At the age of 32 Sigmund Freud developed a new problem. Pricking and other unpleasant sensations had overtaken the skin on the outer side of his right thigh. Walking made his symptoms worse. The affected skin was exquisitely sensitive to touch and even the usual rubbing of his underclothes irritated the area.

Seven years later in 1895, when Freud wrote up his self-observations for a German medical journal, the abnormal sensations were still present, but had migrated. At first, the area of disturbance had been more noticeable near the top of the thigh, but gradually the abnormal sensations moved downward to a palm-sized area a hand’s breadth above the side of his knee.

When Freud squeezed a fold of skin in this area, it hurt more than it did in his left thigh. Although he could feel a pinprick as such, it also burned. Even so, individual spots within the zone of abnormal skin were insensitive to ordinarily painful maneuvers. He also noticed that temperature sense was impaired. Warm objects placed against the affected skin felt cooler than in unaffected areas. And although the original pricking sensations improved over time, his outer thigh had become generally less sensitive to usual stimulations.

Freud’s physician, Josef Breuer, found that the affected skin was in the territory of the lateral femoral cutaneous nerve, a nerve that concerns itself with sensation only and has no muscular connections. Dr. Breuer concluded that Freud’s symptoms were caused by damage to this nerve. Dr. Breuer also suspected that the nerve might be particularly vulnerable to injury in the groin near the front of the hip where it passes between strands of a ligament. As a result, he thought that wearing tight clothing might aggravate the condition.

Our understanding of this disorder has changed little in the 110 years since Freud wrote his report for Berlin’s “Neurologisches Centralblatt,” or in the 20 years since Francis Schiller, M.D., translated it into English for the American journal “Neurology.”

To set the record straight, Freud and Breuer were not the first to recognize this condition. Max Bernhardt of Germany first wrote about it in 1878 and in 1895 Vladimir Roth of Moscow named the condition “meralgia paresthetica,” a term still in use. This name is the sum of its three parts. “Meros” is Greek for thigh, “algos” is Greek for pain and “paresthetica” means unprovoked sensations. This entrapment neuropathy (pinched nerve condition) was one of the first to be recognized as such.

The lateral femoral cutaneous nerve is formed in the lower back from branches of the second and third lumbar spinal nerves which combine to form a single nerve (on each side) soon after emerging from the spinal column. The nerve passes through the interior of the pelvis and exits the pelvis near the outer border of the inguinal (groin) ligament before making a downward turn to run beneath the skin of the outer thigh.

The course of the nerve can vary from person to person and even from side to side in the same person. In about 25% of people the nerve splits into branches before reaching the inguinal ligament, and there can be up to 5 branches. This variability might make some people more vulnerable to nerve-injury than others.

Pressure within the pelvis, as from pregnancy, obesity and (rarely) tumors, can injure the portion of the nerve within the pelvis. And as Freud’s physician surmised, the nerve is particularly vulnerable to injury from external pressure at the inguinal ligament, as from corsets, wide belts and tight pants. However, a cause for meralgia paresthetica is not always found, as was apparently the case when Freud had it.

The nerve can also be injured during a wide variety of surgical procedures, including orthopedic, vascular, gynecological, abdominal, hernia and even stomach-stapling operations. In a recent series of spinal surgery cases in Taiwan, 60 out of 252 patients experienced meralgia paresthetica as a complication of the surgery. Fortunately, in all cases it resolved within two months.

Diagnosis of this condition is usually made from the history and the physical examination, with the key features being numbness and unpleasant sensations on the side of the thigh. Other conditions can mimic meralgia paresthetica, for example, a pinched spinal nerve in the lower back, or impairment in the nearby femoral nerve that also emerges from the pelvis at the inguinal ligament. Tests of muscle and nerve electricity–electromyography and nerve conduction studies–can help resolve ambiguous cases.

Treatment of meralgia paresthetica has not been studied by the gold-standard method of randomized, controlled trials involving a comparison group of untreated patients. So in choosing appropriate treatment all we have to go on are collections of cases published in medical journals. Because many cases turn out well without drastic treatments, conservative approaches are tried first. Weight loss, removal of tight garments, completion of pregnancy and simple watchful waiting can all be effective.

While awaiting a favorable outcome, symptoms can be managed with skin-patches containing a local anesthetic drug, anti-inflammatory medications, certain epilepsy and antidepressant drugs known to relieve nerve-pain, and local injections with steroids. Surgery to relieve the pinch is usually reserved as a last resort.

(C) 2005 by Gary Cordingley

Gary Cordingley, MD, PhD, is a clinical neurologist, teacher and researcher who works in Athens, Ohio. For more health-related articles see his websites at: http://www.cordingleyneurology.com and http://www.neurologyarticles.com

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So there we were, rambling very nicely through out egocentric lives when we had a baby. Well, it won’t change much, we thought. Just means that we’ll have to stop swearing at home as much and occasionally shut the bathroom door.
This, we discovered, was wrong. The swearing, bizarrely, increased and we now find that not only do we forget to shut the door but that it’s a positive advantage as we usually have to emerge from the bathroom very, very quickly.

I was 36 when Tom was born and Jane was 34. Just.
She was pleased about this as it meant that she swept under the radar for ‘geriatric’ mothers, a label that apparently attaches ever so terrifyingly after the age of 35+. Not geriatric then, but not as young as others. There are problems with this, as indeed there are bonuses. I’m sure it will be a source of ever-increasing chagrin to Thomas, our son, as he grows up. Already there are generational warnings. I recall that I initially assumed The O.C. to be another reality TV show in the vein of Big Brother but with some poor bloke endlessly washing his hands. But I am as excited about the World Cup as younger fathers; I like The Simpsons and I still think it’s funny to fart in a lift. I’m just reminded of the old joke about Charlie Chaplin. Yes he was still having kids in his 80’s; he just couldn’t pick them up.

