Ali Weatherford
Back pain during pregnancy is very common. Some back pain after giving birth can be common too. But there are also less common back issues associated with pregnancy and childbirth. If you’re having significant back pain and you just had a baby, there may be some things that you can do about it.
Normal back pain during pregnancy
It’s very normal to develop lower back pain during pregnancy even if you didn’t have any back pain before becoming pregnant. It’s estimated that 50% of people will experience some level of lower back pain during pregnancy. The severity can range from mild to severe and can have a big impact on daily functioning. Some of the causes are just a normal consequence of pregnancy body changes including:
- A shifting pelvis
- Changes in posture due to a growing belly and changing center of gravity
- Changes in the way you sit and lay down
- Extra weight and pressure in the pelvis/pelvic floor
- Hormonal changes causing extra soft tissue laxity – Your joints can get more flexible during pregnancy, and that can cause overstretching of connective tissues resulting in back pain.
- Baby’s position – As the baby grows, if their position is not ideal it can cause or increase back pain.
You can’t usually isolate a lower back problem to just that area. You have many muscles, ligaments, tendons, and joints that support the lower back. When any or all of these are either too tight, too loose, or injured, it can have an affect on your lower back health. If you have pain in the lower back, it’s often caused by problems NOT actually related to your spine.
Normal back pain AFTER pregnancy
Some people have back pain after giving birth. This might be continuing back pain that started during pregnancy and stayed the same or got worse over time. This pain might also develop for the first time after giving birth. There are a lot of reasons why you might develop back pain after childbirth including:
- Labor – Labor itself can be physically taxing. You might need to get into unfamiliar or difficult positions during labor. You may also have a long labor that requires you to work really hard and spend a lot of time on your feet and shifting positions. You might also spend a lot of time lying down, especially if you have an epidural, and that may be something your back is not used to. However you experience labor, these are circumstances that can lead to increased back pain.
- Epidurals – After an epidural, there may be some localized lower back pain caused by insertion of the needle and catheter. That usually goes away within a few days.
- Holding and feeding babies – At first, we hold our babies A LOT, and newborns require us to use two hands. That’s a very good thing, but it can also mean our body is holding unfamiliar positions for long periods of time. If you have a very fussy baby or a baby that has difficulty sleeping or latching on at the breast, you might even be tempted to hold very uncomfortable positions for long periods of time. My first baby had a lot of difficulty latching on to the breast at first. When she would FINALLY get a good hold, I would freeze in whatever position I was in so she wouldn’t lose her grip. That sometimes meant staying in a really awkward and uncomfortable position for way too long. Now I recognize that wasn’t necessarily the best way to handle it. If I could go back, I’d do it differently. My baby would probably have stayed latched on if I had shifted into a more comfortable position, or I could have tried again if she didn’t. You might be tempted not to move because you might wake your difficult sleeper, or cause your fussy baby to cry again if you move them into a different position. Just remember that your back health is important too! You can be a better parent when you’re not in pain. It’s also important to remember that once your baby is old enough to support their head and you start being able to hold them with just one arm, you might create some other imbalances that can lead to back pain. Try to change the way you hold your baby to avoid over-using and under-using each side of your body.
- Recovering from pregnancy – If you had lower back pain during pregnancy, you probably shouldn’t expect it to go away immediately following childbirth. If your lower back pain was caused by issues specific to pregnancy, like the large belly and extra weight or change in sleep position and center of gravity, you can probably expect it to go away gradually.
Normal back pain resolution
For most kinds of lower back pain caused by pregnancy and birth, you can probably do some simple things to make it better or even go away completely. The following non-invasive treatment strategies tend to be highly effective:
- physical therapy
- yoga
- stabilization belts
- nerve stimulation
- acupuncture
- massage
- relaxation
Back pain caused by pregnancy or childbirth INJURY
It’s a lot less common to have an actual spinal injury during childbirth, but it can happen. This is a very scary thought, but fortunately it’s very rare.
