Navigating Pregnancy With Spinal Fusion: What To Expect & What I Wish I Knew
Today I’m going to dive into the horribly under-represented topic of pregnancy with spinal fusion. For so many of us with spinal fusion, we may wonder about how our bodies will handle a pregnancy in the first place, not to mention whether a vaginal delivery is an option for us. Unless I’m working with you I cannot speak to your specific situation, or what type of birth you should aim for. That said, I’ve worked with dozens of women with spinal fusion who have delivered in both ways, so the purpose of this blog is to talk all things pregnancy, delivery and postpartum with spinal fusion.
As a gentle reminder: this blog and all the information therein does not serve as medical advice. This blog is solely for your information from an expert in scoliosis, spinal fusion and pelvic health during pregnancy & postpartum. Please discuss your specific situation with your personal pregnancy medical & wellness team, or you can book a consult with me for my expert opinion.
What Is Spinal Fusion for Scoliosis?
For many people growing up with severe scoliosis, this is a familiar topic. Spinal fusion for scoliosis typically involves the fusion of multiple segments of the spine which are involved in the scoliosis curve, using hardware and bone grafts to stabilize the spine. Usually this involves steel rods and screws, though there are other techniques available depending on the skill set of the surgeon and the person’s individual curve. If you’re interested in more detailed information about the procedure, check out the Columbia Orthopedic’s page.
Spinal fusion surgery is recommended for people with scoliosis curves larger than 46 degrees. This is most commonly seen in growing kids and teens, but can also be recommended for adults who are experiencing rapidly worsening scoliosis curves, have significant pain due to their scoliosis, or instability of any of the spinal segments.
This type of spinal fusion is different than single-level fusions, which are usually seen in adults or people who have had spinal injuries in an accident or other orthopedic issues. This type of fusion, often called a long fusion, is a more invasive surgery, requires a longer recovery time, and results in loss of mobility of those segments.
So why does my opinion on pregnancy with spinal fusion matter?
In case this is your first time finding me, you may not be familiar with my story. You can read my whole story here, but the tl;dr version is I’ve been living with a long spinal fusion (from T4 to L2) since I was 11 years old. Because of my determination not to be defined by this thing that happened to me so young, I never even considered that it would limit my ability to do all the things I wanted to do with my life - including having children. I always knew I wanted a family of my own, and I wouldn’t have taken my spinal fusion as a reason why I wouldn’t be able to.
Luckily for me, no one in my life ever gave me pause about my ability to have kids with my severe scoliosis or spinal fusion - though I’ve now worked with dozens of women who have unfortunately been led to fear pregnancy with these conditions.
That said, I found myself navigating uncharted waters during my first pregnancy almost 10 years ago, with limited to no research or understanding of how pregnancy or childbirth would be different for me. As a Type A, Enneagram 3 personality, trust me that I searched high and low for any insight. There was not much helpful information to be found at that time.
So I became my own case study. I had one pregnancy, and then another 3 years later. And now I’m here to share my insights with you, backed with all experience and expertise I’ve gathered after becoming an expert in this space as a physical therapist and specialist.
A very pregnant Laura the day before her planned C-section.
Not pictured: the hardware in my spine
How does spinal fusion change pregnancy and delivery?
I spoke more generally about pregnancy & c-section with scoliosis and fusion in a different blog, so click that link to get the full story. In case you don’t read it, however, please know this: having a spinal fusion and hardware surrounding your spine does not impact our ability to get pregnant or have a child. Depending on the parts of your spine that are fused, it could impact your ability to have a vaginal delivery.
Some of the factors to consider and discuss with your team include:
If your fusion extends down to your pelvis bones
If you’ve had multiple spinal fusion revisions or structural instabilities
If you have other orthopedic or bony conditions that may limit the flexibility of the pelvis bones or joints
Remember: the bones in our pelvis must be able to move and shift a bit in order for baby to safely exit
As I’ve said before: there is no one spinal fusion or even subsequent pregnancy that is alike, so it’s important to build your pregnancy team and discuss your situation with the experts. I offer monthly pregnancy coaching, in case you don’t have anyone on the team with spinal fusion experience.