Thomas Finlay Fouracre was born at home, on the 12th September 2005. Jane missed her label by two days after going into full labour at six in the morning. Tom was out just after nine. This sounds pretty good but it could have been even better. The midwives who attended were sure that he was popping along fairly swiftly but then…nothing. Except the crying, screaming, panting and swearing of course.

Turns out he was an OP birth. This is a medical definition: ‘A baby is most commonly delivered in the occiput anterior position - head first facing the mother’s spine. When the foetus is in the occiput posterior (OP) position, facing away from the mother’s spine, labour can be prolonged.’
Yes. Prolonged. Quite. But it’s also (I realise that I am speaking at one remove here) a little painful. I’m paraphrasing here but in some births you might imagine you are attempting to divest yourself of an inconvenient watermelon. Now imagine it’s sideways. Of course babies in OP aren’t sideways, but Jane has always felt that Tom might as well have been. And wearing a full stormtrooper outfit. Certainly our friendship with Sam, a birth partner, has never fully recovered from the tirade of abuse Jane flung at her that morning. The upshot is that our lovely, wonderful boy, this bundle of fun and light that has entered our lives and taken them over so dramatically, was born on the toilet.

You see, it’s a bit cramped in OP and a toilet is specifically designed to separate certain anatomical parts. Well, it seemed the best idea on offer that morning. Jane astride, the midwives in front, two crouched runners under starter’s orders, Sam crouching in the bath stage right and me behind, perched on the shelf, straddling Jane’s upper body, like the imp in Henry Fuseli’s painting The Nightmare. A beautiful moment.

His head was misshapen -a common happenstance in OP births- but luckily we had a mother of two in Sam. ‘Eva’s head was like a cone for weeks!’ she relayed merrily and this eased our immediate worries. It took over a month before his head finally started to look less like the terraces of Angkor Wat but by then we had already started noticing other, odd features. Such as the fact that he was clearly the most gorgeous baby we’d ever seen. This might seem to be the standard subjective view of any new father and I understand completely when people try to explain to me how each parent believes that their child is the most stunning the world has ever seen. I nod, smile sheepishly and agree. But in my heart I know they’re wrong and I’m right. He’s gorgeous, unfeasibly so. I’m no-one’s idea of an oil painting, unless of course I just qualify under Fuseli’s rules, but Jane’s quite pretty. Still, Tom’s amazing.

He’s nine months old now and tearing through his milestones at a frantic rate. I keep telling him that he’ll use them up soon and won’t have any more to hit. Who’ll be sorry then? I ask. He usually laughs at this. But then he usually laughs when I ask him, for the fifth time, not to throw himself onto his belly as I’m changing him. He likes a good laugh. Yesterday he was lying at my side, squibbling around, as I lay shirtless on his bedroom floor, enjoying the heat of the afternoon. As he started to clamber onto my midriff I felt a warm paternal joy in his newly found ability to crawl forwards. Then he grabbed two meaty handfuls of my chest hair and hoisted himself onto my chest. I assume that he made it but can’t be totally sure as I think I may have passed out. However, somewhere, in the bowels of our terraced house I’m sure I heard Jane chortling, ‘Now imagine that while you’re also attempting to divest yourself of an inconvenient, sideways watermelon.’

Dave Fouracre aka “Dave the Dad” writes about his experiences as a Dad every week on http://www.thebabywebsite.com

Who is Dave the Dad?

My name is Dave and I have been married to Jane for a little over a year although we have been ‘going steady’ for more than a decade. If people ask, I tend to fluster about my work but when pushed, I admit I’m a teacher.

When they get over all the awful things that happened to them when they were in school I try to pretend I’m still an English teacher as this was my subject for ten years. Eventually, and with some reluctance, I occasionally tell them I’m now a Head of Media Studies. Jane is a Science teacher with a speciality in Physics. This normally helps to stop them laughing as most people still think that there is something preternaturally Godlike about anyone who understands even a small portion of the Universe. They are right.

We have lived in Brighton for seven years and belong to a Burmese cat called William whose grandfather was a great champion. William, however, discovered biscuits and subsequently strayed from the path somewhat. Our son Thomas Finlay Fouracre was born in September 2005.

http://www.thebabywebsite.com/viewSection44.htm

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Pain is the word most associated with labor. Women go to great lengths to deal with the discomforts of childbirth. They attend classes, buy products, read books and talk to their friends. However, relaxation is the one essential ingredient, often overlooked, which helps with the reduction of painful contractions. When Moms have fear in labor, their body tenses. When there is tension (opposite of relaxation), there is pain. Relaxation takes away the fear, therefore, reducing tension and pain. You can’t have relaxation and tension at the same time.

Relaxation exercises help a mother desiring either a medicated or a natural childbirth. The pregnant mom has to take responsibility before labor to prepare for her birth by practicing relaxation. The more the woman practices before delivery, the faster she can draw upon relaxation when she needs it, making her labor quicker and easier.

PREPARING FOR RELAXATION DURING THE PREGNANCY:

Tags: ball, birth, CD, childbirth, delivery, fear, labor, natural, pain, pregnancy, relaxationball, birth, CD, childbirth, delivery, fear, labor, natural, pain, pregnancy, relaxation

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