Scoliosis & Epidurals

You might be wondering whether you can get an epidural with scoliosis or spinal fusion. As a PT sitting squarely at the intersection of scoliosis and pelvic health, this is one of the most common questions I get from people considering pregnancy. It’s one of the most commonly Googled questions, and yet there’s not much reliable, consistent information out there.

Lucky for you, I am an expert in this topic. Seven years in pelvic health, another three in scoliosis specific PT, and personal experience with two pregnancies & two deliveries. This blog post will break down epidurals and scoliosis and whether or not you can get an epidural with scoliosis or spinal fusion.

So let’s get right to it.

What is an epidural?

An epidural is a common type of pain relief option offered for labor and delivery which requires a long needle to be injected close to the spinal cord in a very specific spot of the spine (the low back, or lumbar spine). The needle is aimed at the epidural space around the spinal nerves, hence its name. It is considered to be very effective for pain relief and therefore has been a popular request for women around the world when it comes time to deliver their babies. It typically creates numbness from the lower abdomen all the way down your legs and will remain in place until your baby is born. Epidurals are commonly available in most large birthing hospitals here in the US and throughout most of the world, though it may not be indicated for every situation. More on that a little later.

An epidural is not the only option for pain relief during delivery, even if it is one of the most popular ones. You can also elect to get IV pain medication, or a water birth. Another option is to try for a natural delivery without pain medication. Working with a birth team, including a doula or midwife, can also help labor and delivery go more smoothly. A well trained pelvic PT can also help you prepare your body for delivery, check the directory link listed in my website resources section.

What is scoliosis?

Scoliosis is defined as a complex, 3 dimensional condition of the spine and trunk in otherwise healthy individuals that can be progressive. The Scoliosis Research Society (SRS) states scoliosis is present when an x-ray shows a Cobb angle of at least 10° with rotation of the spinal segments. It’s commonly accepted that it affects 1-2% of the population here in the US, but recent research reports that a much higher number of adults are diagnosed with it later in life. Most cases of scoliosis are called idiopathic, which is a fancy medical word that indicates that no one knows what causes it. There are a ton of theories out there on what actually causes it — as well as some really cool research going on — and there’s some evidence that it can be passed on genetically. Recent studies in this show having a close relative with scoliosis could increase someone’s likelihood of developing it anywhere from 3 to 20%. Higher if both parents have it… Read even more about scoliosis and how it happens in this blog.

Many people diagnosed with scoliosis that progressed quickly in adolescence may have gotten a spinal fusion or other surgery to stabilize the spinal segments in an effort to keep the curve from getting bigger. This can have an impact on someone’s trunk mobility and flexibility, but is also very safe and well researched. In fact, it’s considered best practice if someone’s curve gets higher than 46 degrees according to SOSORT guidelines, which is an international society of scoliosis trained doctors & health professionals.

Despite what some doctors or internet searches may lead you to believe, scoliosis actually does impact the whole body, from how our core muscles can activate, to our awareness of our body position in space (another fancy PT word called proprioception), to our balance, to digestion — you get it.

One important thing to note for everyone here: scoliosis or spinal fusion do NOT impact someone’s ability to get pregnant, sustain a pregnancy or deliver a baby. Our bodies are amazing and adaptable, and if you get nothing else out of this blog post, please know that! Read that again.

Okay, now that that’s clear, moving on:

Scoliosis and epidurals: can you get an epidural with scoliosis?

When the time came for me to expand my family I did a ton of researching here myself, and didn’t find much that was incredibly helpful at the time. In my case, I consulted with an anesthesiologist at the hospital where I knew I would deliver to get some perspective. In her opinion, she determined it wouldn’t be a good idea for me to get an epidural due to where my spinal fusion ended and the rotation in my lower back. Knowing that was a little disappointing, but extremely helpful as I was able to set my expectations and start preparing for other forms of pain relief and management during my labor and delivery, so I planned accordingly.

Getting that anesthesiologist consult ahead of time is still my biggest recommendation: it’s so much better to know early if there’s any question. Having done it, let me tell you now that waiting until you’re in labor to find out you can’t get an epidural is not your best option! It can be an intense experience. Personally, I did extremely well with a technique called hypnobirthing and other pain management strategies… but they did require some preparation ahead of time.

It’s important to know that your ability to get an epidural depends on a variety of factors. First of all, some hospitals, birth centers or health systems may have protocols and plans in place that dictate how — or if — an epidural can be placed. Also, you should know that anesthesiologists are licensed professionals who must be held accountable if they cause any harm. There is a risk of accidentally hitting the spinal cord or a nerve, which could cause some temporary or even permanent damage to the nerves going to your pelvis or your leg. For that reason, an anesthetist wants to be very sure they know exactly where that needle is going when they’re placing an epidural. I know personally, as a professional licensed by the state where I live, I am very protective of my license and would never recommend a treatment I didn’t think could be 100% effective. I don’t mention this to scare you, mainly just to give you some context as to why there may be more hesitation by your anesthetist or medical team. Also, the length of your fusion may impact the ability to place that epidural as well. For example, having a fusion that ends in your thoracic spine or mid-back is different than having a fusion that extends all the way to your pelvis. The same could be said for someone with a larger or more rotated low back (or lumbar) scoliosis curve. All the more reason it’s important to consult with your medical team to determine the options you have.

I also learned through my own experience that should you opt for a c-section, you may be able to get a spinal block, which is different than an epidural. This option was really helpful for me, because it allowed me to stay awake to be present for the birth of my sweet babies. Without a spinal block, I would have been put under general anesthesia, or “put to sleep”, and would have met my baby when I woke up. I really valued the ability to hear my babies cry and see them when they were born and will cherish it forever. [Phew, I think it just got dusty in here 🥲]

Every situation is so different, and so is every body. No one person’s scoliosis curve or spinal fusion is like another’s, which is why there’s so much variation. You may very well be able to get an epidural with scoliosis and spinal fusion, and I’ve worked with many women who have. I’d recommend consulting with your medical team early on and seeking a consult from an anesthetist to get an idea of your options. It may be helpful to get updated x-rays before pregnancy and have them available for your doctor and birth team in case there’s a question.

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In summary, it’s important to know your options for pain relief for labor and delivery. Your body was built to be able to conceive, carry and birth babies — and there are people to help support you along the way! Comment below with questions and remember I’m here to help!

Check out my 90-minute webinar on scoliosis & pregnancy for all you need to know and schedule a personalized virtual consult with me for one-on-one advice and help on your baby journey.