Pregnancy and Idiopathic Scoliosis
Since idiopathic scoliosis is common in girls there are concerns about the effects it may have on pregnancy or becoming pregnant. Over the past 40 years, several studies have been conducted with hundreds of women that showed no difference in pregnancy, labor, delivery and fetal complications for women with scoliosis compared to women without. In most cases there are very few risks to becoming pregnant with scoliosis. There is no evidence that scoliosis damages fertility or leads to an increased number of miscarriages, stillbirths or congenital malformations. It does not provide any adverse effects on the pregnancy nor ability to deliver children.
Another major concern is increased risk of progression of the scoliosis. Some studies have shown that patients lost 2, 6, and 18 degrees of correction during their first pregnancies, but curves stayed the same or improved with later pregnancies. Generally, scoliosis does not increase during pregnancy. Pregnancy hormones decrease the activity of the immune system and scoliosis is often stabilized during pregnancy. As long as the curve is not still progressing, the weight gained during pregnancy does not increase the curvature.
Aside from a mild degree of restricted lung capacity, individuals with idiopathic scoliosis rarely experience breathing problems during pregnancy. Breathlessness on exertion is common in the early months of pregnancy for all women, to some extent. Shortness of breath is partly caused by the rise in progesterone, which stimulates breathing by increasing respiratory rate and the depth of each breath. Blood volume also increases. These normal physiological changes are well tolerated and only likely to prove a problem if the vital capacity is low or heart function is compromised. Scoliosis that occurs in the thoracic (middle) spine may affect breathing. Bladder and bowel problems may be an issue for women with scoliosis who already have urinary or bowel dysfunction
Back Pain and Scoliosis Pregnancy
Almost all women experience mild to moderate back pain in one form or another during pregnancy, therefore it can be difficult to distinguish whether the pain is from the scoliosis or the pregnancy. Specifically, 50% of all pregnant women experience lower back pain. Physical health and pre-existing back problems can affect the back pain experienced when pregnant. That is why it is best to maintain a good fitness regime and address existing back problems before becoming pregnant. Severe back pain can be debilitating preventing exercise during pregnancy.
Pain can start before the 12th week and can continue up to 6 months postpartum. During the 9th month the overall prevalence of back pain is about 50%. Various studies have examined the risk factors that contribute to the development of low-back pain during pregnancy. The greatest risk factors for back pain during pregnancy appear to be preexisting back conditions and/or multiparous (previous pregnancies or being pregnant with multiples).
Different types of lower back pain can be experienced during pregnancy.
Lumbar pain :can occur with or without radiation to the legs. This occurs due to postural changes that take place during pregnancy to maintain balance in the upright position as the fetus grows. The increasing weight is distributed primarily in the abdominal girth. The abdominal muscles become less effective at maintaining neutral posture (shoulders back, avoiding hyperlordosis) because the growing uterus stretches the muscles, reducing their tone. Studies have shown that at first lumbar lordosis remains the same or increases only slightly. The center of gravity as a whole, though, shifts more posteriorly and inferiorly as the spine moves posterior to the center of gravity. A small percentage of lower back pain during pregnancy can be attributed to sciatica but this is rare.
Large hormonal changes occur during pregnancy with the increase in oestrogen, progesterone, and relaxin. These help loosen the ligaments of the pelvis and lower spine to ease the birth of the baby. Although concerns have been raised that hormonal fluctuations could lead to a progression of a spinal curvature, most studies show that changes in the degree of scoliosis are slight provided that the curvature is stable at the outset of pregnancy. Joint laxity is more pronounced in multiparous women than it is during the first pregnancy. As the abdominal muscles stretch to accommodate the growing fetus, their ability to help stabilize the pelvis decreases. The burden shifts to the paraspinal muscles, which become strained at a time when they may be shortened from the increased lordosis of the lumbar spine.
Sacroiliac pain: may radiate to the thigh, usually to the level of the knee and rarely to the calf. It is four times more common than lumbar pain. Symptoms of sacroiliac joint pain typically continue several months after delivery. It is thought that 20% – 30% of pregnant women experience both lumbar and sacroiliac pain. Movement in the sacroiliac joints can increase dramatically, causing discomfort when the pain-sensitive ligamentous structures are stretched.
