Backpain since last delivery - wondering what to do this time. HELP!

[motherpeculiar]

I?m hoping someone can offer some advice. I am 18wks pg with 2nd child and getting increasing worried about the whole labour thing. The reason for this is that I have suffered horrendous backpain since the delivery of DD1, just over two years ago. I had no significant backache during the last pregnancy or before but something happened during the delivery that has caused major problems ever since. (to the extent that I have had periods of barely ebing able to walk ) My osteopath thinks it may be a prolapsed disc but I am waiting to see an orthopaedic consultant on Thursday to see what they think. For various reasons (too lengthy to go into here) I have never been offered any kind of diagnostic tests by the NHS (obviously didn?t complain loudly enough ? too busy looking after DD!) but I have had various physio/osteopath treatments over the two years.

During the last labour I was kind of stop-starting with contractions for a couple of days, I went into hospital where they were humming and hawing about whether to induce but I seemed to be getting started ok at that stage. I got to about 3cm (after about 8 hours of fairly serious contractions) and they decided to give me syntocinon, at which point I also had an epidural. After about another 8 hours I was ready to push. I?d had a mobile epidural so squatted on a birthstool for the 2nd stage. DD was out in about an hour which was great but at one point one of my legs went completely numb and all the pushing went through the other one (IYSWIM). This is the side of my back that I have had all the trouble with since so I do wonder whether it is linked.

Anyway (if you?ve made it this far ? congratulations) ? I am now wondering whether I should think about an elective section and if so how best to go about this. I just couldn?t bear it if this backpain were to get worse from another labour, but equally I am a bit suspicious that maybe it was the epidural that caused the subsequent pain (rather that the pushing bit) in which case it is epidurals I should be avoiding. In which case a section is probably not the best options.

I am really really confused. I don?t know what questions to ask in order to try to determine what I should be aiming for, and have found through my experience with the NHS (apologies to anyone who works in it ? I know it is because the system is under pressure, and I also know there are great people working in there) that information is normally disclosed as a result of asking exactly the right question, rather than being offered pro-actively.

Sorry this is so long, and confused. If anyone can offer any advice I would be extremely grateful.

yours hopefully,
MP

[Chuffed]

MP normally a prolapsed disc is caused by pressure of some type on the mechanics of the spine, ie. lifting, car accident, turning and pushing etc. I'd wait until you have a specialist appointment for another opinion on the diagnosis of a prolapsed disc.
I'm afraid I couldn't give any advice on whether to have a section or try birth again. Let us know how your appointment goes.

[sleeplessmumof2]

MP sorry to hear about your woes, basically i would agree with chuffed you need to have a full diagnosis (if poss) before you make any drastic decisions. However has anyone mentioned SPD to you?

I can however tell you briefly my story,
first pregnancy, back pain not too severe, sciatica etc epidural - agony - didnt work fully- 12 hour labour etc baby and mum ok, 4 days later severe back problems and excrutiating pain in hip day 7 confined to a wheel chair- could not wieght bear at all - this lasted 3/4 weeks and events took over and i forgot about it. Have had on off back problems ever since.

Pregancy 2 - really concerned same would happen, scared of epidural, scared that it was spd and would return. - had a fair amount of osteopathy during pregnancy as soon as twinges, aches started which seemed to keep things at bay. was not sure right up to the end if i would be able to give birth naturally but guess what.....

Not only did i do it without i c section, i did it without the dreaded epidural and gas and air only at the end very proud of myself -

that was 10 weeks ago and although my back is very weak and i am having regular osteopathy again, i am a proud and mobile mum who had a much much better experience second time around!!!! Hope it helps

Either way, like you i am still suspicious as to what part the epi played in my first birth experience and for me, i really didnt want to do it again. I think like you my epi only worked on one side and put way too much pressure on other bits. Were are you hoping to have your baby and have you/could you discuss all this with the midwives?

[motherpeculiar]

Thanks for the advice chuffed and sleepless

I'm seeing the consultant tomorrow so should know a bit more after that I hope.

