Coccydynia and second delivery - what to do?

[Lunarlyte]

Hello,

During the birth of my first child in 2009. I developed coccydynia (terrible pain in my tailbone). It had been a long labour: 24hrs latent phase, 7 hours in active labour and 2 hours pushing her out. I felt the pain in my tailbone in that last hour of pushing. It was like I was pushing against the pain of my coccyx, rather than with the pain of the contraction. I would say that the tailbone pain was worse than those contractions, and the recovery from my eventual episiotomy.

It took a long time to get better. I had physio for a couple of months about 16 weeks after the birth. This, coupled with time passing, has helped the pain go from intense to more like a deep-bone-ache just sometimes.

I'm 29 weeks pregnant now and need to decide the best/safest mode of delivery. I've seen a consultant obstetrician who says that he would perform an elective CS, but he is pro-vaginal birth as there is the chance that my tailbone will be fine. He heavy outlined te cons of CS that sound very scary.

I've also seen a consultant midwife who advises a mobile epidural so that I'd my tailbone 'goes' again, I wouldn't really feel it and would be able to get through the delivery. This would be coupled with birthing positions that keep me off my back. A vaginal birth may or may not make my back worse. It dedinately won't make it any better. Midwife also said that if coccydynia re-occurs, then pain-management post-birth is key (lots of codeine like last time, then).

I just don't know what to do for the best - risk my back, or have the CS and take on board a different set of risks?

Help, please!!!

QE is fab. they'll be v careful with you.

I am such a wriggler now, when sitting down. I hate hard chairs

dunno who my sister had.
my consultant up in MCR -- I never saw her! she was a presence in the background, havent a blardy clue who she was.

even if you're under mr pirie, you may not even see him... they're a mysterious lot

Just noticed these most recent posts, so apologies for my late reply. Many thanks, ladies, and I will certainly keep you posted on all relevant developments x

Hello all, it's time for an update, as promised!

I'm 35+4 today, and have been getting worsening back pain recently. Over the last 5 days or so, I have felt pulling and twinges in my coccyx. It's been making me doubt even more how this area of my body will withstand the pushing stage of natural labour.

DH and I went to see the consultant OB about booking a CS this morning. I figured that I'd probably have a last battle on my hands, and certainly wasn't wrong! Very difficult to begin with; OB seemed against me having the CS, as he felt that it's not absolutely medically necessary. He was actually quite ardent with this - it felt like I had to convince him of my will to have a CS. And I think that is the bottom line. It's unfortunate because he saw that as I have an increasingly painful tailbone now, that this was somehow proof that it was late pregnancy that caused the original coccydynia in 2009, not the 2 hours of pushing after a long latent phase and 7 hour active phase. I just couldn't get this through to him and felt like I was going to cry

Concerning hospital protocol, it appears that I would have had an easier time if I'd requested CS on a 'just because' basis rather than coccydynia. The OB was not impressed by what the chiropractor had advised (likening this profession to advice given by ordinary 'lay' people), but seemed to have more respect for the physio. He wanted the name of my chiropractor to report her as her advice could be putting women at risk! What rot; he didn't understand that she was looking at this issue from te perspective of protecting my spinal health.

I quoted some NICE guidelines in order to put my individual risks into perspective, but these were dismissed by him saying that the hospital isn't totally on board with the 2011 guidelinesyet. Only later did he use them himself when explaining why I had been referred by him to see the Consultant Midwife. Stats too, apparently don't matter. It's all binary: stuff either happens, or it doesn't. Surely statistics are there to help us take calculated risks?

It's exhausting! But to cut a long story a little shorter (sorry, i know this is an essay - thanks if you're still with me x) he did seem to start to relent when I said that I felt that ELCS was what I was more inclined to do. Then he was very co-operative, answering my questions which were about the specifics of the surgery/birth and even stopped painting doomy worst-case scenarios. Towards the end of the meeting we were still being cautioned, but informed that certain risk factors were very low.

We were also told that that the WHO recommends a 15% CS rate. The hospital where I'm going had a rate last month of 34% ... of course, the OB then assured us that this does not mean that the hospital are trying to talk people out of caesareans. However, I can't help but think that this must have a bearing.

We managed to get a date booked. The OB wants me to think about if for another week, go back to clinic next week if I still want a CS to sign consent forms a get a Pre-op appointment booked. I have to say, I am TIRED of going back and forth to the hospital now, and i do feel quite emotional about the whole thing because its not like I'm revelling in the idea of having my abdomen and uterus opened to birth our baby. I'd much rather have a truly normal VB, but I'm honestly constantly doubting whether my coccyx could take the strain. If an ELCS goes as smoothly a it should then it is the right choice. I'm weary of all the potential risks bein hurled at me, at the dismissal of the risks to my spine. I am tired of being made to feel like I am putting the health of my spine over my womb and that it better in some way to risk the spine. To be perfecty frank, I'm terrified of risking both.