Nocturnal pain: can be experienced in the lower back at night while lying down, possibly due to muscle fatigue accumulation throughout the day that culminates in nighttime back pain. Daylong biomechanical stress from sacroiliac dysfunction or mechanical lower back pain from altered posture may also produce symptoms in the evening. Circulatory changes during pregnancy may also contribute to lower back pain at night. Some women have nighttime back pain exclusively, others have both night pain and lumbar or sacroiliac pain
Pregnancy Back Pain Management
Specific treatment and rehabilitation for scoliosis is especially important throughout pregnancy for reducing weakness and back or neck pain. The type of back pain (lumbar, sacroiliac, or nocturnal) can be treated by targeting the specific area of concern. Acute treatment in conjunction with ergonomic adaptation and a specific program of lower back exercises designed for each scoliosis patient can decrease stress on the lower back and alleviate pain.
Some other activities can be practiced for pain relief. Ice or cold compresses can help……. Some pain in the muscles can be alleviated with warm compresses or by sitting in a warm tub or jacuzzi (NOT TOO HOT/100° F). Maternity support belts can be worn that support the lower back and stomach, allowing freer movement. Swimming is also great exercise during pregnancy, as the water will help support the stomach and also allow for freer movement. Strengthening exercises, such as pelvic-tilt exercises can help strengthen the back and relieve pain–always consult your doctor before initiating any exercise program.
Often, just putting yourself into the knee-chest position to move the baby out of the pelvis and off of your pelvic nerves may make you more comfortable.
Scoliosis Surgery and Pregnancy
Doctors recommend women having surgery for scoliosis to wait for at least six months after the surgery to become pregnant. This is the recommended healing time for the spine.
Scoliosis and Labor
Research shows labor and delivery is virtually the same for women with mild to moderate scoliosis as it is for women without scoliosis. In the past, obstetricians routinely scheduled women with scoliosis for delivery by cesarean section. Currently, more and more women with scoliosis are finding a vaginal delivery is possible with no unusual complications. The position during labor and delivery is important for the patient’s comfort and the most comfortable position will vary for each patient. Weakness due to scoliosis may make pushing during labor more difficult for some.
Very rarely do back problems prevent the use of the epidural (anesthesia injected into the spine). For some scoliosis patients it can be difficult to receive an epidural. This is particularly true if they have had spinal fusion surgery or if the scoliosis is in the lumbar (lower) spine because this is where the epidural is placed. The epidural in some cases can be placed lower on the spine. If the scoliosis is in the mid to upper back it should not present a problem, however, it is important for ALL pregnant women with scoliosis to discuss epidurals and pain management with their doctor, and if necessary the hospital’s anesthesiology department, before going into labor.
Pregnancy and Severe Scoliosis
Women with severe scoliosis should consult their doctor before becoming pregnant as some cases may require monitoring of the scoliosis and fetus. Also, because the uterus pushes the diaphragm higher and decreases capacity, some breathing problems may be experienced during the later stages of pregnancy. Back pain can also be significant for pregnant women with severe scoliosis, compared to non scoliotic patients.
Pregnancy and Congenital Scoliosis
Individuals with Congenital scoliosis or early-onset scoliosis and those with weak muscles and heart problems should seek medical advice before becoming pregnant. Congenital scoliosis is usually associated with a neuromuscular condition such as muscular dystrophy or poliomyelitis. These conditions are genetic and some can be detected prenatally.
Breathing will also be affected if the muscles that expand the rib cage are weak. Lung size may also be more severely restricted because of certain birth defects. Evidence suggests that as long as the vital capacity exceeds around 1.25 liters the outcome will probably be good. Below this level problems with a reduction in oxygen worsens on exertion and during sleep, and may be accompanied by a rise in the waste gas level (carbon dioxide). Low oxygen levels are harmful for the growing baby and can also lead to heart strain in the mother.
The best way to ensure a healthy pregnancy with scoliosis is to follow the guidelines for proper nutrition, rest, exercise and prenatal care outlined by your obstetrician and regularly see your scoliosis specialist to monitor your curve during pregnancy.