Specific Questions For Your Providers With Fusion In Mind
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. An epidural may be an option for you, and it may not. There are multiple pain management options, depending on where you are birthing and the equipment and personnel available, including:
Spinal blocks
IV medication
Electrical stimulation
Water birth
Nitrous oxide (also known as gas & air, particularly in the UK)
General anesthesia
As I’ve stated before, I am a doctor of physical therapy, not an expert in pain management during birth, and it’s important to have a thorough discussion with your birthing team - whether that includes an obstetrician, a midwife, a doula or anyone else.
If you’re planning on birthing in a hospital, I’d recommend scheduling a meeting with an anesthesiologist to learn the options you have given your specific situation. Bring a copy of your x-ray and your medical records if you have them.
You may also want to ask what equipment and resources are available to you during labor and delivery, including (but not limited to):
Will you have access to a private room?
Is laboring in the tub an option?
Could you use a birth ball/ birthing bar (to hold while squatting or standing)?
If so, does the hospital provide access or do you need to bring your own?
Can you use portable baby monitoring so you can move around easier?
How many support people can be present during labor? during delivery?
Some people with spinal fusion choose to forgo a trial for vaginal delivery, and for that I have a whole blog on preparing for a c-section you can read by clicking the link. Scroll down to read some considerations for birth and early postpartum with spinal fusion.
Birth and Postpartum With A Spinal Fusion
First, let me say - every spinal fusion is different as is every pregnancy. The main point I wanted to make: your ability to move and use different birth positions may vary for you based on how many levels are fused and your medical history.
If you have a long thoracic fusion (most common for scoliosis, usually involving a large number of segments in your mid-back and your ribcage), you may also have some fused segments into your lumbar spine.
Because of the fusion, you may have difficulty getting into or out of certain positions due to the lack of spinal movement. On top of that - speaking from experience - moving around with a fully pregnant belly can feel challenging enough on its own!
If aiming for vaginal birth, you may be most comfortable laboring & birthing:
Lying on your back, head of the bed elevated
Try placing a pillow under one hip to allow the pelvis bones some space to move out of the way as baby descends!
In a squatting position
This could be on a birthing ball, balancing on a toilet (for laboring, not for delivery)
On hands and knees, leaning over the headboard or the back of a chair
Lying on your side, one foot on the stirrup or someone’s shoulder
If aiming for a c-section - or belly birth, I have a whole section on preparing for a c-section you can read by clicking the link!
Regardless of how you deliver, moving around in the first few days after baby is born can feel very wonky! Remember, your core muscles stretched twice their size to accommodate baby and then baby is suddenly gone, with those muscles still stretched. Add to that the limited trunk movement courtesy of the spinal fusion and it may take twice the effort and strength to get in and out of bed.
One way to harness your core a bit better when you move is to “blow before you go” - or exhale and engage your core before your movements. When you do this, it creates some stability so that you can feel more stable during transitions like getting from lying down to sitting or vice versa. (This technique can also help with the incision pain that happens initially after a c-section too!)
Ask if your hospital has an abdominal binder you could use for additional support for those first few days. It’s basically a big elastic band that acts like your core muscles. This can also minimize the strain on your incision (for c-section) or your pelvic floor (for vaginal birth) - particularly when paired with the breathing technique I mentioned above!
So there’s the lowdown on navigating pregnancy & delivery with spinal fusion. Ultimately, as I mentioned above, every birthing experience is different and these are all lessons I learned after my own two pregnancies and childbirths, as well as working with pregnant and postpartum women for over 10 years. I wanted to put this information out there because, last I checked, there really wasn’t much out there specifically about preparing for childbirth and postpartum recovery with spinal fusion. I hope you’re leaving this blog feeling a little more prepared to create the birthing and postpartum experience you’re dreaming of - after all, the highest gift you can give yourself is feeling confident and self-assured going into this new chapter.
If it still feels daunting - and it might! - please remember I have a myriad of resources all about this time of life, with scoliosis and spinal fusion in mind. One way to start would be to schedule a personalized virtual consult with me to get your specific questions answered! Additionally, I offer monthly 1 on 1 scoliosis & pregnancy coaching which includes monthly coaching calls, access to both of my pregnancy masterclasses as well as my 6-page Pregnancy + Birth Plan for Scoliosis & Spinal Fusion custom created for you and your birthing team with your birth preferences in mind. I also have links to directories to seek local pelvic or scoliosis specialists in the resources section of my website.
Feel free to contact me with any specific questions or drop a comment below. Happy birthing!
