What kind of back trouble to you have? I'm just asking as I've had some problems with my own back which is why I'm having a CS. I injured my back at 20 weeks pregnant and although it started as a bad back sprain - no broken bones or whiplash or anything - as my bump grew it became much more complicated as things got pulled further out of line.
I found that midwives were generally very sympathetic as they have experience of pregnant women suffering pain and mobility probs from SPD etc. However, SPD or back problems aren't an automatic indication for a CS. In fact my Dr said a CS could be more damaging for my back long term as the temporary damage from cutting through stomach muscles and disrupting core strength can exacerbate existing back problems in a way a natural birth wouldn't.
However, when my back deteriorated to the point of having more nerve involvement, such as sciatica symptoms down one leg and increasing numbness in my bottom and fanjo etc, the MW and Drs started taking worries over the birth way more seriously. My physio warned me how the increased nerve involvement and numbness might be a sign of loss of continence being around the corner (eeeek!) and I talked this over with the MW and obstetrician. My worry was that my back problem had limited my mobility so much that I wouldn't labour well and I was concerned that my existing pain and muscle contractures would hinder the birth process and I'd be very high risk for interventions at the end. Also very worried about permanent nerve damage to continence.
Dr and MW were very supportive of CS in the end and I've been booked to have this done at 37+6 to minimise risks of permanent nerve damage in my back from huge bump in later stages.
Sorry it's a bit long winded but my general advice would be:
- Get a referral from your MW to a specialist pregnancy physio early on
- Do their exercises, follow their advice about changes (eg they told me to really limit my walking/stairs, wear a serola belt them later another kind of brace, then crutches etc..)
- Any signs of nerve involvement rather than more general back or SPD symptoms flag up ASAP as this really changed their approach to my birth
- Make protecting your back from deteriorating a real priority as all the relaxin and preg hormones loosen things up and can make simple problems get very complicated and scary. I wish I had rested more early on and started wearing the back belt earlier.
- Talk to your dr and physio about postures and positions that cause you more pain or set your back off - if there is risk of more damage from you being in the kinds of positions they would use for forceps etc.
It all counts towards your case if you really want a CS. But think seriously about whether you really want one - loss of core stomach strength impacting on back pain, major surgery etc. But maybe you'll decide that the element of control from a CS in how you and your back are treated in labour will be the deciding factor.
Also, you may have to have a special back assessment re: safety of epidural/spinal for CS if you have an existing injury. Would you still want a CS if you had to have a general anaesthetic instead and miss the birth?
All very complicated! I hope you reach a decision that works for you and that your Dr and MW support xx