While not every case of nerve damage in the lower extremities from childbirth can be prevented, there are certain actions that women can take to decrease their risk of such an injury.
- Talk to your doctor, midwife, nursing staff, doula, spouse, or whomever will be attending your labor and delivery about the potential for nerve damage in your lower extremities. This side effect of childbirth is rare, so is often not focused on or considered by those assisting with labor and delivery. Just by speaking to them about this health issue you can more likely ensure it is in their consideration throughout your labor. If they don’t know anything about this health issue, ask that they read about it prior to your giving birth. A little education by all goes a long ways.
- Throughout all of labor, but especially the pushing phase, make sure you change positions constantly. Do not spend long periods of time with legs bent at extreme angles (such as in the lithotomy position, in stirrups, or in deep squats), without taking a short break. This does not mean you can’t be in those positions at all, especially if it is helping your labor progress. Just make sure you stretch out every 15 minutes or so, or however often your medical practitioner suggests.
- Be especially aware of moving your legs (or having your legs moved) if you have an epidural. An epidural limits feeling in your hips and legs, making it much more difficult to sense any pain, numbness or tingling in those areas, which would indicate potential nerve damage.
- Nerve injuries are much more common in women who begin pushing with the fetus presenting at a significantly higher station. If your baby is still at a high station, discuss with your medical practitioner if you should try to hold off a little longer on pushing until the fetus descends further on it’s own.
- Nerve injuries are also much more common in women who had longer periods of pushing and second stage labor. Discuss with your medical practitioner prior to labor about how long s/he recommends you to push for before moving on to other options (i.e. assisting devices, c-section). Alternately, if you have been pushing for an extended period of time, ask your medical practitioner if s/he is concerned about your chance of nerve damage.
- Forceps can sometimes put extra pressure on several of the nerves running through the pelvis. If forceps are needed to assist with delivery, it is good to discuss risk factors with your medical practitioner.
It is important to note again that unfortunately not all cases of nerve damage during childbirth can be prevented. There are risks that you cannot prevent, such as fetal macrosomia (a very large baby), malpresentations (when a fetus is in an abnormal position or presentation), and specific pelvic features (like platypelloid pelvis, shallow anterior sacral ala, and flattened sacral promontory).[i][ii] Further, just because you push for a long period of time, use forceps, have a large baby, etc, does not mean you will automatically have nerve damage. Many women deliver their babies under all or any of those circumstances without complication.
It is also understood that in the middle of labor, when you probably have no idea what time it is or exactly how long you have been pushing for, you will be hard pressed to say to say “excuse me doctor, I think I need to change out of this position to decrease my risk of Lumbosacral Plexus neuropathy.” So the biggest recommendation is to discuss this potential side effect of childbirth with those who will be attending your labor in advance of the big day. The discussion alone ensures everyone is aware of this potential problem and knows how best to avoid it.
[i] Wong, Cynthia A. MD et. al. “Incidence of Postpartum Lumbosacral Spine and Lower Extremity Nerve Injuries.” Obstetrics & Gynecology. February 2003. http://journals.lww.com/greenjournal/Fulltext/2003/02000/Incidence_of_Postpartum_Lumbosacral_Spine_and.14.aspx
[ii] McDonald, Allison MD et. all. “Obstetrical Nerve Injury.” Partner. Spring 2008. http://www.mncyn.ca/wp-content/uploads/2013/08/volume31.pdf