Sleepless, congratulations on the birth of your 2nd child and well done for getting through it as you did. If you are anything like me you were terrified beforehand. You've given me a bit of confidence again. It's not that I am against a section per se, I just don't want to go down that route if the problem was actually as a result of the epi, not the epi and pushing combination - ifswim.

At the end of the day all I want out of this is no. 1 a healthy baby and no.2 as little exacerbation of my back problem as possible. A "natural" birth would be lovely but I didn't really deal with the pain all that well last time so am a bit nervous about that if I couldn't have an epi (although, you have given me back a bit of confidence on that score). I just need some guidance on what delivery route will offer best chance of achieving this (I'd go for a section if that was agreed to be the best option although if I'm honest I really would prefer not to have to have a section with General Anasthethic!)

anyway - will post after the consultation tomorrow to let you know how it went (and doubtless ask more confused questions )

[motherpeculiar]

oh BTW sleepless I am due to have the baby at Kings College London. I have tried to discuss with the one midwife I've seen so far but she was very non-committal and just said to see what the othopaedic consultant says. I guess it would be hard for her to say more, but I would have liked some info on whether the problem could have been linked to teh epi alone, or whether it was likely to have been from the pushing with one side numb, or what...

roll on tomorrow when i might know more

glad you got relief from your osteo, I have tried a number of them with varying effectiveness but the guy I am seeing at the moment has helped so much I almost can't believe it - he does say the problem will never really go away though. Tell me, can you do any exercise at all? (well, prob not with a toddler and new baby I guess, silly me!). I haven't been able to do anything since DD was born and have found it very frustrating...

[Chuffed]

MP is there anything you do yourself which helps relieve the pain...ie walking, lying on your stomach (hard to do now you are pregnant). I have disc induced back pain on and off and had a back labour which was just excrutiating and ended up with an epidural (no side effects thank goodness).
I had accupuncture during pregnancy for this and it did help but I could only get 6 sessions on NHS.
It sounds to me more labour induced with feeling in only one side than epidural induced but that is also assuming it is a prolapsed disc and the prolapse is in keeping with the mechanics of injury (ie fwd bend, slightly rotated to one side).

[motherpeculiar]

Hi chuffed

you sound very au fait with the problems associated with disc prolapses - sorry to hear it. My labour with DD was a (fairly extended) back labour too, so no break between the contraction pains - sometimes I think that's why I couldn't bear the pain in the end (although who knows, might have been as bad with normal position). Do you know whether you are more likely to have another backwards presentation second time round if you've already had one?

The reason the osteo suggested a diagnosis of disc prolapse was because my problems were exactly as you describe - extreme pain bending forward and in one side.

I'm afraid walking hasn't really helped - there have been times when I almost can't walk, have to drag the bad side along. There have been days when I've looked at 80 year old women and though that they looked nimbler than me . Although things are feeling much better as a result of the osteo now so I'll be comparing myself to a 50 year old shortly

I used to love swimming, running and yoga but find them excruciating now. The osteo has recommended pilates and I keep meaning to find a class. I do think that would help, but again it is expensive.

The best thing I find is lying on my back on the floor with my knees bent and head slightly raised (doing pv exercises too if I can be bothered). It does seem to help if I can do this once or twice every day.

I'll wait and see what they say tomorrow

Thanks again

[Chuffed]

MP see what the specialist says tomorrow. I have only one dd and will have elective c next time as had emergency this time.
I used to find exercise bike cycling a good exercise during pregnancy. I found pilates hard as a lot of it is lying flat on my back and I was avoiding that from 12 weeks.
Ask your midwife if there are classes at your hospital with the physios for things like backpain/spd as they may have specialist antenatal advice.
Let us know what happens.

[sleeplessmumof2]

good luck for tomorrow MP i find swimming is ok so long as i dont do open leg movement but up and down with breast stroke and have to do the head in water style, no keeping hair and face dry for me!!! Too much pressure on the spine!!! I was recommended to do pilates when i was pregnant and found a really good sports injury rehabilitation pilates lady who happens to be local to me but also works in a place in Oxford Street. W1. Dont know where you are but i can dig out her number for you if you like. She was very very knowledgeable and i guess when i get some more time on my hands (when !!!!) i will try to take it up again. Before that i did yoga but stopped really early in pregancy cos i couldnt do any forward or side bends without pain or chucking up!!! Out of interest did you/do you suffer from morning sickness???

