Expert: Ronald Levy, M.D. - 10/26/2007

Question
In November 2006, I discovered through MRI that I had two slightly herniated discs at L4-L5 and L5-S1 that kept me bed-ridden and in constant pain for four months.  (At its worst, the pain radiated out of my back, through my buttocks, and down my right leg all the way to my foot.) I finally went a month without pain, then discovered that I was pregnant in April 2007.  I had some back pain in the first trimester, almost none in the second trimester, but at about 30 weeks, it got bad enough that I've had to severely limit my physical activity and occasionally use a walker around my house.  (The pain has been limited to my lower back only, no sciatica yet at 32 weeks.)

My question is whether or not I should opt for a c-section to prevent possibly reinjuring my back.  I'm concerned that if I have a natural labor and delivery that the pressure on my back will cause permanent damage, or at the very least, cause another herniation and prevent me from being able to care for my newborn.

I have been unable to find anyone else with this problem, and my OB wants to wait and put the final decision into the hands of a neurologist at the hospital when I go into labor.  However, this issue is causing me distress, and I would like to have some sort of idea on where I stand.

Thank you for any advice or experience you can provide me.

Answer
Labor itself should put that much increase stress on your back whereas carrying around the baby in the last 8 weeks and post delivery might. The answer anout whether you should deliver naturally is a complex one and is partly related to the type of pelvis you have. Some women have a pelvis type that makes delivery relatively easy while others make it next to impossible. Unfortunately there is no way to know your type until you've had your first baby. Since c-section is always an option, I tend to agree with your OB and see how the labor progresses (of course, this is an anesthesiologist speaking!). If you find it to stresful on the back, they can always perform a section.

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston