Post ADR Pregnancy

[Texas-T]

Howdy,
I haven't posted to the site in a while, but have been checking in over the years. I know a lot of women have questions regarding pregnancy post-ADR and there doesn't seem to be a lot of detailed information, so I wanted to share my pregnancy experiences in the hopes of helping the next person. I had a successful ADR in May 2006 at L-5/S-1 and have been doing well but am not 100%. I'm now 30 years old, almost 5 years post-op and am starting my 2nd trimester with our first baby. We are just thrilled - I'm due July 24th.

First - I know a lot of the doctors who have answered questions about pregnancy post-ADR on the forum have said that it is safe to get pregnant 3 - 6 months after surgery. However I would caution you against that. Just because you can do something doesn't mean you should. You need to be in the best shape possible when starting a pregnancy because it puts a tremendous strain on your back, hips and entire body. Also, when you are pregnant, especially during the 1st trimester, you can't take anything stronger than Tylenol and it's not good to take hot baths or use heating pads (or even ben-gay!) so there isn't much you can do for relief. Everyone is different, but I know that at 6 months post-op my body could not have handled a pregnancy. I would caution everyone to try and wait a full year after surgery before getting pregnant.

I talked to several OB's prior to selecting my doctor and they all said I was welcome to try a natural birth, but cautioned that given my back history I have a higher probably of having a c-section and I should be prepared for that. My PT who has worked with me for years said there is no way I will be able to push. Also, since my discs above the ADR are damaged I'm overly worried about blowing them out during labor so my doctor and I have decided to just schedule a c-section and not risk further damaging my back. Honestly, I'm relived. They have also cautioned me that I may be on best rest towards the end because of my back, so I'm just planning ahead for that.

The doctors have all told me that I would have more pain during pregnancy, but it shouldn't affect the baby. So far they have been right... My back and hips have been really aching since about 8 weeks and as horrible as this sounds, I truly miss vicodin and muscle relaxers. I used a cane before my ADR due to compression of the sciatic nerve in my right leg. At 12 weeks I started having shooting pain down my right leg like I had prior to the ADR surgery and by 14 weeks it has only gotten worse. It seems to be triggered by my expanding hips. My doctor has advised me that I may need to use a cane again to make sure I'm stable. I worry so much about falling on my stomach and hurting the baby, I'd rather walk with a cane then risk falling.

During my first prenatal visit my OB sent me back to physical therapy in the hopes of helping me better manage my changing body/shape. So far PT has been a lifesaver, however between visits my hips keep moving out of alignment as my body expands for the baby and it's causing a lot of pain and problems. Hopefully we'll be able to better manage this going forward. My PT is ordering me a pregnancy hip brace which we hope will help my hips stay aligned at night when they seem to be most problematic. I'll let you know how that works.

Going forward I'm going to start a prenatal aquatic class and prenatal massage to help with the stiffness. I'll let you know how it goes!

So far this pregnancy post ADR hasn't been easy or pain-free, but whenever I start feeling really bad I just listen to the baby's heartbeat with our fetal doppler and it makes all the pain worthwhile.

Tricia

[Harrison]

Tricia, it's very thoughtful of you to take the time to detail your experiences as a mother to other patients! Thanks so much, and congrats on your new child! I hope your baby learns to move away from your sciatic nerve -- that must be grueling. I bet the massage and aquatics will help.

And btw, I am impressed with your technology -- fetal doppler! Wow, things have changed through the years. How cool is that!?

[Cirobi]

Tricia,

Thank you so much for posting this and congrats on the little one!

This has actually been something on my mind since before my own ADR at the same level. I usually pushed the thoughts away in favor of more immediate concerns since I wasn't even married yet. So far, my post-op has been very successful. But, now that I'm engaged and getting married this spring, thoughts have returned to the "what ifs" and "how will my back handle its" regarding childbirth as I definitely want children.