On the subject of coping with the pain, i have to say that my dp and my two best friends laughed at me for saying i was going to try really hard to do it without an epi and they even put money on me not being able to do it, I think at times it was the pure thought of proving them wrong that got me through!!! I remember clearly swearing at them all during contractions but i also have to say that i was lucky my labour established itself quickly and regularily from the start so i just went with the flow, by the time i thought i cant take anymore i also knew it was too late for an epi, with the right support and (have to say it!!!) good breathing technique (didnt do any or learn any first time round) it was too bad. Oh the other thing was making quite quite sure that you are fully supported by the midwives and doctors to use postions that work for you and that dont put any added pressure on your spine. I have to say that i tried the birthing chair for 2 contractions/pushes and it was complete and utter agony- too much pressure on the base of my spine.

Anyway, hope to give you more confidence to go which ever way you'd like to and best of luck for tomorrow

[SoupDragon]

My back problems aren't specifically pregnancy/labour related (minor scoliosis) but I was advised that lying on your side puts the least strain on your back followed by lying on your back and with lying on your front being the worst. I certainly am less stiff in the morning if I've slept on my side (usualy hugging a pillow to stop me rolling onto my front).

One thing to think about in labour is to maybe labour/deliver either on all fours or on your side which will give your spine the best opportunities to flex - this is particularly important for the coccyx. I opted for side with DS2 (no epidural) and experienced no back problems until I got lazy getting him in and out of the moses basket by my bed - too much twisting and lifting!

You can't really make any decisions until your check up/diagnosis.

FWIW, DS1 was spine-to-spine, DS2 was not. Look up optimal fetal positioning for ways to help avoid another one. I found leaning over a birth ball quite comfortable. Has your osteopath given you any stretching exercises etc? I have some I do every morning before getting out of bed to stretch out the spine after sleeping - this is my worst time generally speaking. And I'm another one who never got round to finding that pilates class my osteo recommended!!

Good luck - I hope you find the right solution for you, and quickly. Back pain is miserable

[SoupDragon]

A water birth might be an option actually. My Mythical Third Child will be a water birth...

[sleeplessmumof2]

Soupdragon i agree the best position for me was drapped over the birthing ball or leaning forward over the bed with a beanbag on the bed to support my shoulders, have you tried a birthing pool with either of your babes sd?

[Yorkiegirl]

Message withdrawn

[SoupDragon]

Didn't get the chance to have a pool with either DS1 or 2 unfortunately, SMof2.

The leaning over a ball bit is also good in the last weeks of pregnancy for helping avoid a back-to-back baby.

[aloha]

I've looked at a lot of studies on the issue of epidurals and back pain and the consensus is that is no correlation between epidurals and back pain. However, there may be a correlation between long, complicated labour and back pain - hence the confusion as painful, complicated labours are more likely to involve epidurals (surprise!) - I hope that makes sense. This should put your mind at rest re the epidural if you should need one. Discuss it all with your consultant. I don't think midwives - highly skilled though they can be - are experts on back problems.

[aloha]

RECENT STUDY RESULTS
A study released on February 6, 2001 in the British Journal of Obstetrics and Gynaecology found no evidence that the use of epidurals increased the incidence of backache in the first three months or in the first year.
Utilizing two groups of patients, one of which received epidurals for their labor pain and the other which received pain relief in another form, the researchers compared the amount of backache at three months and then at twelve months. Interestingly, while the rate of back pain was high (about 20% at three months and about 35% at twelve months), there was no difference between the two groups.
This study lends more weight to the statement that backache is multifactorial. The high incidence of back pain in these patients suggests that back pain is real - but that it is due to other factors associated with pregnancy. In addition, it suggests that epidurals play no detectable role in the development of back pain.
SUMMARY
These conclusions are important, as many patients wonder if the back pain they experience was somehow caused by a mistake in placing their epidural, or even from a normal epidural. While it is not unheard of to have complications associated with any anesthetic technique, including an epidural, it does not seem that backache is a common problem related to epidural anesthesia.

