Herniated disc + pregnancy = ?

May 14, 2008 1:19 PM

Back trouble and pregnancy: Which is worse for a person with a herniated disc, a C-section (which I imagine will compromise the all-important core muscles) or vaginal delivery (which might cause the disk to rupture)? Also, I am prone to sciatica and assume that pregnancy will involve a lot of sciatic nerve pain--can this lead to a permanent worsening of my condition or would it be relieved once I gave birth?

I've had surgery (microdiscectomy) for a ruptured disc at L5-S1, and have a slightly herniated disk at L4-L5. I am mostly fine now and am contemplating having a baby, but my biggest concern is the possibility of worsening my back condition. Frankly, the back pain I used to suffer was so bad that if it's a choice between having a child and being pain free, I would choose to forego having children. However, I want to have a child if there is a reasonable likelihood that it will be okay. I know nobody can predict the future, and of course I will consult with my doctors, but I'd like to get the hive mind's take on this first.

1) I have read that a C-section is bad for people with back trouble because you're slicing through the muscles that you need to have a strong core. I know that in my case, the stronger my core, the better my back. What will my abs be like after a C-section? Would it be safer than risking a ruptured disc during labor? Also, from the perspective of plain old vanity, will my stomach ever be flat again after a C-section?

2) Since even a tiny bit of constipation makes my sciatica worse, I predict that pregnancy will make it dramatically worse. I think I can bear it for 9 months, but I worry that having pressure on it for so long will somehow lead to permanent damage. Is that possible?

Any advice on these matters is welcome, although I am looking more for dry-eyed realism than "have the baby, everything will be fine!" I mean, I think I have the best chance of everything being fine if I really know ahead of time what I'm getting into and make an informed decision. Thanks for your help.

posted by HotToddy to health (8 comments total)

You can rebuild your core after slicing through it. My core strength is probably better now than it was before my c-section. Also - the c-section will not cause you too loose flatness - it's your stomach swelling to the size of a beach ball that will cause it to loose flatness. My incision is very low and almost unnoticeable at this stage (2 years on). Even if you never slice into your core muscles - they are still strained quite a bit by the growth of your uterus. I was told to stop core exercise as soon as I started getting noticeably big - there is supposedly a risk of tearing your abdominal muscles if they are too tight.
posted by Wolfie at 1:32 PM on May 14

I've had back pain in the past, but never bad enough to require surgery. I had occasional bouts of sciatica late in my pregnancy, but they were generally alleviated with exercise and strategic placement of pillows while sleeping (eg one between the knees). I stopped doing ab crunches while pregnant, but continued doing back extension exercises on the roman chair.

Also, YBodyMV. Some people have problems (constipation/sciatica/whatever) throughout pregnancy, others not at all.
posted by mogget at 1:59 PM on May 14

I can only speak to the incision -- had a C-section like incision last year, a transverse incision right along my bikini line. I also had a microdiscectomy in 2000.

My back pain increased for about 6 months after the 2nd surgery, but it wasn't anything I'd call unmanageable or significant. I just felt more sore at the end of the day, more achey at the start of the day. I found regular OTC ibuprofren to do the trick, along with professional fitness training 2x/week. A year later my abs are stronger than they've ever been before.

On the down side, I do have a somewhat uncomfortable sensation when I work my lower abs, along the incision. It's fully healed and not quite true pain, but it's unpleasant just the same. I do a lot of supportive work around the area, and a lot of alternative exercises to access the area. It seems to help.
posted by cior at 3:19 PM on May 14

Oh, and the sciatica did not return.
posted by cior at 3:20 PM on May 14

I personally would not opt preemptively for a c-section, which carries with it additional risks to mother and baby, in return for an unknown impact on postpartum back pain. I would try to treat/manage the herniated disc as needed beforehand and be prepared to make spur-of-the-moment decisions while in labor (which is kind of normal for labor, anyway). I have periodic sciatica which got unbearable in the two weeks leading up to my due date. It went away almost completely a few days before labor (baby dropped, I think) and disappeared after labor (vaginal delivery). All of the women I know who had c-sections had difficulty returning to even normal functional movement for one to two months after delivery. I think with dedicated time and effort (a la cior), and depending on your age and current fitness level, you could regain your strength but let's face it, between the physical trauma of surgery and labor, and the physical, mental and emotional resources needed to care for an infant, you're in for an uphill climb. Also, you might get more targeted answers by posting your question on some of the pregnancy boards like urbanbaby.com or ivillage.
posted by cocoagirl at 6:37 PM on May 14

It seems to me that the hive mind can't possibly help answer your questions as well as a qualified OB, but here's my two cents worth:

1) I have read that a C-section is bad for people with back trouble because you're slicing through the muscles that you need to have a strong core.

As far as I know, the c-section is not some huge cut all along your tummy, it's a small cut just above your pubic bone. One of my girlfriends says her pubic hair covers the little scar completely. So I can't imagine you'd be slicing through that many core muscles - and in any case, muscle tissue can heal itself nicely.

2) Since even a tiny bit of constipation makes my sciatica worse, I predict that pregnancy will make it dramatically worse.

I'm up to seven months now, and even with iron supplements (I got anemic) I've had NO constipation! Yay! I had been worried about it too, but luckily craved salads through most of the first and second trimesters... which I'm sure has helped. As has getting a prenatal vitamin with a DHA (fatty acid) supplement. In fact I've read some pretty convincing stuff that constipation is *not* a necessary evil of pregnancy and can be avoided.

I have had some slight sciatica for the first time ever, though; it was worst in the first trimester. I think my body was getting used to my joints suddenly getting looser. It disappeared in the second trimester and now I'm getting little achy twinges again. Other back pain I've had - worse (or at least stranger) than the sciatica was lying on my back and feeling like my pelvis was going to fall apart like a cracked eggshell. It doesn't hurt *that* bad, but it's hella uncomfortable... you can almost feel your pelvis parts loosening up against each other.

if I really know ahead of time what I'm getting into and make an informed decision.

Well I hope this helps somewhat, but I really think your questions are geared towards technical rather than opinion-based answers, and can only make you really "informed" when answered by a doctor. Especially the one about muscle recovery.

In any case, birth vs. c-section is not something you necessarily choose at the beginning of pregnancy. See how the pregnancy goes for you, how your back is feeling in month 8. Talk to your doctor to work out a birth plan.

And anyway, in a surprising number of cases you don't get to choose anyway - you go in for vaginal delivery and something happens and you come out with a c-section. Happens all the time.
posted by GardenGal at 6:59 PM on May 14

I ruptured two disks in my lower back (L4-L5 and L5-S1) when I was in college. I had two (relatively large - 8.5 and 9.7 pounds at birth) children vaginally 9 and 15 years later. Other than fairly severe back labor, I had almost no extra back trouble during pregnancy or labor with either child. Neither of my OBs even suggested a C-section at any time during labor, although we had discussed them during pregnancy. I found that the pregnancies actually helped my core muscles.

An acquaintance of mine had L4-L5 fused (full fusion, rods/screws/etc) six years before she got pregnant. She found an OB who was willing to work with the constraints of a totally non-flexible lower back, and her daughter was born vaginally.

Not really an answer, per se, and I know that the plural of anecdote is not data. Talk to your back doc, talk to a couple of OBs /midwifes/doulas and get actual medical information and opinion, rather than anecdotes.

As GG said, you never really know, unless you get a C-section scheduled and labor doesn't start before the surgery is scheduled.
posted by jlkr at 7:35 PM on May 14

I can't speak to what you should do, but I have whiplash-induced back/neck problems and I had a C-section a few months ago (for other reasons, although I had major problems with whiplash throughout my pregnancy). My OB said that, in modern C-section, the incision is quite small and, rather than slicing through so many muscles, they try to weave the baby through some of the muscles. So it's not like it used to be...not even like a handful of years ago. They took special care with numbing the incision and the drugs they used and everything, as part of managing my C-section and whiplash. You should ask to be referred to an OB who will look at how to manage all these things, if you do have a C-section. Mine was amazing.
posted by acoutu at 9:00 PM on May 14