Pelvic Pain, Vulvodynia and Pushing

Pelvic and hip pain are common in pregnancy, especially in the third trimester. Here's one FAQ and one NAQ (never asked question) about labor and pelvic pain.

Pelvic Pain, Vulvodynia and Pushing wavebreakmedia/Shutterstock

Jackie is 38 weeks pregnant and has a couple of questions: one that I get a lot and one I've never had a reader ask before in all the years I've written this blog.

The frequently asked question

Jackie's thighs and hips are getting really sore. She thinks its from the extra weight and her midwife says it's because of the hormone relaxin, which is released during pregnancy. It softens joints so pelvic bones will allow the baby to pass through the birth canal. Jackie wonders how this pain will affect her ability to push.

Jackie, I agree with both you and your midwife about the source of your pelvic pain. The baby is pretty heavy now and your pelvic bones are loosening up in preparation for delivery. That makes for an achy combination. Pick up a full gallon of milk (which weighs about the same as a good-sized baby) and see how long you can carry it before your hand and arm ache. When you think of your baby and pelvis that way, it makes sense that many women feel sore in the hips, thighs, back and pelvis during the last weeks of pregnancy. For most women however, this pain won't be an impediment to pushing.

What can you do about it?

Try Tylenol, heat, soaking in a tub, gentle yoga and massage. I know a few women who got chiropractic care and acupuncture specifically for this type of pain and had great success.

The never asked question

Jackie has vulvodynia, which causes chronic pain in the vulvar and vaginal area, but has no obvious source. It's not caused by infection, obvious trauma or injury and yet, the pain can be really bad. It's hard to diagnose and even when a doctor does properly diagnose it, many women are treated ineffectively and disrespectfully, because the source of pain isn't anything doctors can see or test. Vulvodynia isn't terribly rare (unusual, but not freaky-rare) and Jackie, I suspect lots of women are worried about it.

Jackie wants to know if she should use an epidural to relieve vulvar pain during labor and pushing. Her midwife says epidurals are only for labor pain and therefore not appropriate for vulvodynia, but I disagree. Epidurals make most women numb from the waist down to their feet. They won't feel much (if any) contraction or vulvar pain, though they might feel pressure. That makes an epidural a pretty effective tool for dealing with pain from vulvodynia during labor.

Jackie's also worried about how delivery and pushing will affect her vulva. Jackie, you'll absolutely be able to push. Yes, you'll probably feel pain in your hips, thighs, pelvis and vulva, but most women feel pain in those areas (sometimes a little, sometimes a lot) and are still able to push effectively.

Will your vulva be damaged by delivery?

Maybe, but vulvodynia won't have much to do with that. Many women deliver vaginally without any vulvar, pereneal or vaginal tears, lacerations or even skid marks. Many other women experience some type of injury during vaginal delivery and vulvar swelling is common.

Do these conditions cause permanent damage?

Not usually if you deliver with a skilled provider. Swelling goes away within days. Tears and lacerations are sutured and heal within a month or so. Vulvar pain usually subsides fairly quickly after birth.

Will vulvodynia make labor and delivery worse?

Not necessarily. I've taken care of several women with vulvodynia who delivered vaginally. I can't say for certain whether their pain was worse than any other woman's (all pain is subjective), but they managed just fine. Some had epidurals and others did not. All were able to push their babies out and healed normally.

Jackie, I strongly recommend everyone study and practice natural pain management techniques for labor, but there is no crime in getting an epidural if you need or want one. Birth is not a competition and you're no better or worse a mother if you deliver naturally or use pain management tools. Go easy on yourself, honey. You're going to be fine.