If you’re ready to start a family, don’t let fear of your spinal fusion pain stop you!
1. You may have back pain, but also, you may not!
I am on my third pregnancy after having a spinal fusion 18 years ago, and with my first baby I had low back pain and SI joint pain more in my third trimester. I was able to alleviate this with PT and a steroid injection in my SI joint at 34 weeks.
With my second pregnancy, I didn’t have much back pain at all, even with working full time. I did however go to PT consistently for prophylactic reasons.
With this third pregnancy, I am just starting my third trimester and so far, so good. I have had some hip pain due to a pulled muscle chasing my son on the playground, but other than that I’ve been doing well.
Looking at a recent scientific study, 48% of mothers with spinal fusion had back pain during pregnancy, compared to 34% of mothers with non-fused spines. Patients who were fused lower (L3 or L4) had higher incidences of back pain. So, although this shows a higher incidence of back pain for those with fusions, you still have over a 50% chance of not having pain.
2. You can still have a vaginal birth if you’d like to!
When I was pregnant with my first child, I asked my physiatrist (back rehab and pain specialist) if she had any suggestions for me. She suggested avoiding a C-section if at all possible to keep my core strong.
I did a lot of research on birth, talked with a lot of mothers, and discussed my wishes with my doctor. He didn’t see any reason why I couldn’t have a vaginal birth with my fusion, which is from T2 to L2.
It turned out that I couldn’t have an epidural (see next point), but I had successful births with both of my two children. I chose to do alternate medications to help with my pain, but no problems with the actual labor or delivery.
3. You may be eligible for an epidural, but if not, other options are available.
First, to be said, just because you’ve had a fusion, it does not mean you can’t have an epidural. It all depends on your specific level of fusion and how your spine is aligned in the lower region.
My doctor set up an anesthesiology consult for me before my first birth to see if I could have an epidural. I took my x-rays and a written report from my physiatrist, and met with the anestiology department at the hospital I had chosen to give birth at.
During this meeting, I was told that it was very risky for me to have an epidural due to scar tissue and the position of my lower vertebrae. She suggested however that I take my xray to my birth and let the anesthesiologist on call double check her opinion.
At the time of birth, the on call doctor agreed that I should not have an epidural. I decided to try natural pain management techniques for a bit, but my labor was taking quite some time. At about 24 hrs from when my water broke, I needed rest, and contractions/pain were keeping me from it. I still had a ways to go, so the anesthesiologist came back to discuss options.
We decided to do a PCA pump of fentanyl. This meant that I had an IV with fentanyl attached and every 6 min or so I could push a button and a small dose would be delivered. I was able to rest a bit, and then this helped control the pain until my daughter finally came. 40 hours after my water broke.
If I needed a C-section, I was going to have to undergo general anesthesia due to being unable to have an epidural.
My second birth went much quicker, and I only needed one dose of fentanyl in the active labor stage to help me through. We will see how this next one goes!
4. Your physical therapist will become your new best friend.
I think this should be true for every woman during pregnancy. However, especially if you have a fusion, building and maintaining core and hip strength is critical.
Additionally, when back, hip, or pelvic pain pops up, your doctor is not going to be particularly helpful. Most doctors will say, yes, that is just a symptom of pregnancy. But, if you ask for a PT referral, you’ll get over to someone who can really help!
As a PT myself, I know all of the secrets that were available to me, and personally, dry needling has been the most helpful. Having had a few strained muscles, the dry needling, stretching, and hands on therapy from my colleagues has been so helpful.
Additionally, if you have never heard of pelvic floor PT, it may be time to look into it. Not only is it helpful after pregnancy for pain or incontinence that my helpful, but it is also helpful during pregnancy for pain, weakness, and finding the best birthing positions for you!
5. You can do this! Truly!
Take it from me. I’ve had 3 fusion surgeries, and am on my third pregnancy. It is possible.
In fact, my first two pregnancies, I worked full time in an outpatient PT clinic, which means I was on my feet 40+ hours a week. Now, I’m only working 20 hours a week, but taking care of my two kiddos the rest of the time is even more exhausting than working 😉
Now, don’t discount all of the other symptoms of pregnancy that may get you (nausea, vomiting, swelling, exhaustion, weight gain, etc.). But, there is no extra symptoms from spinal fusion to be concerned about.
With the right support around you, including massage therapists, physical therapists, supportive doctors, midwives, friends, family, you have nothing to worry about.
Please let me know your concerns in the comments and let me do my best to answer them!
<3 Hannah