I'm glad your doctors allowed you to opt for a c-section as I had wondered if that would be possible. I also have degeneration at the disks above my replaced L5/S1 and I pretty much assumed the extra pressure from carrying the baby as well as the pushing for natural delivery would come with major spinal risks. While many women seem afraid of having c-sections, I feel like I would welcome it because of my back problems! In a silly way, it's almost fitting that I welcome such a procedure... I never was one to follow the masses all that well. Haha!

I look forward to hearing how the aquatics and whatnot go for you as well as if you wind up needing bed rest. I'll also be curious to see how your back recovers after your little one is born. I'm turning 30 this year and figure I will probably closer to 32 when we have our first. I'm hoping those two little years won't make too big a difference with recovering afterward. Hopefully I can keep my gym routine going so I'm in the best shape possible for whenever we start our family.

I feel like I can't thank you enough for posting your post-ADR pregnancy experience.

~Sara

[Texas-T]

So now I'm 24 weeks along and wanted to let you know how things have been going....

I think the 15 - 17 week time period was the WORST for my back. I started having horrible pain in my hips (sacroiliac joints) which wasn't easy to manage. And then just as suddenly as it started, the it went away. My OB said that the levels of the hormone relaxin vary each day / week during pregnancy and that is probably why I started feeling better... (relaxin causes all your joints and ligaments to relax which can cause hip pain) however she cautioned that it will likely get bad again as my due date approaches. So I'm enjoying the break and preparing for the worst again...

So far though, I've been fine. When things got bad, I saw my pain mgmt. doctor and they were ready to give me a steroid shot in my hip joints to help. (Steroids are commonly used during pregnancy and are considered safe). I also started wearing a hip brace (I got the New Serola Sacroiliac Belt on Amazon which has a low profile and doesn't compress my tummy). Now I just wear it when my hips get sore and it really works.

My OB also prescribed vicodin for when the pain was unbearable (and it was really bad for a few days). I've only taken 1/2 pill a few times, but it has been a sanity saver. My husband and I were VERY concerned about taking this while pregnant and my OB really made me feel better. She said that in all her years of practice, she's only had one baby be born addicted to vicodin and it's mother had to take it several times a day for weeks prior to the birth and even then, the baby was okay. Given all the limitataions the pain was putting on my movement, she felt that the benifit of taking a pill every now and then, far outweighed any risk. Additionally, she told me that codeine has been prescribed for pregnant women for years and is considered safe. We saw a fetal genetics counselor later in my pregnancy (for other reasons) and he was not concerned about me taking vicodin either.

Thankfully the pain subsided, but my hips still hurt a great deal at night and when I roll over it wakes me up... so my doctor also suggested that I take Benadryl at night to help me sleep. Benadryl is considered a class A drug during pregnancy (meaning it has been testing on pregnant woman and shown to have no effect on the baby) so that has really helped me get some decent sleep. Also, I've started doing the 'log-roll' which I used after my back surgery to get in and out of bed and that helps too.

I also started a prenatal aquatics class which has been really fun, once I got over the humiliation of swimsuit shopping... I would highly recommend this to any pregnant woman, especially those with back pain. However, if you have a history of problems be careful not to over-do it! My first class I did EVERYTHING and ended up having horrible cramping pain the next day which required a visit to the OB to make sure I wasn't having pre-term labor. Moral of the story, take it easy and remember that's it good just to keep moving, you don't have to be a super start in the class! Also, make sure you tell the instructor about your back issues before class so they can suggestion modifications.

In the last 2 weeks I've started having bad cramping pain (like menstrual cramps) which can be scary, but my OB said it's round ligament pain, which is common in pregnancy and is caused by your muscles spazzing out due to the weight of your now extended tummy. I don't know if having weak ab muscles from back issues makes it worse or not... When I lay down and rest it goes away, so I'm just resting more and now my hubby makes dinner (and when I say 'make' I mean picks up take-out).

As I've gotten larger I have started arching my back more to compensate for the change in weight distribution. I've found that if I stand in one place for a while, it starts to hurt and at night it feels like my tail bone is sore. I haven't seen my pain mgmt. doctor in a while, but she warned me about this so I'll see what she says next time I go....

