Mattress Intervention
Unlike most mattress-condition relationships, the effect of a mattress on pelvic girdle pain during pregnancy has been directly tested in a randomized controlled trial.
A study published in the International Journal of Women's Health randomized 66 pregnant women with nightly PGP to either a new mattress-and-pillow system plus standard treatment, or standard treatment alone. The results:
- Pain reduction: The mattress group experienced a 16.5 mm greater reduction in nightly posterior pelvic pain compared to the control group (p=0.028)
- Sleep duration: The mattress group gained 26 minutes of additional sleep per night compared to 14 minutes in the control group (p=0.046)
- Nighttime awakenings: Significantly reduced in the mattress group (p=0.049)
- Evening pain: Significantly reduced in the mattress group (p=0.008)
- Control group decline: The control group experienced functional deterioration and increased daytime sleepiness over the study period, while the mattress group improved
This is not theoretical. A randomized trial, the gold standard in medical evidence, demonstrated that changing the mattress and pillow produced measurable, statistically significant improvements in pain, sleep duration, and sleep quality in pregnant women with pelvic girdle pain. The control group, sleeping on their existing mattresses, actually got worse.
What the Trial Used
The trial used a body-conforming mattress (memory foam type) with a pregnancy support pillow. At Mattress Miracle, we do not sell memory foam, and for good reason: memory foam retains heat (a significant problem during pregnancy, when body temperature is already elevated) and resists repositioning (a problem when you are already struggling to turn). The trial's key finding was not about the specific material but about the principle: a mattress that conforms to the hip and supports pelvic alignment produces measurable benefit. Natural latex and quality pocket coil hybrids achieve this conforming without the heat and repositioning drawbacks of memory foam.
What to Buy in Canada
Best choice for SPD: Pocket coil hybrid with natural comfort layers.
A pocket coil hybrid provides the combination SPD requires: individually pocketed coils that respond independently to each body region (allowing the hip to compress into the coil zone beneath it while maintaining support at the waist), combined with a natural fibre comfort layer that conforms to the body without retaining heat.
Our Restonic Silk & Wool Pocket Coil is particularly suitable for pregnancy with SPD. The natural wool comfort layer provides gentle conforming at the hip and shoulder, facilitating the pelvic-level side-sleeping position that SPD demands, while the individually pocketed coils maintain support at the lumbar spine and prevent the pelvic sag that triggers symphysis pain. The wool also regulates temperature, which matters because pregnant women already run warm.
Alternative: Natural Talalay latex.
Talalay latex provides proportional pressure response, the heavier your hip, the more it yields, but it also pushes back proportionally. This creates natural pelvic alignment in side-sleeping without requiring a zoned coil system to achieve it. Our Restonic Talalay Latex in medium-firm is an excellent SPD option for women who prefer the buoyant, non-sinking feel of latex over the more traditional feel of a coil hybrid.
| Feature | Why It Matters for SPD | What to Look For |
|---|---|---|
| Hip conforming | Keeps pelvis level in side-sleeping; reduces symphysis shearing | Adequate compression at hip zone; independent coil response or proportional latex |
| Lumbar support | Prevents pelvic drop that loads symphysis unevenly | Firmer support in the centre third; zoned coils or consistent latex density |
| Temperature regulation | Pregnant women run warm; overheating disrupts sleep further | Natural wool, cotton, or latex; avoid dense memory foam |
| Ease of repositioning | Turning in bed is already painful; mattress should not add resistance | Responsive surface (coils, latex); avoid slow-response memory foam |
| Motion isolation | Partner movement should not disturb already-fragmented sleep | Pocket coils (not interconnected springs); latex absorbs motion |
Firmness Guide for SPD
The research on mattress firmness for back and pelvic pain is clear: medium-firm is better than firm. A landmark Lancet trial of 313 adults with chronic back pain found that medium-firm mattresses produced significantly less pain in bed, less pain on rising, and less disability over 90 days compared to firm mattresses. For SPD specifically, the medium-firm range provides the hip conforming needed for pelvic alignment without the excessive sinkage that creates pelvic instability.
| Body Weight (Pre-Pregnancy) | Firmness Target | Notes |
|---|---|---|
| Under 60 kg | Medium (5–5.5/10) | Lighter body weight needs softer surface for adequate hip compression |
| 60–75 kg | Medium-firm (5.5–6.5/10) | Standard medium-firm range; most common SPD recommendation |
| 75–90 kg | Medium-firm to firm (6–7/10) | Higher pre-pregnancy weight plus baby weight needs firmer base with conforming comfort layer |
| Over 90 kg | Firm support with medium comfort layer (6.5–7.5/10) | Firm coil base prevents excessive sinkage; medium comfort layer provides hip conforming |
Important: These targets are based on pre-pregnancy weight. By the third trimester, when SPD is typically worst, you may be 10–15 kg heavier. A mattress that felt medium-firm at your pre-pregnancy weight may feel slightly softer as weight increases. Starting at the firmer end of the medium-firm range provides a buffer for this natural progression.
The Complete SPD Sleep Setup
Mattress: Medium-firm pocket coil hybrid or natural latex. Adjustable-base compatible if budget allows.
Pregnancy pillow: A full-body pregnancy pillow (C-shape or U-shape) is the single most important accessory for SPD. It supports the belly, goes between the knees to keep the pelvis level, and provides back support to prevent rolling onto the back during sleep. The clinical trial that demonstrated mattress benefit used a pillow system alongside the mattress, the combination is what produces the best results.
Pillow between the knees: If you do not use a full-body pillow, a firm pillow between the knees is essential for SPD. It prevents the upper knee from dropping, which would rotate the pelvis and load the symphysis asymmetrically. The pillow should be thick enough to keep the knees hip-width apart.
Silk or satin sheets: Low-friction sheets reduce the resistance to turning in bed. For SPD, where every turn creates symphysis pain, reducing friction means less force is needed, and less force means less pain.
Bed height: Getting in and out of bed is painful with SPD because it requires asymmetric leg movement. A bed at approximately knee height allows you to sit on the edge and swing both legs together, minimizing asymmetric pelvic loading.
A Mattress You Will Keep After Pregnancy
SPD typically resolves within weeks to months after delivery, though some women have persistent symptoms. The mattress you buy for SPD management should be one you will be happy with long-term, a quality pocket coil hybrid or natural latex mattress that works for pregnancy will continue to provide excellent sleep for years after delivery. At Mattress Miracle in Brantford, we help you choose a mattress that solves the immediate problem and remains a great sleep surface for the next decade.
Pregnant with SPD? Mattress Miracle at 441½ West Street in Brantford carries adjustable bases that take pressure off the pelvis by allowing leg elevation. Symphysis pubis dysfunction makes every sleeping position uncomfortable, but the right mattress and base combination can reduce the pain significantly. Dorothy has helped several pregnant customers with SPD find positions that work. You do not have to suffer through it. Call (519) 770-0001.
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We are a family-owned mattress store in Brantford, helping our community sleep better since 1997. Come try mattresses in person and get honest, no-pressure advice.
441 1/2 West Street, Brantford, Ontario
Call 519-770-0001Frequently Asked Questions
Is a firm mattress better for SPD?
No. A firm mattress prevents the hip from compressing into the surface, which tilts the pelvis and creates the asymmetric loading that causes symphysis pain. Clinical research on back and pelvic pain consistently shows that medium-firm mattresses produce better outcomes than firm ones. For SPD specifically, the mattress needs to be soft enough at the hip to allow pelvic-level side-sleeping, but firm enough at the waist to prevent pelvic sag.
Will a mattress topper help with SPD?
A topper can help if your current mattress is too firm but otherwise structurally sound. A 5–7 cm latex topper adds hip conforming without changing the underlying support. However, if your mattress already has body impressions or uneven support, a topper cannot fix the structural problem, replacement is more effective. For the remaining months of pregnancy, a quality topper is a reasonable short-term investment if replacing the mattress is not practical.
Can a mattress cure SPD?
No. SPD is caused by hormonal ligament loosening and pelvic joint instability, no mattress can reverse that. What a mattress can do is significantly reduce the nighttime pain and sleep disruption that SPD causes. A clinical trial on pregnant women with pelvic girdle pain showed that a supportive mattress and pillow reduced nightly pain, increased sleep duration, and decreased nighttime awakenings compared to standard treatment alone.
What sleep position is best for SPD?
Side-sleeping with a pillow between the knees. This position keeps the pelvis level and prevents the upper leg from dropping, which would rotate the pelvis and load the symphysis. A full-body pregnancy pillow provides the most complete support. Avoid back-sleeping in late pregnancy (research links it to reduced birth weight), and avoid lying with legs apart or twisted, which stresses the symphysis directly.
Should I buy a new mattress just for the remaining months of pregnancy?
If your current mattress is making SPD pain worse, and SPD pain is significantly disrupting your sleep, a new mattress is a worthwhile investment that will serve you well beyond pregnancy. A quality pocket coil hybrid or natural latex mattress lasts 8–10 years. You are not buying a mattress for four months; you are buying a mattress for a decade that happens to solve a significant immediate problem.
Does memory foam help with SPD?
Memory foam provides good pressure conforming, which can help with hip pressure in side-sleeping. However, it has significant drawbacks during pregnancy: it retains body heat (pregnant women already run warm), it responds slowly to position changes (turning is already painful with SPD), and it softens with body temperature (meaning support decreases as heat builds). A clinical trial on pregnant women used a memory foam type mattress with positive results, but responsive alternatives like natural latex and pocket coil hybrids provide similar conforming without these trade-offs.
Sources
- Wu WH, et al. Pregnancy-related pelvic girdle pain (PPP), I: Terminology, clinical presentation, and prevalence. Eur Spine J. 2004;13(7):575–589. PMC3476662.
- Lagadec N, et al. Factors influencing the quality of life of pregnant women: A systematic review. BMC Pregnancy Childbirth. 2018;18(1):455. PMC6251086.
- Feldthusen C, et al. Effects of a new mattress and pillow and standard treatment for nightly pelvic girdle pain in pregnant women: A randomised controlled study. Int J Womens Health. 2021;13:1251–1260. PMC8687882.
- Anderson NH, et al. Association of supine going-to-sleep position in late pregnancy with reduced birth weight. JAMA Netw Open. 2019;2(10):e1912614. PMC6777255.
- Kovacs FM, et al. Effect of firmness of mattress on chronic non-specific low-back pain: Randomised, double-blind, controlled, multicentre trial. Lancet. 2003;362(9396):1599–1604. PMID 14630439.