So, that's where things stand right now. The message that is comin from the hospital - a least in my case - is that it's not really a simple choice that you have to aim for ELCS on the NHS. you have to fight and be damned strong whilst doing it. Its not what women (and their families) need when heavily pregnant. More updates to come when more developments occur. Thank-you again for reading xx

Hey Lunar - have been thinking about you and wondering how you've been getting on. Sorry that things are more painful for you now . Glad that you have got the outcome that you are happiest with (although I know 'happy' is probably the wrong word to use!), but I am so and that you are being put through the mill like this. It feels like they just want to harangue and bully you until you cave and go for VB. You've done your research, you've thought about the pros and cons of each carefully and you have come to a decision that is best for you. Why make your life harder and more difficult? Very glad that DH came with you - he was quite anti ELCS at the beginning of your thread. Good luck and please let us know how you get on! XXX

Hi Cardamom, thanks for your reply and words of support (yet again! x) DH and I have had the weekend to think about things and still think that ELCS is the right thing to do. DH ha rather changed his mind over recent weeks - I think because he sees how uncomfortable I am in terms of my lower back and coccyx. I also got in touch with a close friend of his who had an EMCS in Nov 2010: her recovery was straightforward, even considering the urgent nature of her son's delivery, and she was very positive about her experience.

It's just so frustrating to keep having coccyx pain (and what caused it) dismissed. I never had any problems with it before I pushed my lovely little girl out! [Sighing emoticon]

How are you and how is your recovery progressing? Hope that all is well :) xx

Hi Lunarlyte, thank you for keeping us posted. As I mentioned before I have a very similar problem with my coccyx, now made worse by a touch of SPD. I have formally requested an ELCS at Kingston Hospital and they keep sending me home to 'think about it'. It is terribly frustrating and it is causing a great deal of unnecessary stress. I am due to meet the consutant again tomorrow but so far she has been incredibly dismissive of my condition and keeps comparing the a best possible vaginal birth with a worst case scenario CS which makes it very hard for me to trust her. I feel I don't really have a choice and they will keep sending me home to think about it until I finally say what they want to hear. I will let you know how it goes.

Sigma This (unfortunately) sounds all to similar to my recent escapades! Will you have someone to go with you, to prompt you and provide moral support? I found the presence of my husband to be extremely beneficial. I'm not particularly intimidated by consultants, but when you are trying to argue a point when you're feeling very emotional (and in their territory) their professionalism disconnectedness can leave you feeling confused/upset/frustrated and unable to argue effectively or even coherently! I had a list of questions written down, too, which helped. Just don't lose sight of the fact that hospitals have protocols to follow and if you insist that you are aware of, and accept, the risks of ELCS then as far as I know the hospital has a duty to abide by your wishes (according to 2011 NICE anyway).

You need to stress that you were sent away to 'think about it' (as was I) an that you HAVE thought about it, and feel that an ELCS is the better option. If you are refused tomorrow, then you have been misled. What is the point in letting you think about it, if you're just going to be told 'no' in any case?

In the event that my OB refused the CS, I had a prepared response: I was going to say how unhappy I was with the decision and demand to be referred to an OB who would perform the CS. This is a term under the 2011 NICE guidelines. If the OB would have then informed me that the hospital wasn't/ wasn't fully on board with these guidelines (as he did when dismissing a statistic that I pulled out), then I would have said how worried I was by this, and would have gone to the extreme of being referred to another hospital.

Like I said in Friday's post, I'm not enthralled at the idea of having major surgery and am frustrated that I'm having to argue so ferociously for something that I feel is a prophylactic choice (that is, a taking on another set of risks so as to avoid the coccydynia risks). I'm also frustrated at the OB's insistence that this is my choice; they are not making it that simple! I have found myself willing Babba at times to somersault into a breech position because then that would be it: decision made, no more worrying, no more arguing.

However, I will not be bullied into a VB. I've thought about it - perhaps too much now - and am seriously concerned about the damage that a VB could do to this weakened area of my body. I'm bothered about feeling that sitting-to-standing pain; not being able to bend down to pick my baby up out of the Moses basket; of shuffling up the stairs because of sciatica; of not being able to get comfortable enough to breastfeed; of not being able to sit down for long in any one position ... whereas with an ELCS that goes smoothly (which it should do), then there is a good chance that pain and discomfort should subside after the prescribed time of 6 weeks and will be managed with painkillers in the meantime anyway.

You just need to be insistent. And stay strong. It's really horrible, but if you've decided it's what you want to do then you have to argue calmly and reasonably.

When is your baby due? Good luck for tomorrow - I hope that you get the outcome that you want. Please keep us updated! Xx

2 weeks to the day to my ELCS date! And I'm freaking out!