Despite all this, the baby is very healthy and is doing great! We learned we're having a little girl and even when she's kicking me to death, I think she's adorable! My OB has scheduled my c-section for July 18th and I'm already counting down the days (104). We did learn one potently upsetting fact about back patients and epidurals... if you have scar tissue in your spine there is a chance that an epidural will not work. So if you're having a natural birth, you won't be able to use that for pain relief and if you're having a c-section (like me) you may have to go under general anesthesia. If you have to have general anesthesia for a c-section you won't be awake for the birth and US hospitals will not allow anyone (i.e. the father) to be in the delivery room. We're meeting with the head of anesthesiology in a few weeks to discuss this, but I'm hopeful that an epidural will be an option. I'll let you know what they say!

Anyway, that's all for now. I hope if there are any other ADR patients expecting you're having a healthy and happy pregnancy!

[Harrison]

Wow, Tricia, time flies. It was so nice of you to find your topic and update people that can learn and benefit from your experience! And thx for the new lesson: I never heard of "round ligament pain!"

Do you have a name for your baby girl yet? In the meantime, go 104!

[Cirobi]

Hi Tricia!

Glad to hear you're doing well and they were able to help you manage the pain. I'm finding this highly fascinating. I actually started doing some Google searches on the topic since it's looking like my fiance and I won't be waiting long before starting our family. (After already being with him this long, I had kinda hoped we wouldn't wait much longer!)

It's been interesting to see the variations in how things went for the handful posting info on the web like yourself. I should have known there would be just as wide a range of experiences as there are for ADR recoveries! Haha.

Gogo countdown to your little lady's birthday! That's nice that they scheduled you so far in advance. My coworker is due with her 2nd next month and had to wait until the end of March to get her c-section scheduled! I'll keep my fingers crossed that everything keeps going well for you!

~Sara

[Texas-T]

It's been a while since I've posted an update and I wanted to fill you in on the latest... my pain mgmt doctor's warning that things would get much worse in the end has come back to haunt me. I'm now 37 weeks along and considered full-term, but it hasn't been easy getting here. Around 26 weeks my horrible hip pain (caused by the hormone Relaxin) came back with a vengeance and as I started arching my back more it become more difficult to walk and stand. I had steroid shots in my hips and back at 27 weeks which provided a little relief but had to start taking more vicodin at this point to get through the days.

Getting up out of chairs become much harder and sitting the whole day at work almost unbearable, so I asked and my boss agreed, to allow me to work part-time. This kept me working from 27 weeks - 32 weeks which was a big help psychology. I was also able to continue my aquatic therapy until about 31 weeks until it hurt more than it helped.

At 32 weeks it took me so long to walk to the bathroom at work that I almost didn't make it a few times and the pain was just too distracting so I went on partial bed-rest and disability. At first being able to lay down more helped and I was able to get by with less medication, but as my tummy expanded just sitting and standing has gotten harder and my mobility has steadily digressed. At about 33 weeks my husband bought me a cane to use because I started having weakness in my legs and was falling periodically. It's gotten to the point now where I must use the cane at all times. Getting out of bed without help is hard too. I had another round of steroid shots at 35 weeks, but it didn't help much. (however my husband now thinks our baby will have super powers from the steroids)

When I first went on disability my husband and I would go on short walks each night to keep me moving, now I simply can't do it. It seems like my biggest issue is that my hips are unstable which is causing the weakness in my legs along with not being able to arch my back. When I stand or walk I feel like my stomach is thrown forward and my head tilted up, it strains so much that my upper back starts to spaz out and I usually don't get very far. Also, it feels like my tailbone is being pulled apart into two pieces (think of a wishbone being pulled apart) most of the time. My pain mgmt. doctor said the tailbone pain is normal in pregnancy, however it's very severe (lidoderm patches help with this). So I'm miserable right now...

