Foward curving coccyx

[Dollyroux]

During my recent birth, which was a failed vacuum then forceps delivery, I experinced extreme coccyx pain during the actual delivery, heard an audible popping and felt an extreme pain. After the delivery I had extreme coccyx pain for at least 3 weeks, leaving me with much diffiulty walking or sitting an in extensive pain. I've been informed that I ma have broken my coccyx. My coccyx, after much physio and osteo intervention is now feeling back to 98% thank god! However, the doctor who delivered my daughter and the osteopath have both commented on how my coccyx curves much more forward (eg towards my front) then normal.

I'm terrified that I will end up in a simlair situation for my second child (not yet conceived! ). I'm wondering if anyone has any experience or information on how I could minimise coccyx damage and pain with my second birth. I'm after resources or people that may be exprienced in this area. I'm paticurlary interested to see if positioning could have a positive effect, and if so, which positions.

Thanks in advance!

[Trillian]

The big thing to remember here is that when you give birth on your back, or in a sitting/reclining position, your tail bone can't move to allow the baby to pass through. Think of it as being on a hinge, when the baby moves through the vagina, if you were squatting/on all fours the tail bone would move so that the baby has enough room to pass. I would suggest that for your next birth you make sure that you are not on your back, or in a position that would stop that from happening.

I found some info for you which may be helpful;

Positioning for Prevention


What image comes to mind when you picture a birth in a hospital?
Most people see a picture of a woman on her back, with her legs raised or perhaps in stirrups. That is the perception that the technological model of birthing has transfixed into our mind's eye.
The obvious problem is that by lying on one's back or by sitting semi-reclined on one's tailbone, the space of the pelvic outlet (birth canal) may be reduced by up to 30%. By adopting a traditional hospital position that is convenient for birthing professionals, one unknowingly reduces the space the baby has to enter this world.
There is no medically sound reason to give birth on one's back, and there is every reason to give birth in a safer position that works with female anatomy and physiology, in a way that women’s bodies were designed.
It is so easy to open up the birthing canal to help ensure a safer passage for the baby, and to reduce the risk of injury to the mother's body as well.
By simply rolling over to one's side, which can be easily accomplished, even with an epidural, allows the sacrum the freedom to move back as the baby is passing through.
What is most important to remember is to get the mother off her back!
Changing positioning during the first and second stages of labor can dramatically reduce the incidence of shoulder dystocia, and thus eliminate the resulting complications Risks of Traditional Positioning


With positions that close the birthing canal, such as lying down, there may be increased risk to the baby of:

• increased need for forcep or vacuum delivery
• broken clavicle/collarbone
• excessive bruising
• pressure on baby’s neck vertebras
• excessive head molding
• compression of umbilical cord
• stress on baby
• poor position/angle of the fetus in relation to the pelvis
• brachial plexus injury
• broken humerus
• disruption of the baby’s oxygen supply

and increased risk for the mother of:

• less effective contractions
• labor slowing and not progressing
• possible increased hypotension & pregnancy-induced hypertension
• ineffective pushing
• may lead to illusion of cephalo-pelvic disproportioin due to reduced pelvic diameters from poor positioning
• increased risk of need for Cesarean section
• strain and tearing to the mother's tissues
• episiotomy
• back pain
• fractured coccyx/tailbone

Janet Balaskas, the recognized pioneer of natural childbirth and author of “Active Birth” reiterates the danger of being in a supine position:
“In the semisitting position the mother’s weight rests on her coccyx and the pelvic capacity is reduced.” “In the semireclining position the sacrum is immobile and the pelvic outlet narrows.” “Your coccyx is designed to move out of the way as your baby’s head descends. Sitting on your coccyx during birth restricts the pelvic outlet and can also lead to dislocation of the coccyx, which can be extremely painful for months after the birth.”
The sacrococcygeal joint, the joint between the sacrum and the coccyx or tailbone, also softens in pregnancy; it is designed to swivel backwards to widen the outlet of the pelvis as the baby emerges. Of course, this is impossible if the mother is sitting on her coccyx. Benefits of Proper Positioning


