For years after the birth of her daughter in 2003, Debra Shaw regarded the prospect of any sort of treat — a foreign holiday, a trip to the cinema, or a meal in a restaurant — with total dismay.
For she couldn’t sit down because of agonising pain radiating from her coccyx, the bony stump at the base of the spine. So any activity that involved sitting was out of the question.
The coccyx is a remainder of a primordial tail, which most other mammals retain. It is made up of small vertebrae and is attached to the spine by a joint, allowing it a degree of movement.
In humans, it is exquisitely sensitive to pain if injured, as anyone who has fallen hard on their bottom will testify.
Debra, who is slim and fit, suffered the excruciating dislocation of her coccyx during the long and difficult birth of her daughter Sophie, now 13.
The condition has left a legacy of pain and disability, which Debra is only now finally learning to deal with.
‘Sophie’s back was in line with my back when she was in the womb, which, I discovered afterwards, is just about the worst position for giving birth,’ says Debra, 46, from Shepton Mallet, Somerset. ‘It means a really difficult and painful labour.
‘It was made worse because the trainee anaesthetist couldn’t get the epidural in. He kept putting it in and taking it out again. I remember hearing Pete, my partner, shouting: “She’s not a pin cushion!”
‘Eventually, he got it in, and they said it was working — but I was in so much pain by then, it was unbearable. They were very short-staffed and, as soon as I had given birth, they all disappeared. We were left alone for hours, it was so scary.
‘There was quite a lot of damage and I had to be stitched up afterwards, but there was so much going on after the birth it took my mind off the pain from my tailbone.’
But, after the birth, the pain in her coccyx gradually became worse.
‘It started as a permanent, dull ache but, by the time Sophie was two, the pain was so bad, I couldn’t sit down.
‘I had various scans and investigations, and it turned out that the coccyx had been pushed into an unnatural position, so it feels as if it’s stuck at a strange angle. When I sit down, I can feel it digging in and it’s agony.
‘I adore Sophie, but it certainly put me off having any more children.’
Debra’s tailbone is now permanently twisted, a condition that afflicts countless women as a complication of childbirth, when the baby’s head is pushed against the bone, shunting it out of line.
Around 7 per cent of women experience coccyx pain during pregnancy and childbirth, and an unknown number suffer from it long-term, according to Ruth Jones, a physiotherapist and lecturer at Southampton University who specialises in pelvic disorders.
‘This is much more of a problem than people think,’ she says. ‘I see patients who can’t wear jeans because of the fabric pressing on their coccyx.
‘If you have pain like that for more than six months, you become hypersensitive — your brain processes the pain signals differently; it is primed for them. Lots of women need treatment to sort this out.’ But Patrick O’Brien, a consultant obstetrician at University College Hospital and spokesman for the Royal College of Obstetricians and Gynaecologists, thinks coccydynia — damage to the coccyx — is well recognised, but not very common.
He says he sees only about one case a year, and that the condition should get better of its own accord.
‘If the baby’s head is very big, it can push back the coccyx as it comes down,’ he says. ‘It’s very rare, but it does happen.
‘In half of the cases, the women have had previous damage by falling off a bike or some earlier childhood injury that may have fractured or slightly moved the coccyx.
‘It may be that their coccyx has healed outwards and the baby’s head pushes it back again. It should always heal with time.’
Yet, for a seemingly well-recognised condition, coccydynia has been oddly overlooked by medical researchers. To date, there has been only one study of how and why it occurs.
Doctors at the Hôtel-Dieu hospital in Paris who were running a specialist coccydynia clinic compared 57 women who suffered the damage in childbirth with 192 women who had coccydynia arising from other causes.
The new mothers, all of whom had had difficult deliveries, often involving forceps or other instruments to extract their babies, were in agony as soon as they tried to sit up after giving birth.
Almost half had suffered dislocation of the coccyx and, in six cases, people attending the birth had heard a ‘cracking noise’ as the bone fractured.
The researchers, reporting in 2012, said greater awareness of the condition was needed, and that doctors should take measurements during pregnancy to identify women at risk.
They pointed out that obesity is a key risk factor even among women who aren’t pregnant, because of the abnormal pressure it causes.
But even slim, fit women can suffer issues with their coccyx during childbirth because of the position of the baby.
Maureen Treadwell, a spokeswoman for the Birth Trauma Association, believes the problem may be becoming more common — as babies’ birth weights increase and more mothers are unfit, with largely sedentary lifestyles.
‘The NHS is determined to cut caesarean rates but, clearly, these women should be having this surgery,’ she says.
‘The system has to start taking into account the long-term health costs of caring for women with this sort of damage, compared with the slightly greater cost of offering them a caesarean instead of a natural delivery in the first place.’
Over the years, Debra Shaw saw physiotherapists, acupuncturists and osteopaths and did regular yoga, but with limited improvement.
She says: ‘It would feel better for a while, but then the pain would come back. There were so many things I couldn’t do. My parents wanted us to go on holiday with them to the Lake District, but there was no way I could sit for the six-hour journey.
‘If we visited my parents-in-law, who live about 40 minutes away, I had to lie on the back seat.
‘It got really awkward because there are lots of situations where everyone is sitting down and it’s embarrassing to stay standing up.
‘I used to try kneeling on chairs or standing with one knee on a chair.
‘I had to inspect the chairs everywhere I went to see if I could sit right on the very edge of them, so my tailbone wasn’t touching anything — but even that caused huge pain in my back after a while. I ended up with pain everywhere.
‘I just had to eat meals and do everything standing up. I could sometimes sit with one leg curled under my bum, but that gets really uncomfortable after a while.’
For some years Debra’s discomfort was relieved with hydrocortisone injections into her coccyx, to dampen down the inflammation.
She has had seven hydrocortisone injections, with the four most recent administered in hospital under general anaesthetic to try to pinpoint more accurately the precise location of the damage.
But this treatment masks, rather than treats, muscular and skeletal problems, and Debra found it gradually became less effective, lasting just weeks at a time, rather than six or seven months, as it did originally. She was then referred to a specialist for a coccygectomy, where the end of the bone is cut off.
‘But the surgeon I saw was pessimistic about whether it would work, because it often doesn’t, and they put me right off by talking about the risk of paralysis and loss of bladder function,’ she says.
‘Apart from that, you need your coccyx for balance because muscles and tendons are attached to it and it gives your skeleton stability.’
After years of pain, however, relief has come, at last, in the form of Pilates, which may help by strengthening muscles around the area. ‘I go to classes twice a week and I feel I’ve got my life back,’ says Debra, who now finds sitting less painful.
‘I think it’s made me use specific muscles in a different way and strengthened the support structure around the coccyx. I may get the odd twinge, but it has made a massive difference. I’m just so happy.’