Thankfully the baby is still healthy and strong. In a strange twist of good luck she is stuck laying in the horizontal position with her head on my left side and butt on my right. My pain mgmt. doctor believes this has eased some of the back strain. Normally baby's move into the head-down position by 28 weeks which strains your low back more. BTW even if she wasn't in the wrong position my OB agreed that there is no way I could have endured a natural labor given all the problems. I did have high blood pressure at one of my recent check-ups b/c of the pain, but it went right back down, otherwise the stress of it all hasn't seemed to affect the baby.

Because of all the pain and mobility issues, my OB offered to bump up my c-section to 37 weeks (this Friday 7/8), however the baby's lungs might not be ready and we risk having more problems by going earlier. It's tempting to say yes and just get this over with, but I think it's best to wait till I'm 39 weeks along and stick with our original date of July 18th, unless the baby decides to come on her own. At this point I'm taking 3 vicodin at most (5/500mgs) per day. My OB doesn't think this will cause the baby to go through withdraw at birth, however if I must increase my dosage to 4 pills a day they want me to go ahead and have the c-section rather than take the risk. So now I'm just waiting and trying to manage the pain with the least amount of drugs. Only 11 more days... I can do this.

I spoke with the head of anesthesiology at the hospital and they are willing to try a lumbar epidural administered via a catheter for the birth so I may be awake for the big event. (this is better than the usual spinal block b/c it will allow them to give me more medication if needed during the surgery. Also, due to all my scar tissue from the back surgery they expect the actual c-section to last about 30 minutes longer than the usual 90 minutes) My OB believes they will be able to re-use my back surgery scar (I had a Maylard incision) which is also great.

I'll be sure to let you know how everything goes with the delivery and after. I know reading this it probably sounds like pregnancy after ADR can be horrible / scary / awful... I'd be lying if I didn't admit that at times it has been pretty bad... but it's worth it, and for me the pain hasn't been nearly as bad as it was before my ADR. I'm really happy and excited about our daughter and knowing what I know now, I'd still do it again. I suppose my best advise is to expect the worst, prepare for it, but hope for the best and stay positive if things start going badly. Get in excellent shape before you get pregnant, stay in shape during your pregnancy and get a good team of doctors both OB's, PT's and Pain Mgmt. to work together to help you. Have a support system in place in case you must go on bedrest and remind yourself that all of this pain is temporary and at the end you'll have an adorable baby.

Tricia

[jss]

Tricia,

Wow, what an ordeal. As difficult as pregnancy can be on its own, it sounds doubly difficult with back problems.

Only 11 more days! That's very exciting! Please let us know how it all went and how the little girl is doing when you're able.

Good luck and congratulations!

Jeff

[Cirobi]

Tricia!

Thank you for updating! I'm glad to hear you're surviving even if it has been with pain meds and sheer will power for the benefit of your little angel. You definitely said it best though, expect the worst and be prepared for it and hopefully it'll be somewhere less than that.

It's so interesting to read the different steps you've had to go through because it is a huge help to know exactly what I might expect. I found out about a week ago that my husband and I are expecting our first child now thanks to an amazing honeymoon (haha, still get a kick out of the potential jokes from this). I feel like I have a much more rounded view on the possibilities between your story and a few other things I've been able to dig up on the internet. I'm only at about 7 weeks and don't have an appointment with my OB until I'm 10 weeks along (they wait until somewhere between 8-10 & that was the soonest I could get in thanks to schedule conflicts).

I hope all goes well with the last few days of your pregnancy and that you notice some relatively quick relief once she's here. As Jeff mentioned below, only 11 more days! You can make it!

~Sara

[Texas-T]

That is WONDERFUL news Sara! If you have any questions or concerns please shoot me an email. I hope I didn't scare you with all my problems, if it makes you feel any better my doctor told us yesterday that I was the most sever case of mobility issues she has ever seen. Hopefully your pregnancy will be MUCH easier. Either way it's a true adventure and a lot of fun along the way.