Opening the birth canal by using positions that support a woman’s anatomy, will decrease the risk of possible trauma to the baby and mother’s body. .Moving around during labor and using birthing positions such as left side-lying, hands and knees, upright, squatting, etc. offer several benefits:

• increased comfort
• reduced pain
• an enhanced sense of control and involvement in the birth
• more effective contractions
• better progression of labor
• baby more likely to descend in an optimal position
• work with gravity instead of against it
• better blood and oxygen supply to the baby

Beyond these advantages, there are equally important effects on the baby and on the progress of labor. Changing positions during labor can change the shape and size of the pelvis, which can help the baby's head move to the optimal position during first stage labor, and helps the baby with rotation and descent during the second stage.
Swaying motions such as walking, climbing stairs, lunging, and swaying back and forth are especially helpful with this.
Movement and upright positions can help with the frequency, length, and efficiency of contractions. The effects of gravity can help the baby move down more quickly. Changing positions helps to ensure a continuous oxygen supply to the fetus.
“There is evidence to suggest that if the mother lies flat on her back then vena caval compression is increased, resulting in hypotension. This can lead to reduced placental perfusion and diminished fetal oxygenation. The efficiency of uterine contractions may also be reduced”. (Humphrey et al. 1974, Kurz et al. 1982)
Changing position can also reduce the length of labor. Mendez-Bauer and Newton (1986) state that duration of labor from 3 to 10 cm cervical dilation was about 50% shorter in patients who alternated supine and standing with standing and sitting positions.
Another positive outcome from positioning is the reduction of the use of episiotomies and fourth degree tears. Since there will be less dystocias, doctors will not feel inclined to cut the perineum, to give more manipulation room. These have been done for many years without anatomical reason, but more so for legal record.
An ideal position would include:

• opening the pelvic outlet as widely as possible
• providing a better fetal position with a smooth path for the baby to descend through the birth canal
• using the advantages of gravity to help the baby move down
• giving the mother a sense of being safe and in control of the process
• and most importantly, decreasing the risk of injury to the baby and to the mother

[Dollyroux]

Hi Trillian,

Thanks for the info. It's very helpful.

I laboured standing/squatting/on all fours for the majority of my labour, but my second stage was around 3 hours with no progression. I could feel my baby, Eleanor's head if I insertd a fingerbut she never hit the perineum and never advanced further down the vagina - which the doctor told me was due to my coccyx.
So now I'm not sure where to go from here...will I will always need to have assistance to give birth? I would like to avoid the forceps if I could next time.

What would be my other options? I had lost my contractions and pushing urge by the time the Dr arrived and had absoloutly no energy left. Would've it been better to request some oxytocin to get my contractions to restart? *sigh*

[Trillian]

There could have been other factors at play that prevented her coming all the way down on her own, but that's not to say that if there were, that they will repeat themselves in any subsequent births. I also think for next time you should get a copy of the Pink Kit to help you get to know your vagina and pelvis thoroughly and also get a doula as you can't always rely on the hospital/birthcentre midwife to be there for you 100% of the time to coach you into different positions or even to pick up on when a position change would be beneficial to you. I don't think having oxytocin would have helped in your situation as all it would have done was make it more intense, make you more tired (cause it's bloody hard on your body) and the outcome could still have been the same but with the possibility of the more intense contractions making her become stressed if the ctx were trying to force her into somewhere she wasn't able to go kwim, and that could have led to more drastic interventions.

[Glamourcide]

Wow, thanks for this thread, Dollyroux, and thanks for that info, Trillian! Everyone thought I was nuts for holding myself up off the bed (the midwives wouldn't let me birth on all fours/squatting/any position that would allow the birth canal to be fully open as 'it's interfering with the monitoring equipment, just lay back') with my arms so that my bum was completely off the bed and DD could get out...
My arms were dead for days afterwards because of the strain, but it felt better than trying to force her through a semi-closed canal!

[Olive]

i was also going to suggest getting the pink kit, its explains how to open up the pelvis,