The coccyx — or tailbone — is at the base of the birth canal. The baby comes in direct contact with the coccyx when coming out of the birth canal. The pressure caused when the baby passes through the birth canal can cause bruising, dislocation, or even fracture to the tailbone.
Expecting mothers who have had past tailbone injuries are more likely to experience another tailbone injury during birth. It is important to fix any existing injuries before your baby is delivered to decrease the likelihood of additional injury.
Can You Injure Your Tailbone During Birth?
Tailbone injury during birth does happen. It is often due to pressure from the baby’s head as they pass through the birth canal, especially during the later stages of labor.
This pressure can be intense and can bruise, fracture, or dislocate the mother’s coccyx (tailbone). The coccyx is the lowest part of the spine and is made up of 3-5 vertebrae. It is small and triangular in shape. Women are five times more likely to have tailbone pain than men.
Tailbone injury during childbirth is more common when labor is long or difficult, especially when forceps or vacuum delivery is needed. These complications are also known to be some of the more common causes of birth injuries.
Women who experience tailbone injury during childbirth may feel tenderness in the tailbone area. They may also experience severe pain when sitting or lying down.
Causes of Tailbone Injury During Childbirth
Tailbone injury during birth occurs when the baby passes through the birth canal and comes into contact with the coccyx. If the mother’s tailbone is aligned correctly, it extends backward so the baby can pass through.
However, some women have tailbones that are stuck forward which causes the baby to pass through with force. This pressure can even cause the tailbone to become dislocated, which can lead to muscle spasms and pain in the pelvic floor.
Several different situations can lead to a tailbone injury during birth, including:
- A baby who is born facing up, causing the back of the skull to push on the tailbone
- Babies weighing over 8 pounds, 13 ounces
- Difficult or complicated labor
- Medical negligence
- Small or narrow pelvis
- Use of forceps or vacuum delivery
Additionally, if a woman has broken her tailbone in the past, she has a greater risk for another tailbone injury during birth.
“It’s important to let your healthcare team know if you have had any pain or injury to your tailbone before going into labor because there are things you can do to minimize the pressure.”
— Deena Blumenfeld, Lamaze Certified Childbirth Educator (LCCE) and Fellow of American College of Childbirth Educators (FACCE)
Tailbone Injury During Birth Diagnosis & Treatment
Most women who experience tailbone injury during birth hear a crack or a pop during childbirth. If the tailbone is injured, there is usually tenderness and pain that is worse when seated.
Additional symptoms of tailbone injury during birth include:
- Achy tailbone
- Back pain
- Pain after sitting for a long time
- Pain while straining for bowel movements
- Pain during sex
- Piercing pain in the tailbone
- Poor sleep
If a tailbone injury during birth is suspected, your doctor will perform a visual exam of the area to check for any obvious fracture, deformity, mass, or infection. They will then conduct an internal and external rectal exam and may order x-rays to confirm the injury.
Your doctor will likely recommend at-home remedies, which may include:
- Applying hot or cold packs to lower back
- Decreasing time spent seated
- Leaning forward while seated
- Stretching and strengthening pelvic and lower back muscles
- Taking a hot bath to relax muscles
- Taking non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, to reduce pain and swelling
- Taking stool softeners to decrease pain from bowel movements
- Using a wedge-shaped gel cushion or donut-shaped pillow
- Wearing loose-fitting clothing
Chronic tension in pelvic muscles may cause pain. Long-lasting pain may be treated with physical therapy or steroid and local anesthetic injections.
In more severe cases, surgery may be required for chronic pain; however, this option carries a far greater risk to the surrounding bones and muscles.
Doctor recommended surgical options include:
- Partial coccygectomy (removal of part of the coccyx)
- Total coccygectomy (removal of the entire coccyx)
A bruised tailbone can usually heal itself in a few weeks. Fractures can take up to 8 weeks to heal, but pain may last even longer if there is inflammation of the muscles or ligaments.
About 90% of patients who require treatment for a tailbone injury recover with at-home remedies only.
Risks for Future Pregnancies
If you become pregnant again, it is very important to let your healthcare provider know that you had a previous tailbone injury during birth.
Since women are at greater risk of re-injuring their tailbones, you should talk to your doctor about your options. Your doctor will discuss with you whether a C-section or vaginal birth is best for your next pregnancy.
If you decide to deliver vaginally, your doctor may suggest different delivery positions to prevent pressure on the tailbone and baby’s head.
Certain positions for delivery decrease the risk of tailbone injury during birth. These include being upright, forward-leaning, or squatting.