Today I’m going to dive into the well-needed yet under-represented topic of scoliosis & pregnancy with c-section. For so many of us, particularly with spinal fusion, we may have reservation on whether or not we can deliver a baby vaginally. You may have even heard from a provider that vaginal delivery may not be your best option. Since we’re not face to face, I cannot comment on your particular situation, but my aim in this blog is to discuss all the considerations of c-section with scoliosis & spinal fusion.

Note: this blog is not intended to serve as medical advice. This blog is solely for your information from an expert in scoliosis, spinal fusion and pelvic health in the pregnancy & postpartum realm. Please discuss with your personal pregnancy medical & wellness team for your individual situation.

So what do you need to know about c-section?

In case you’re unfamiliar, c-section is a common shortened term for a surgical birth called a Cesarean section. There are several techniques used around the world, but all involve a surgeon or OB/GYN doctor who makes an incision into the abdomen of the birthing parent from the skin all the way to the uterus, where the baby and placenta are delivered. Once baby and placenta have been safely removed, you get to see your baby (yay!) and the medical team begins the process of closing all the incisions and sewing everything back together. It’s a relatively common mode of delivering a baby in most countries, and though it’s considered to be very safe, it is still a major abdominal surgery.

Keeping in mind that those of us with a uterus were designed for carrying and birthing a child, and even if you aim to have a certain type of birthing experience, it doesn’t hurt to be prepared for c-section in case vaginal delivery isn’t an option.

For many birthing parents, even without scoliosis or spinal fusion, they may elect to have a planned c-section for a number of reasons, including:

• Baby being in a “breech” position (facing sideways and not head down) or another position that can prove more difficult for vaginal delivery

• History of previous unsuccessful vaginal delivery or prior c-section

• History of pelvic floor conditions, certain pelvic surgeries, pelvic organ prolapse or similar concerns

• Medical conditions in which labor & delivery may prove overly stressful on the body (think heart conditions, significant medical traumas or certain types of connective tissue disorders, to name a few)

• High risk pregnancy such as placental abnormalities, multiples or certain pregnancy complications

Truthfully, even in the most ideal situations, any given situation during labor & delivery may require a c-section. Childbirth can be unpredictable, and ultimately your health & safety - as well as that of your baby (/babies) - are of the utmost importance!

How does scoliosis or spinal fusion impact delivery?

In case you aren’t familiar with the description of scoliosis, click the link to my blog where you can read all about it. For a percentage of people with adolescent idiopathic scoliosis with a larger degree curve, they have undergone a spinal fusion in which a certain number of spinal segments have been fixed into their most optimal aligned position and balance. This is most traditionally done in the thoracic spine (or mid-back), but often extends into the lumbar spine (low back) and may even involve hardware all the way into the pelvic bones.

See picture below for reference:

The curvature of our spinal column alone doesn’t change our ability to get pregnant, stay pregnant or carry a healthy pregnancy to term. Similarly, the structure of our spine and even pelvis do not dictate how our bodies can or cannot respond during birth, which is a physiological process and almost completely involuntary. In over a decade of treating patients with scoliosis, spinal fusion and pelvic health concerns, I’ve heard of numerous people who are able to have successful vaginal delivery - even with spinal fusion.

It’s important to note, however, that our bodies do require a certain amount of movement within the pelvis to allow a baby to safely exit. As baby descends from the uterus, the bones of the pelvis need to be able to gently bend and flex at the joints (a certain amount of separation is natural and expected, thanks to the hormones flooding our systems in late-stage pregnancy and delivery). Having a fusion that extends into the pelvic bones may limit the amount of movement those bones can do, which can impact baby’s ability to appropriately descend and exit. This is likely one of the reasons why many healthcare providers recommend that people with spinal fusion with hardware into the pelvis elect to deliver via c-section.

