Giving birth when you have nerve damage

[Obsidian77]

Does anyone have experience of giving birth whilst suffering from pudendal neuralgia? I sustained permanent damage to the pudendal nerve during DC2's birth 5 years ago and have been in constant pain since. It has not responded to meds (Lyrica, OxyContin etc), nor to a spinal block and is only eased slightly by cortisone injections.
I am 36 weeks with DC3 and so stressed about the birth. I can't find any clinical guidelines relating to this and don't think my midwives have grasped what I'm actually saying about pain management during the birth.
I have been told that an epidural is unlikely to provide adequate pain relief as it doesn't affect the pudendal nerve.

I would recommend asking for an appt with the anaesthetist asap

May I ask who's followed you so far? Urogynae? Colorectal? Pain management clinic? A combination?

Thanks, was living abroad for while & under pain management there, returned early this year, haven’t seen anyone local for it yet. Not pushed this as the only (slightly) effective treatments I’ve found are contra-indicated for pregnancy & lactation. Asked community midwife to query recommendations with pain clinic at hospital where I’m booked in.
Saw consultant OB/GYN who thought I’d be fine with epidural. Saw anaesthetist who explained epidural unlikely to provide adequate pain relief & put note on file for me to be topped up to spinal block although this would increase chance of instrumental delivery which could cause further damage. Had informal consultation with another anaesthetist who reiterated epidural unlikely to help, was very concerned about birth causing further damage, said if I were his patient he’d recommend C/S.
For various reasons am not at all keen on C/S although if there’s no sensible alternative, will accept this. That’s why am hoping to hear from anyone who has similar experiences.
Have seen different midwives, who seem to think that since baby is perfectly healthy, it’s fine for me to be assigned to the midwife-led unit and wouldn’t I like a water birth?

Do opioids help at all?

My hospital also offers Remifentanil to people who can't have epidural

Stories I have of women with that level of damage is 1-no more children (that's me) 2-planned c-section.

Thanks for your replies. Midwife has arranged follow-up with anaesthetist & I'll be asking about fentanyl etc.
I'll post again after the birth to say how it went.
Pinguina 1) would have been a good idea.. :(

OP - I hope you manage to get the advice you need on anesthetics ASAP.

You don't say why you don't want ELCS but I think if ELCS has been discussed it would be worth serious consideration. They don't offer these out lightly so there must be some strong indications this is a good option for you. There's a lot of myths out there about CS. They can be wonderful experiences and many people recover quickly and the recovery is temporary, whereas any further damage during a vaginal birth may or may not be so temporary. Please don't dismiss this option without significant thought.

Hello obsidian77, just wondering how you are getting on?
I also have had pudendal nerve problems for the past year due to ivf and I am now 28 weeks pregnant with my first baby. I've had a constant pain in my lady parts and pelvic floor pain and spasms for the past year, I've discussed the problem with an obstetrician and it seems like the safer choice to have a CS so I'm going for that but still quite worried as I don't want to make the nerve pain any worse! I've had the same problem as you, nobody seems to understand the pain and distress this nerve pain causes. I'm currently on amitriptiline and having pelvic physio every week in the hope it helps but so far the meds have just dulled it a little.
I hope everything's gone well with your birth and that your nerve pain is ok too! Best wishes!

Hello, sorry to revive and old thread, but this is such a rare issue.
I have vulvodynia and pudendal symptoms and would like to have a baby soon. Am on amitriptyline 50 mg and worried. Has anyone experienced this? Thank you!