[motherpeculiar]

so much information - thank you all very much. I've tried to take as much of it in as possible and I'm sure will be referring back, asking lots more questions after I see the consultant tomorrow

you lot are doing a good job of making me believe that i might be able to go the non-interventionist route after all . Aloha, thanks for the info on relationship between epi and back problem. That was my gut feeling so it is quite reassuring for me if a section is recommended (as I really don't want GA, but was worried about epi). However I think that while the epi itself is probably not to blame, it undoubtedly masked some warning pains about my back being under too much pressure. I think that if I were to try the "natural" route next time I would need to try to avoid an epi then I'd at least be able to. Sleepless and Yorkiegirl have really boosted my confidence about being able to get through it w/o an epi though - maybe I should get a book opened on whether I can manage it and aim to prove the doubters wrong like Sleepless did .

Soupdragon - thanks for the tips re. positions - sounds like I was in just the wrong position, but couldn't tell because of the numbness. I was also glad to hear that a spine to spine first time round doesn't necessarily mean another one. I'll try the tips for OFP (although that didn't work last time)

Sleepless, if you could get the number for that sports rehab pilates woman I'd appreciate it. I live in SE24 but work in central london so could get to Oxford St. Oh yes, and to answer your q. re. morning sickness - with both pgs felt VERY nauseous from about wk 7 to 14, although no actual puking. This time round was reduced to eating nothing but cornflakes after about 4pm (I've always hated cornflakes but they seemed the blandest things available!)

Chuffed, good idea about checking the hospital for classes. I'll try to do that tomorrow too.

Thanks again you lot - you have given me plenty to think about and made me think of things I'd never considered previously. I'll let you know how I fare tomorrow.

[SoupDragon]

Also your whole stomach area is much looser second time round - more space for the baby to mocve about

[motherpeculiar]

soupdragon - thanks for managing to put a positive spin on that, ahem, "feature" of second time round. I shall embrace my enormous girth (at only 18 wks it reall is impressive) with a completely different attitude now

[Yorkiegirl]

Message withdrawn

[sleeplessmumof2]

pleased to hear you sounding more optomistic, i'll cat you katherines number (the pilates teacher) and good luck for the doctors!!!

[motherpeculiar]

Hi again

well, I went to the othopaedic consultant at Kings on Thursday and left the appointment almost incandescent with rage. However I have calmed down now and am interested to hear what anyone thinks of what they told me there. Basically the registrar and consultant both said that what I am experiencing is normal and a recognised aftereffect of pregnancy and childbirth and there is nothing to be done - no need for further diagnostic tests or investigations and no implications for the next delivery, just to see how it goes on the day. My DH tried to press them to at least offer an MRI scan to make sure there hadn't been any spinal damage during the last delivery but they refused, saying a scan "probably" wouldn't reveal anything further (I would have though that if there was any chance it could reveal something extra they should offer one - but hey, who am I to offer an opinion?). Thye said that I can expect the pain to get significantly worse during this pregnancy and that I should be prepared not to be able to work at all towards the latter stages. Great. (Looking forward to eating into my mat leave before babe arrive, given that I can only afford to take the minimum). They said to go back after babe is born and they may be able to refer me to an expert in post-childbirth backpain at Guys and St Thomas. Something to look forward to.
In a throwaway remark the consultant referred to the pain I am experiencing as "sacroiliitis" - anyone heard of this - know anything more?

I guess that I was a bit peed off as I felt they were just brushing the very severe pain I have been feeling under the carpet as a side-effect of pregnancy/birth. I may be wrong but I didn't think it was all that normal to be unable to walk properly 2 and a half years after a baby was born. I got the feeling it was another case of "if men had babies" this wouldn't be the message I was getting. But as I say, I am much calmer now and thinking - well maybe they are right, in which case I don't need to worry about thedelivery anymore and stop trying to plan it in advance in an attempt to minimise any risks. I feel just as confused really though...

sorry for yet another long and rambly one....

