Expert: Dr Ian Jackson - please note UK based - 11/17/2009

Question
QUESTION: Hi

I am rather desperate since I am unable to find answers around my concerns. Although my case does not seem to be rare, I find many questions regarding this on the internet, with none/few answers. Both my gynea and orthopedic surgeon do not seem to have the answers, therefore, I would really appreciate your help, and am hopefully asking the right expert.

I was diagnosed from and MRI with a herniated disc (L4/L5) and sequestrated disc (L5/S1) in May 2009, when I was around 10 weeks pregnant, and had conservative treatment i.e. bedrest.
I am now 36/37 weeks, all well, with hardly any back pain at all, which is a fantastic. I can move around pain free, etc.  
However, I am very concerned about the delivery, and my gynae seems to be more comfortable with a c-section delivery.
My questions is whether I could have a spinal epidural during either c-section or natural birth with my back condition?

Thank you so much for taking the time.

ANSWER: Hi Ilana
Now that is a good question. I doubt that anyone has been able to carry out a controlled trial on this which is the classical way in medicine of coming up with the right answer. Hence I am not surprised that your doctors don't have all the answers.
Normal labour can put you into positions that may well strain your back and so I can understand your obstetrician suggesting a c-section. This does sound like a reasonable point of view and given my own history of back problems I think I would go for it.
As to the anaesthesia - there is no reason why you shouldn't have a spinal, an epidural or a combination of the two for your section. There is no reason why these would aggravate your back problem.
I hope this helps a bit.
Kind regards
Dr Ian Jackson

---------- FOLLOW-UP ----------

QUESTION: Well that is exactly what I wanted to know, thank you! I was really worried that I would have to have general anaesthesia for a c-section, and miss out on the birth of my son.
Is there anything else around the anaesthesia (spinal) that we should take into consideration?

Answer
Not really there is a good background nfo leaflet about spinals available at www.rcoa.ac.uk/index.asp?PageID=69#ysa and the Obstsetric Anaesthetists Association in the UK has a good one about anaesthesia for C-section at
www.oaa-anaes.ac.uk/assets/_managed/editor/File/Info%20for%20Mothers/CS_leaflets/CS_ed2_english.pdf
All the best
Dr Ian Jackson
Sorry you will need to copy and paste the web addresses!