Tailbone Pain and Subsequent Pregnancy
Many women with current or previous tailbone pain are concerned about whether subsequent pregnancies will cause their pain to worsen or to return. This is a valid concern, since we know that tailbone pain can indeed be worsened both by pregnancy and by giving birth.
Timing Related to Future Pregnancy
One important approach for a woman with coccyx pain is to treat the condition as thoroughly as possible BEFORE a subsequent pregnancy. This is important because many of the treatments will no longer be available to a woman while she is pregnant. For example, pregnant women are often advised to avoid using nonsteroidal antiinflammatory drugs (NSAIDs) such as ibuprofen. Pregnant women should generally avoid getting x-rays or CT scans of the pelvic region, due to harmful radiation exposure to the developing fetus. Similarly, pregnant women should generally avoid injections at the tailbone or other pelvic regions during the pregnancy. Thus, pregnant women are limited from some of the standard testing and treatment for tailbone pain. This makes it important for women to optimize their tailbone testing and treatment before any subsequent pregnancy.
Vaginal Birth versus Cesarean Section (C-Section)
Pregnant women who have a history of previous or current tailbone symptoms should tell this to their medical birth team (obstetrician or midwife). Ideally, this conversation should take place well in advance of labor and delivery, so that the expectant mother and her team can have time to consider and plan for the delivery in advance. I have seen many women with tailbone pain who go on to deliver vaginally without difficulty. Unfortunately, many other women who have attempted to do so have suffered a significant worsening of their pain. So, there is no single answer or approach that is best for every individual patient.
Some of this may depend upon factors such as the specific anatomic location of the tailbone in an individual patient. For example, a tailbone that is in a position of abrupt forward flexion (angled forward into the pelvis) may cause obstruction of the birth canal, raising the reasonable consideration for a delivery by cesarean section (instead of through the obstructed birth canal). Alternatively, a woman with a bone spur projecting backward from the lower tip of the coccyx would have no obstruction of the birth canal and might be more capable of delivering the baby vaginally. Instead of cesarean section, perhaps this woman just needs better use of padding or cushioning so that she is not leaning backward onto the bone spur. Or she may need to change her position so that she does not spend labor and delivery leaning backward on a medical bed or table. Instead, she and her birth team may wish to consider having her deliver the baby in a squatting position.
Already Pregnant and Having Tailbone Pain
If a woman is already pregnant and already experiencing tailbone pain, this is a challenging situation. The pregnant woman will typically spend more time sitting and sitting leaning back, which tends to worsen tailbone pain. Also, the woman and her birth team need to discuss and plan for the eventual childbirth, including considering vaginal delivery versus C-section. Plans should also be made for evaluating and treating the tailbone pain after the baby is delivered.
Sadly, the otherwise joyous occasion of a new baby can instead be a time of pain and suffering for a mother whose tailbone pain is not adequately addressed. So, even though there are many limitation to the testing and treatment available during the pregnancy, plans should be made to move forward with such medical care once the pregnancy is over. Parents’ time and energy after delivery are understandably focused on the newborn, so having the mother’s tailbone treatment plan in place before that can be extremely helpful. Also, having a plan in place can provide some level of reassurance to the pregnant woman who is suffering with tailbone pain.
Patrick Foye, M.D., is Director of the Tailbone Pain Center at Rutgers New Jersey Medical School. For more information or to contact Dr Foye please visit his website located at www.TailboneDoctor.com