L5-S1 Spinal Fusion and Pregnancy/Delivery

[IzzyLeigh]

Hi everyone,
I know this is a long shot, but I was wondering if anyone here has had an L5 S1 spinal fusion and then gotten pregnant and given birth afterwards?
I had my surgery when I was 18 (I'm 33 now), so I'm totally healed, but I've wondered how this might impact my pregnancy and delivery options.
Is vaginal birth still possible? Is late pregnancy more painful? I've read some people say that, depending on the amount of scar tissue, sometimes they won't be able to give you an epidural. What then?

I'm only 8+5, so it's still early days, but I'm just looking for some insight from people who may have done this already.
I've attached a very old x-ray of my back in case it helps. Sorry for the poor quality; phone cameras back then aren't what they are now haha

Hi OP, I can’t answer your question (sure people will be along to offer insights though) but just wanted to say your midwives will add almost certainly want to refer you to a spine specialist for an opinion so they have a plan for eg if you needed a C-Section. This was my friends experience anyway. From my distant recall epidurals go a bit higher up that where your fusion looks to be but sure someone more knowledgeable will be aling soon. X

I would suggest contacting a spinal specialist directly (and privately if you can afford it, probably about £200) to discuss. Midwives won't be able to advise, and if they do I don't think they would have a full understanding of the situation.
I've had the same fusion but had it done after having my child, so I'm afraid I don't know in your case. The trouble is lots of people will have opinions, but i think you really need to speak to a specialist. I can recommend one, based in London but does zoom consulting, if you'd like.

thank you @Tethersend01!
And thank you for the offer @HeadToToesNo, however, I'm in the US :/
I'm sure my OBGYN will refer me to a spinal specialist and I'll probably also need to have a consult with the anesthesiologist when the time comes closer. I recognize that this sort of thing is probably very different for everyone since I imagine each spinal fusion is almost as unique as each pregnancy.
I suppose I'm just looking for first-hand accounts of people in my shoes? I know my doctors will give me lots of info and will take care of me, but I can't imagine it's a very common circumstance, so I'd also like the insights of people who have lived it already, if that makes sense? Maybe just the get an idea of all the different ways that it could go?

@HeadToToesNo oh, question for you! since you've had fusion in the same spot and have been pregnant before that, do you think that the pressure of the baby in the later months will cause any extra pain on where the infusion is?
I've heard that many women have lower back pain in pregnancy already, but do you think the location of the fusion will increase that? This is my first pregnancy, so I have no idea where in the back women typically end up experiencing the baby pressure/pain

Hi! I've got T3-L4 double rod fusion. Surgery at 17, baby 1 EMCS under GA at 34 and baby 2 VBAC at 37. DM me if you want to talk more specifically

I had part of a disc removed at L5 S1, don't know how similar that is to your operation.

I'm in the UK and it is standard to see an anaesthetist in pregnancy if you have had previous back surgery.

I was advised to never have an epidural. There was also doubt as to whether a spinal would work in a C-section scenario and I was told if it didn't I would need to be put to sleep.

As it turned out I've had 2 sections and the spinal worked perfectly both times.

In my pregnancy, my lower back was painful but I'm not sure how much of that was pregnancy and how much was me having a rubbish spine.
I think your fusion is in a place that has potential to cause discomfort, given so much pressure is on your lower back and hips.

How fit and healthy are you generally? If you are a healthy weight and reasonably fit that will give you a head start.

@JohnLapsleyParlabane whoa, that's a heavy duty fusion! Did you find that you had more pain, limited options, etc. in your pregnancy as a result?
I have this fantasy that since everything has been healed for so long that it won't make any difference at all and I'll just be like anyone else. I know that might be naïve, but it's certainly a nice thought

Well it freaked out most people when I first told them! But I was absolutely fine. My EMCS was nothing to do with my back. The only issue was that we always knew there wouldn't be spinal access as the top of my fusion is above the safe level. So when we went for CS we went for it. I had done a lot of thinking beforehand and my birth plan was all about 'in the event I have a CS, do this'. Second baby was almost a home birth

@frazzled101 did they explain why they didn't want you to have an epidural? If I'm being honest, I think I'd prefer the c-section for a couple reasons. However, I'll be absolutely devastated if they can't do an epidural or spinal and I have to be asleep for the birth. Besides the health and wellbeing of me and my baby obviously, I think being unconscious for the birth is my biggest fear.
That's incredibly reassuring though that you were able to get a spinal both times!

I had a spinal fusion at 15 and actually don’t know the technical details but it’s a long fusion. Rods must be a foot long or so.

I had a totally normal pregnancy. Needed an elective due to any being breech which was fine. Obviously some extra concerns but it all went fine in the end. I had it under a local.

It’s bound to be different for each person but my experience was that it all went smoothly.

Sorry posted too soon. The only real issue in both pregnancies was that I just can't lie on my back comfortably so getting checked was sore

@HeadToToesNo I'd say I'm about average? my BMI is 20.4 but I've got a pretty sedentary lifestyle. I don't really work out or anything. However I do go up and down the stairs about a zillion times a day. That counts for something, right? haha
Maybe I should consider starting to do some pregnancy safe exercises to better prepare.
The other thing is that I've got fairly narrow hips, so I feel like maybe that won't be doing me any favors in terms of skeletal support?
I've also got this scar across my lower belly from my surgery (they went in through the front and the back) and so that sometimes stretches and itches still. I'm a little worried about that how that's going to handle being stretched out with a bump

@JohnLapsleyParlabane that's all incredibly reassuring! almost a homebirth for the second even! I would have thought that kind of thing would be deemed absolutely off-the-table. Thank you so much for sharing! And yes, I'm figuring that my birthplan will likely have to have a lot of "in the event of" scenarios built in haha

@Calist I may be dumb here, but is the local the same as the spinal block? I tried to look it up and couldn't be sure. It's lovely to know that some of the people responding had very normal pregnancies and births despite having way more intense hardware than me!

@JohnLapsleyParlabane sorry, I'm behind haha
I imagine that'll be the same for me. Lying flat on my back even before pregnancy has always hurt. I need to have a little arch going on. Thank goodness they don't recommend sleeping on your back during pregnancy though!

@IzzyLeigh I was told the needle for an epidural is much thicker than the one for a spinal, and they wouldn't be keen on putting that into my back when there's scar tissue, prior surgery.

Also I was advised to have an active upright labour. With an epidural there was the risk that by being numb I wouldn't feel if labour/delivery was causing me any pain related to my back.

I wish I could answer this but tbh I don’t know the difference. I’m sure I was told but it’s all a blur now. The drugs went up my spine and everything went numb. That’s all I know!

@frazzled101 ah, that makes perfect sense. I hadn't considered that they would be differently sized needles. And that totally makes sense about wanting you to not be numb so as to feel if something was going wrong. Then again, I imagine that during labor (especially for the first time) that it might be difficult to tell what is supposed to be normal pain and what isn't?

@IzzyLeigh I didn't labour with my first but I did with my second, although it resulted in a section anyway.

I'm sure it's different for everyone but my original back problem was sciatica and I'm sure I would have been able to distinguish between that and labour pain!

If you were in the UK, you would be referred to an Obstetric Anaesthetist by your midwife and they would explain all your pain relief and delivery options and how they are affected by your previous spinal surgery. This usually happens around thirty- something weeks. It’s not particularly uncommon. I doubt a spinal surgeon would be helpful.
Essentially, you still have options, so try not to worry at this stage.
Spinals and epidurals are different but both involve a needle in the back and some local anaesthetic. They go into different anatomical spaces around the spinal cord and therefore have different characteristics and uses. Not exclusively, but nearly always, a spinal is a single shot injection but an epidural leaves a little plastic tube in the space which you can use over time.
Good luck with everything!

Anaesthetist here.... it would definitely be worth asking to see an obstetric anaesthetist in clinic - they will be able to discuss the pros & cons of different pain relief and anaesthetic options for you.