Just got off the phone to an auntie of mine who doesn't understand why I'm even considering CS as a birth option. Essentially: 'It's surgery you'll be recovering from, and your back might be okay. Hmmmm [dubious silence]'.

Also had my last ante-natal on Tuesday, where everything has the go-ahead for CS on paper. Which is fine if I could just stop bloody worrying, and my community MW hadn't again suggested a 'trial of labour'. (Thinking about it, I know this wouldn't be a good idea because I think I would only have tailbone issues when pushing - and by then, all you can do is push babba out. Or, putting us in an EMCS situation, which I wouldn't want). It's just throwing more doubt at my poor addled and pregnant brain.

So I feel a bit wobbly because 1) THE CS IS ONLY 2 WEEKS AWAY 2) I'm scared about making the 'wrong' decision 3) With so many 'what ifs?' buzzing around my brain, I'm finding it hard to think straight, or to think about anythig else. And I'm doing poor DH'a head in, so don't want to go on at him anymore.

Please someone, some words of reassurance? x

Hi Lunar!
We're away and we all have the lurgie big time, so I haven't been checking MN for about a week now. So I hope you are feeling better about things. Re-read your posts - you are incredibly well-informed about this and have made a reasoned and well thought out decision about what is best for you. One of the things that's so horrible about all this is that there is no straightforwardly uncomplicated decision (as far as that can ever be said with childbirth!). It's a trade-off - one set of risks against another, an operation vs potential severe damage possibly requiring surgery to repair it. It's not great. But you've thought about this and you know what you are doing and you're going into this with your eyes open. This isn't EMCS, this is ELCS, and other than your coccyx this has been a healthy and uneventful pregnancy - so hang on to that!
That said, I'm not surprised you are bricking it! But the run up to childbirth, no matter who the baby comes out, can be pretty unnerving, not to mention the fact that your family will soon be increased by one, and you will all have to adapt to that. You're nearly there Lunar! You can do this! Your lovely baby is nearly with you! Hang on in there! (And get as much rest and sleep as you can.) Oh, and don't talk to your Auntie or to anyone else about the birth choices you have made - just asking for trouble.... XXXX

Hi Lunar! Not long to go until you can cuddle your little one now, let me know how you get on.
I saw my consultant today. She thinks a second delivery should be straight forward and my coccyx should not be an issue but she is willing to support me if I decide to go for an ELCS. So really it is up to me and I just can't make up my mind! Too many what ifs like you say. Such difficult decission and I am 36 weeks gone!

Hello both, thank-you for your replies. Cardamom bad luck with being struck down with illness over Easter! I hope that you are all recovering now.

I haven't been able to bring myself to speak to my offending auntie again just yet - to be fair, she isn't the most compassionate person and can be incredibly judgemental, particularly when issues concern those aside from her own son and daughter and their kids. I would go so far as to say she revels in other people's problems. Definitely one to avoid when caught in a trying situation! Thank goodness she has no idea how long it took us to conceieve this little one.

My 'sensible head' tells me that ELCS is the best birth choice for this baby. Aside from limiting further damage to my coccyx, the degree of control in terms of arranging childcare (and dog care!) and preparing DD1 for the baby's arrival; knowing that there will be one, calm trip to the hospital this time on the day of the birth; hefty pain control during and after and a prescribed recovery time if there are no complications are all very appealing. My family (DH, Mom, Dad and my OTHER auntie, who is like another Mom to me), have all scheduled time off work so that we'll have someone on-hand for 5 weeks at least.

It's the not knowing, the unpredictability, and risk of re-damaging my coccyx that make VB less appealing this time. I also had an episiotomy with DD1 and although I know that this does not increase the likelihood of needing another, or naturally tearing, if I was to tear, then it could tear along the scarline and create a more extensive tear. Oh, and the swelling, brusing and haemmerhoids eek, lets not even go there!

Whatever the birth choice though, I think I would be bricking it by now. The soreness and pulling sensations in my tailbone are maki me wonder about whats goin on with it now, let alone what woul happen during labour and delivery. Its just that what doesnt help - and I'm feeling this from you, too, Sigma - is our obstetric professionals are not particularly supportive of ELCS for coccydynia. So, any doubts we might have are echoed by them, and obviously this affects your thoughts and decision-making process. I don't think I'll be totally comfortable with the CS until I know the outcome, if that makes any sense? All I can say to you, Sigma is to be fully informed and follow your gut instinct (even though you might still find yourself questioning it!)

Pre-op next Wednesday ... Birth-day schedules for next Thursday! I'll keep you both posted as soon as I can with developments xxx

Some ridiculous type-o's there ladies - hope it's legible! iPhones for long emails/posts are not ideal!