That said, this is definitely a case-by-case scenario and there is no one-size-fits-all approach here. Only you and your direct medical team can make that decision on what will be safest for you and your family, based on your preferred birthing experience.

Pain Management Options During Delivery With Scoliosis During C-section

One of the most common and well-known pain management options during delivery is the epidural, which is a large needle injected into a joint space in the lumbar spine (or low back) providing numbing to everything below that area. I wrote all about the nuance on epidurals with scoliosis in the attached blog, which you should check out for the full picture. Long story short, it’s another example of the importance of discussing your particular case (and spine!) with your medical team. You shouldn’t rely on an epidural unless you’ve gotten clearance from the anesthesiologist or other provider ahead of time. I would strongly recommend getting a consult early on in your pregnancy as your team can decline giving you an epidural if they have any reservations about your safety or the effectiveness of the epidural.

All that in mind, there are several other options available to you aside from an epidural. The one I elected for during both of my deliveries was a spinal block, which is a similar procedure to an epidural without the risk of damage to the spinal nerves. I liked this option as it allowed me to stay awake to witness my babies’ first moments outside! You can also elect for general anesthesia, in which you are put under for the birth of your baby.

Again, I am a doctor of physical therapy, not an anesthesiologist, and I won’t pretend to know all the options available for pain management. It warrants a thorough discussion with your medical team and the local hospital or delivery center so you can know your options and be prepared.

How To Prepare For a C-section

If you opt for c-section, you can certainly take steps to set yourself up for success! Having done this twice myself and having coached several people through the process, I have developed a number of tips and tricks to make it a smoother process, which I will share below:

• Pack your bag for comfort during your hospital stay! Pick out a comfy maternity/ nursing robe, soft clothing, warm grippy socks, all the chargers and entertainment.

• Make sure you are able to get plenty of sleep the night before (certainly an option if you’ve elected for a planned c-section).

• Keep hydrated and eat a good meal the night before, knowing that most hospitals require you to be NPO (having ingested nothing by mouth) at least 12 hours before.

• Start taking gentle stool softeners (Miralax, Dulcolax, magnesium) a few days before your c-section and continue on them until well after your first postpartum poo.

  • On that note, I’d recommend having a toilet stool to use, and consider bringing something to press to your incision as you bear down. Think a pillow or a balled up sweatshirt. Keeping gentle pressure on your incision can lower the amount of discomfort you could experience when bearing down to have your BM.

  • Try not to strain! Use your breath, exhale and make a soft sound when you’re passing your stool.

• Plan on getting yourself up and out of bed as soon as you’re able to after delivery. Take it easy, but moving earlier will help improve your blood flow and get you feeling more like yourself.

• Don’t forget your abdominal binder! You’ll want to support that fresh incision for at least the first week or two, it helps.

• Keep on top of your pain medication for the first 72 hours at least (as in, take the dose as soon as you’re able. Consider setting an alarm).

• Your body will need some rest as you recover from your surgery, you’ll want to limit your physical activity.

• If possible, arrange for some help during the day to help with managing baby to allow your body to heal in those first few weeks. If you don’t have family or good friends close by you can count on, consider hiring a postpartum doula to help meet those early needs like meal prep, laundry, simple baby care, et cetera.

I hope this has answered some of your questions about scoliosis & pregnancy with c-section. Ultimately, this is a discussion best had with your medical team, but more information is always better to allow you to make an informed choice on how you’d like your birth story to look. If you’re feeling overwhelmed and unsure how to start that discussion, I’ve created a 6-page Pregnancy + Birth Plan for Scoliosis & Spinal Fusion that spells out all you and your birthing team could ever want to know about your spinal situation with your birth preferences in mind.

I have links to directories to find local scoliosis specialists or local pelvic health specialists near you in the resources section of my website. You can also schedule a personalized virtual consult with me for insight on your specific spine! Additionally, I offer monthly 1 on 1 scoliosis & pregnancy coaching which you can explore by clicking the link.