[sleeplessmumof2]

mp sorry that you had such a bad consultation, although i too have been told that i have sacroilitis i have to be honest and i think that it is a generalised terms for inflamed sacrum, however no doubt someone with google it and tell us both what it is I do not think that it is at all acceptable that you have been in that severe a state for 2 years. I have been told numerous times that it takes about a year for the body to recover from the trauma of childbirth but here they are referring to recovery in the fullest of terms not just getting over practical incapacitation. Im sorry i'm not really offering much in the way of solutions but wanted to offer you my support and understanding.

Have you had xrays? Have you had a chance to contact the pilates woman? What about going back to your doctor and insisting that they refer you for xrays/mri etc?


Also hate to be a little sceptical but after all this time why not try a different osteopath, perhaps this one just hasnt hit the right note for this particular problem for you!!!

Hope to help and remember as far as childbirth second time around is concerned there is really good chances it will be ok!!!

[motherpeculiar]

Thanks for the support Sleepless. Glad you don't think I am over-reacting.

I haven't had any tests at all done yet - which is why I was hoping for an MRI. I was booked in for Xrays but then found out I was pg the week beforehand so couldn't have them. I had been to my old GP on and off about this problem overt he two years but was never really taken seriously, diagnostic tests were never requested. In retrospect of course I should have insisted (which is actually what I did when I joined the new GP practice after moving, on my sister's insistence) but I guess I had too much faith in the first GP telling me it would all just "go away". Ho Hum. The really irritating thing is that the consultant acted as though this too was my fault in some way, that I had left it very late to be trying to work out what had gone wrong. Grrr.

Anyway. The pain isn't so bad at the minute, because the osteo I have finally found after all this time seems to have helped a lot. But I am still extremely nervous about any exercise and about the labour (Although, as I've said before you and the others have helped a lot in that regard - thanks again).

I just hate being brushed aside like this.

Never got the cat with the woman's details by the way - could you try again?

Thanks. I'm trying to think it will all be fine

[motherpeculiar]

I wrote that message last night in a real rush!

Sleepless, I don't think my insistence on an MRI will get me anywhere. That's exactly what I tried to do last week, brought DH for backup too. We saw the registrar first and he was resistant about a scan so when we kept going on about it he called in the consultant, who was the one who said it "probably" wouldn't show up anything. We kept going on about it but they wouldn't budge. I was in tears in the consulting room, and basically told them nicely that while I respected their expertise and all that I was in no way re-assured and that I still felt something untoward may have happened last time round and would like at least one daignostic test. They would have none of it, even after what must have been 30 mins of both me and DH trying to convince them that the pain I have been experiencing couldn't be considered "normal" two and a half years down the line.

Of course, the fact that the pain has been much less over the last two weeks or so due to the osteopath made it a bit more difficult....if I thought that was it fixed that would be fine, but the osteo says it is merely alleviated for now.

Anyway, I'll try the pilates. ALso got a good name for the Alexander Technique which might help too. Still very fed up with the NHS though.

Will stop moaning now and try to get positive, as you say it may well be ok this time round. I need to try to get myself to really believe that and I'm sure it will help, mentally if nothing else. Thanks again for the support. You are a star!

[sleeplessmumof2]

mp ugh that is so so infuriating, i guess they blamed your insistance on hormones or something? It may well be the effects of the hormones, i like you also think that the problem with the epi is nt so much that it may have gone wrong as much as the numbing stopped us from knowing we were putting too much strain on areas etc and couple that together with the hormones is a bad cocktail. Anyhow I have just come back from a funeral and had to stand up for 1 hour and am now in agony!!! But i did deliver without an epi, and without any intervention and no stitches. Where are you hoping to have your babe? and would you consider having a private midwife their to support you who knows your whole history etc? It might be worth thinking about? did i email you katherines number, im so nappy brained i dont remember?