Who is at Risk of Tailbone Injury During Birth?

Tailbone injuries during childbirth are more common than many people realize. While the focus during pregnancy often centers on the baby’s health, maternal injuries like coccyx fractures, dislocations, and bruising can have lasting effects on a mother’s recovery and quality of life. Understanding who faces the highest risk can help with planning, informed decision-making, and recognizing symptoms early.

What Happens to the Tailbone During Vaginal Delivery?

The coccyx, or tailbone, sits at the base of your spine, right at the back of the birth canal. During a vaginal delivery, the baby’s head passes through this narrow space, and the tailbone is designed to move backward slightly to make room. This movement is natural and usually harmless.

However, when the tailbone cannot flex back enough or when there’s excessive pressure from the baby’s head, the bones, joints, and ligaments can sustain damage. This might result in a bruise, but in more serious cases, it can lead to dislocation or even a fracture.

The injury may not always be obvious right away. Some mothers notice sharp pain when sitting or standing shortly after delivery, while others experience discomfort that builds gradually over the first few days postpartum.

How Common Are Tailbone Injuries After Giving Birth?

About 10% of new mothers experience postpartum tailbone pain, medically called coccydynia. While this includes a range of injuries from mild bruising to fractures, it reflects a significant number of women dealing with avoidable discomfort during an already demanding time.

Women are five times more likely than men to suffer from tailbone pain in adulthood, largely because of childbirth-related trauma and anatomical differences. This makes pregnancy and delivery a particularly vulnerable period for coccyx injury.

Which Mothers Face the Highest Risk of Tailbone Injury During Birth?

Instrument-Assisted Deliveries Increase Risk Significantly

The use of forceps or vacuum extractors during delivery is the most clearly established risk factor for tailbone injury. In one clinical study of 57 postpartum women with tailbone pain, more than half had forceps-assisted births. Vacuum extraction also increases risk, though to a somewhat lesser extent.

These instruments are sometimes necessary to help guide the baby out, especially during prolonged or stalled labor. However, they can apply direct force to the mother’s pelvic bones, increasing the chance of coccyx dislocation or fracture.

Delivering Larger Babies

Babies weighing more than 8 pounds 13 ounces, a condition known as macrosomia, place extra pressure on the tailbone as they move through the birth canal. The larger the baby’s head, the more the coccyx needs to flex backward, and if it cannot accommodate that movement, injury becomes more likely.

Unusual Pelvic Anatomy or Prior Tailbone Trauma

Some women have anatomical factors that make tailbone injury more likely, including:

• A coccyx that angles forward rather than back
• A shorter perineum (the area between the vaginal opening and the anus)
• Previous injury or fracture to the tailbone
• Naturally narrow pelvis

These variations can limit how much the tailbone can move during delivery, increasing the risk of trauma when the baby’s head applies pressure.

Baby Positioned Face Up During Labor

The most common and safest fetal position is head down with the face toward the mother’s back, called occiput anterior. When the baby is head down but facing up, known as occiput posterior or “sunny side up,” the back of the baby’s head presses more directly against the mother’s tailbone.

This positioning increases both the duration of labor and the likelihood of needing instrumental assistance, both of which contribute to higher rates of tailbone injury.

Multiple Prior Vaginal Deliveries

Women who have given birth vaginally before may have stretched or weakened pelvic ligaments and joints. While experience can make labor faster, it can also mean that the structural support around the coccyx is less stable, making displacement more likely.

Higher Body Mass Index

A BMI over 27 has been associated with increased risk of coccyx displacement after birth. Extra soft tissue in the pelvic area may alter the mechanics of birth and the way pressure is distributed across the tailbone and surrounding structures.

Prolonged or Difficult Labor

The longer the baby’s head presses against the coccyx, the more opportunity there is for injury. Extended second-stage labor, when the mother is actively pushing, can lead to sustained pressure that causes bruising or joint damage even without instruments.

Types of Tailbone Injuries That Occur During Delivery

Bruising and Soft Tissue Trauma

The most common form of coccyx injury is a contusion or bruise. This happens when the baby’s head compresses the tailbone and surrounding tissues. While painful, bruising typically heals within a few weeks with rest and supportive care.

Dislocation

A dislocated coccyx occurs when the small bones that make up the tailbone shift out of their normal alignment. This type of injury usually causes sharp, localized pain that worsens with sitting or transitioning from sitting to standing. Dislocations may require physical therapy or, in rare cases, manual realignment.

Fracture

A fractured coccyx is the most severe type of injury. It can occur during normal vaginal delivery but is much more common in instrument-assisted births. Fractures often appear suddenly and cause intense pain with any movement involving the lower spine or pelvis. Healing can take several months.

Warning Signs of Tailbone Injury After Delivery

Not all coccyx injuries are diagnosed in the hospital. Many mothers assume the pain is a normal part of postpartum recovery. However, certain symptoms suggest a more serious problem:

• Sharp or stabbing pain at the base of the spine when sitting down
• Pain that gets worse when standing up from a seated position
• Difficulty finding a comfortable position while feeding the baby
• Bruising or swelling visible around the tailbone area
• Pain during bowel movements
• Discomfort that doesn’t improve after the first week postpartum

If any of these symptoms are present, it’s worth speaking with a healthcare provider. Early diagnosis and treatment can prevent long-term complications.

Can Tailbone Injuries During Birth Be Prevented?

While not all coccyx injuries are avoidable, certain practices can reduce risk:

• Careful monitoring of fetal position throughout labor
• Avoiding unnecessary use of forceps or vacuum extractors
• Consideration of cesarean delivery in cases involving known pelvic abnormalities, very large babies, or prior tailbone trauma
• Allowing labor to progress naturally when safe, rather than rushing delivery
• Proper positioning during pushing, such as side-lying or upright positions that take pressure off the tailbone

These interventions align with best practices from the American College of Obstetricians and Gynecologists and are designed to balance maternal and fetal safety.

What to Do If You Suspect a Tailbone Injury

If you’re experiencing tailbone pain after giving birth, document your symptoms and bring them to your healthcare provider’s attention. Diagnosis often involves:

• Physical examination of the coccyx area
• Discussion of delivery details, especially use of instruments or prolonged pushing
• Imaging such as X-rays or MRI if fracture or dislocation is suspected

Treatment options depend on the severity of the injury and may include:

• Ice packs in the first 48 hours to reduce swelling
• Cushioned seating or donut pillows to relieve pressure
• Pain relief through medication safe for breastfeeding mothers
• Physical therapy focused on pelvic floor and tailbone mobility
• In rare cases, injection therapy or surgical removal of the coccyx (coccygectomy)

Most women recover fully with conservative treatment, but early intervention improves outcomes and quality of life during the postpartum period.

Moving Forward After a Birth-Related Tailbone Injury

Tailbone injuries can be physically painful and emotionally frustrating, especially during a time when you’re trying to bond with and care for a new baby. Sitting to nurse, getting in and out of bed, and even holding your child can become sources of pain rather than joy.

Recovery takes time, but it does happen. With appropriate care and support, most mothers see significant improvement within weeks to months. If pain persists beyond three months or significantly limits daily activities, further evaluation by a specialist in pelvic health or pain management may be helpful.

Understanding the risks, recognizing the symptoms, and seeking timely care are the best tools for protecting your health and ensuring that a tailbone injury doesn’t overshadow the early days with your newborn.