Meant to say that doubts are 'amplified' rather than 'echoed' and with ELCS, I won't be totally comfortable with it until it I done and the outcome is positive, of course! X

Well, I've only bloody done it!

DD2 was born yesterday, 19/4/12 by elective cesarean section at 10:51am. It's still all very surreal and hasn't completely sunk in yet, but although I was very nervous, it was a lovely birth and I was euphoric afterwards. No hours of agony in labour, no issues with my back. Stand by Me was playing when she was born - I'm getting teary thinking about it!

Physically, I am sore and have been using hefty pain medication since yesterday, but I'm not exhausted like I was after my VB. I'm finding breastfeeding enjoyable and don't feel shocked by the birth. I don't know how things will compare long term, but this will be an interesting thing to consider in say, 6 months time.

Interestingly, it took a while for my blood to clot yesterday. The OB said that this could be because of the diet that I eat (a healthy, whole-food pescsterian) but that my skin and tissues are 'stretchy' and my leg bent to an unusual angle suggests that I might be hyper-mobile! Damn it Cardamom I thought of you and then about how that would explain a lot about what caused my tailbone to get injured in '09!

I'm also relieved that I didn't go through with a VB this time because, if I am hyper-mobile, my tailbone and who-knows-what-else might have 'gone'.

So, beautiful second baby girl is finally here - hooray! :)

Sigmahave you made your mind up yet about your birth options? X

YAY Lunar!!!!!!!! CONGRATULATIONS!!!! Fantastic news! I am delighted for you. Well done you . You can't have a , so I'll have that for you, but have a and lots and lots of .

Stretchy skin and an oddly bendy leg, eh?!?!?!?!? Yikes .
XXXXXXXXXXXXXX

Congratulations!!! I am so so happy for you!
I have my elective c-section on Friday and my pre-op tomorrow - I will let you know how it goes.

Good luck Sigma: Enjoy the experience - I have really happy memories of the events of 11 days ago. Your lovely baby will be in your arms on Friday ... Can't wait to read all about it!! X

Cardamom Just realised that I've made myself sound like a right cheeky freak of the week with tales of my stretchy skin and bendy legs! I'm honestly not a frog How is your recovery going? X

Not at all lunar!!! Things OK here. Gearing myself up for second and hopefully final surgery next month and getting a referral to a hypermobility specialist for an assessment. This won't change what we're doing about the birth injuries, but given that I had no idea I was hypermobile until recently, I'd like to know what's going on and whether I have any other health issues I need to be aware of! How are you? How are you healing? And how are your lovely DDs? XX
Good luck Sigma! XX

Hey Cardamom things are going pretty good here touches wood 12 days post birth/CS. Actually forgot yesterday that I've recently had major surgery and let out a sneeze, only to suddenly have my abdominal muscles remind me of recent activity! The good news is now that my lovely 6-and-a-half-pound baby has been retrieved from my pelvis, I have also forgotten about my coccyx. That part of my anatomy has been very well-behaved since the birth.

It's amazing, really :) I loved the ELCS birth experience so much, both in theatre and on the post-natal ward. I cannot commend Birmingham Womens Hospital enough. The place is wonderful. Granted, a CS is not for everyone, but it was the right birth choice for me, for this baby.

DD1 is loving being a big sister - she's very helpful at nappy-changing times and givesthe baby lots of kisses and cuddles. She even likes to pretend that she's just had a baby, and re-enacts the scene of mother and baby on the post-natal ward. Sounds weird, but it actually really funny/cute! As for DD2, she's a very sweet and calm baby. She only cries when she's hungry, wants a cuddle or needs to have her nappy changed. She's absolutely lovely :)

I'm so glad that all is going well for you, and best of luck for your next surgery. Please do let me know how you're going. You've been so supportive to me, and really helped me to make a measured and informed decision about DD2's mode of delivery. You're in/near London, aren't you? Probably too far from one another to meet for a coffee one day, I suppose ...

Take care and I hope to hear from you again soon xx

So pleased that things have continued to go well after the ELCS. Well done on producing a calm baby !! Really happy that you're enjoying it all!

Thanks for the good wishes - will keep you posted. Glad that you feel I helped you - I'm only too pleased to share my experiences if people want it. Well, Birmingham's not THAT far..... . XX

I never realised untill this pregnancy that i fractured my tailbone during last delivery 28 hour labour with epidural so didnt feel it ...it affected my knees after birth for a year needed physio as my pelvis rotated...
But anyway ...that also caused spd in this pregnancy ...i am seeing a private consultant...and yes having a c section this time...he said if i had a long labour with induction after 40 weeks then second one is most likely to be a long labour as well and i could cause some more damage there in my pelvic coccyx area...
So i would like to have 2 more babies..next one due in august...elective c section have decided it...and dont think i will ever vaginally deliver again as it has permanently damamged my ability to walk properly and do certain sports i used to enjoy....