July 28, 2020

By Emeline Mugisha, M.S.N., M.P.H., R.N.

Several types of nerve injuries may result from pregnancy and childbirth. Although postpartum nerve injuries are relatively uncommon (the estimated risk is 1%), it can be helpful for new moms to recognize them. If equipped with information, it is easier to prevent these injuries and heal from them as early as possible in the unlikely event that they occur.

What are the symptoms of postpartum nerve injuries?

A “neuropathy” is a problem in any part of the nervous system outside of the brain and spinal cord, also known as the peripheral nervous system (PNS). The PNS contains the nerves that run throughout your body “Peripheral neuropathy” refers to damage to the nerves of the PNS.

How do you recognize whether you may have a nerve injury after birth? Symptoms of peripheral nerve injuries depend on the severity and types of nerves affected and might include:

• Numbness (loss of sensation)
• Pain in the lower extremities (pelvis, hip, thigh, knee, leg, ankle, and foot)
• Muscle weakness
• Motor impairment
• Bowel and bladder dysfunction

What causes postpartum nerve injuries?

There are several possible causes of postpartum nerve damage. First, it's essential to know that the majority of nerve injuries are not related to anesthesia. Instead, postpartum nerve problems most often result from repeated pressure on a nerve (known as “compression”).

Factors that may increase the risk of nerve injuries after birth include:

• First experience of childbirth
• Pre-existing neuropathies, such as diabetes
• Short maternal height
• Prolonged second stage of labor
• Delivery assistance tools, such as forceps or vacuum extraction

What are the types of postpartum nerve injuries?

Compression of the peripheral nerves is the most common type of postpartum nerve injury. These nerve compressions can happen during labor, vaginal delivery, or cesarean section (c-section), and the majority lead to superficial nerve damage.

Compression neuropathies commonly affect the following peripheral nerves after birth:

• Lateral cutaneous nerve of the thigh. This injury results from compression of this nerve as it passes under the groin area and affects the front and side of the thigh.

• Lumbosacral plexus. Compression of this area usually occurs due to the baby’s head and results in numbness over the outside thigh, lower leg, and top of the foot.

• Common peroneal nerve. Damage to this nerve can result from prolonged lithotomy position (laying on your back with your knees bent and legs flexed at your hips while raised in stirrups). Compression occurs as the nerve passes over the calf bone, resulting in numbness over the outer area of your lower leg and top of the foot.

• Femoral nerve. Injury of this nerve can result from its compression during forceps delivery or a c-section in the lower area of the uterus (known as a lower segment c-section). Its damage can lead to numbness over the front thigh and inner part of the lower leg, weak knee extension, and difficulty climbing stairs.

• Obturator nerve. Damage to this nerve can result from compression by the baby’s head or forceps and results in both numbness over the inner thigh and weak hip mobility.

Additionally, postpartum nerve injuries may affect the following areas:

• Pudendal nerve. This nerve runs along your pelvic floor muscles and can malfunction from slight stretching during vaginal delivery. Its damage may cause pelvic floor neuropathy, a type of peripheral neuropathy that causes pain, discomfort, or numbness between your pubic and tail bone. The most common symptom is pain with sitting.

• Sciatic nerve. Stretching or compression of the sciatic nerve during vaginal delivery can lead to neuropathy. Stretching can occur from prolonged lithotomy position, particularly when the hip flexes beyond its normal range or rotates excessively. Compression can occur as the baby’s head passes through your pelvis.

• Upper extremity nerves (brachial plexus, radial nerve, and ulnar nerve). Problems with arm positioning or padding over areas of the arm bones that are closest to the skin’s surface may cause these injuries during any mode of delivery.

How do I manage postpartum nerve injuries?

Fortunately, most postpartum nerve injuries are temporary and resolve on their own. However, some injuries can lead to severe short-term and, more rarely, long-term problems, if left untreated. Early detection and treatment are critical to reducing the risk of long-term damage.

Various therapies and procedures may help relieve symptoms of peripheral neuropathy for injuries that do not resolve spontaneously. These interventions include:

• Medications. Medication management involves the same treatments for any other chronic pain condition, such as over-the-counter pain medications. Additionally, topical treatments may provide an alternative with fewer side effects than oral medications.

• Physical therapy. The goal of physical therapy is to improve your movements if you are experiencing muscle weakness and decrease pressure on the affected nerve.

• Transcutaneous electrical nerve stimulation (TENS). TENS involves placing electrodes on the skin that deliver a gentle electric current to help relieve pain.

• Referral. If nerve injuries lead to long-term problems or motor impairments, optimal care may require referral to a physiatrist, neurologist, physical therapist, or surgeon.

The estimated time to recovery for postpartum neuropathies depends on the type of nerve damage. For superficial nerve injuries, such as compression neuropathies, you can expect a spontaneous recovery within weeks to a few months. If the damage occurs to the nerve fiber (axon), improvement typically occurs over several months to years. If the injury results in an entirely severed nerve (transection), spontaneous recovery is unlikely without surgery.

Sources:

Bird, R., & Backe, S.K. Management of neurological deficit in postpartum patients. Retrieved from https://www.oaa-anaes.ac.uk/assets/_managed/cms/files/Clinical%20 Guidelines/Neurological_Deficit_Northumbria.pdf

Menorca, R. M., Fussell, T. S., & Elfar, J. C. (2013). Nerve physiology: mechanisms of injury and recovery. Hand Clinics, 29(3), 317-330. https://doi.org/10.1016/j.hcl.2013.04.002

McDonald, Alison. (2008). Obstetrical nerve injury. Retrieved from http://www.mncyn.ca/wp-content/uploads/2013/08/volume31.pdf

Pudendal Neuralgia. (2017, March). Retrieved from https://ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Patient%20information/Pudendal-neuralgia.pdf?ext=.pdf

Tanner, Holly. (2015, December 7). Postpartum neuropathies of the lower extremity. Retrieved from https://hermanwallace.com/blog/postpartum-neuropathies-of-the-lower-extremity



Emeline Mugisha, M.S.N., M.P.H., R.N. - Emeline Mugisha is an award-winning, master's-prepared nurse with over a decade of experience in community/public health and clinical health services at the field and management levels. She has co-authored two professional manuscripts in Women's Health Issues and the Journal of Midwifery and Women's Health. She has an M.S. in Public Health Nursing and an M.P.H. from Johns Hopkins University.