- Sacral stress fracture – This is an actual crack in the bone near the tailbone or on the tailbone. The sacrum is considered part of the spine AND the pelvis. It’s the triangular shaped bone that essentially attaches the spine to the pelvis. The tailbone or coccyx is at the bottom of the sacrum. This part of the spine can be damaged during childbirth for a number of reasons. It curves into the pelvic bowl and the baby needs to maneuver around it to get through. Sometimes it can happen because a baby is especially large or in a bad position. It’s also just a little more likely to happen from a normal amount of stress because of the hormones of pregnancy and extra ligament flexibility. It also happens more frequently when a forceps or vacuum assisted delivery is needed. The pain associated with a coccygeal fracture usually feels like lower back or buttock pain and usually means it’s painful to sit at all or for long periods of time, bowel movements may be painful, and you may have difficulty getting comfortable for sleep. Sex may also be painful.
- Dislocated tailbone – The causes and consequences of this injury are similar to a fracture.
- Bruised tailbone – While less severe, a bruised tailbone may feel similar to a fractured or dislocated tailbone, and can have similar causes.
- Sprains and strains around the sacrum and tailbone – The ligaments supporting the lower back can be overstretched and strained and damaged during childbirth. This can cause postpartum back pain.
- Spinal anesthesia complications – Some back pain after childbirth can be caused by complications with an epidural or spinal anesthesia. The procedure involves inserting a needle near the spinal cord in the lower back. Very rarely, there can be infection or nerve damage associated with the procedure. This can cause pain, or loss of feeling in the lower body.
- Pelvic floor injury – The muscles, ligaments, and tendons of the pelvic floor are responsible for holding up your uterus and supporting your bladder, urethra and rectum. There is a lot of extra pressure, weight, and stress on this area during pregnancy. Injury to the pelvic floor can definitely cause lower back pain.
- Diastasis recti – This is a separation of the abdominal muscles. It’s normal for those to separate some during pregnancy as your uterus grows. Most of the time, those muscles come back together after birth, but in some cases the separation persists and can be a cause of back pain.
In most cases, spinal injuries and other kinds of pregnancy and birth injuries will resolve on their own with time. It’s also important to get direction from your care provider. To help with the discomfort, you might use some of these strategies:
- Rest is important while your injury is healing.
- Hold an ice pack on the area for 20-30 minutes at a time a couple of times a day.
- With your care provider’s recommendation, you may try using nonsteroidal anti-inflammatory drugs like ibuprofen.
- Take warm baths or sitz baths.
- Apply warm cloths or heating pads to the area.
- Sitting on a ring-shaped cushion may help with discomfort. These can be foam or inflatable and usually found at drug stores or online.
- Sleep on your side or belly instead of your back.
- Certain stretches can be helpful, and best done under the supervision of a physical therapist.
- Make sure to eat well and stay hydrated to avoid constipation. Straining while having bowel movements increases discomfort.
- Avoid any direct pressure applied to the area whenever possible while it’s healing.
The more severe spinal injuries are extremely rare, but can be a huge setback to your postpartum recovery and early parenting. Some level of injury after childbirth is very normal, and whatever is happening whether normal or severe, it’s important to give yourself time to heal. It’s also normal for your body to have some adjustments to make with a new baby.
Many long term complications can be prevented with some immediate and simple care after childbirth. Whenever possible, rest and take care of your baby. Let others take care of you, your home, and anything else. It’s important to eat well and sleep well. If you can get support from a physical therapist, chiropractor, massage therapist, acupuncturist, occupational therapist or pelvic floor physical therapist, you will likely experience some relief and potentially lower your risk for long term pain or complications.
Pregnancy and birth are VERY BIG and very physical life events. Be kind to yourself and be patient. If you can see a therapist, it’s also important to take care of your mental health while you’re healing. It’s also important to remember that you can most always get back to feeling strong and healthy again. Most of these complications will not cause problems for you in future pregnancies, especially when you have done the great work of healing.
Resources
https://keck.usc.edu/news/does-childbirth-lead-to-low-back-pain-later-in-life/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9809019/
