Saturday, November 10, 2007

CephaloPelvic Disproportion: AKA Will my baby fit through my pelvis?

I wanted to write about this because I am a bit shocked as to how many women I've met whose physicians have told them they have cephalopelvic disproportion, OR they think they can't push a baby through their pelvic bones and out of their vagina because they themselves are of a small size. Let's start by clarifying- Cephalopelvic disproportion (CPD): A baby having a head too large to fit through the mothers pelvis- therefore causing her to need a cesarian. CPD does exist, but it is far more rare than people think.

Let's start with some common misconceptions.


If one of my babies was delivered via cesarian birth due to CPD, all of my babies will be CPD.


While it may be possible that CPD is due to an abnormally shaped pelvis which can make it difficult to ever be able to push a baby out (rare indeed-and still wont necessarily mean you have CPD), most reasons a woman is diagnosed with CPD is 1. A very large baby that is having a hard time coming through the pelvic bones, and 2. stalled labor (which can be normal for SO many reasons and still turn into a CPD c/s).

Now, the truth of the matter is simply this: Every baby will have his/her own birth. Every baby is going to be a different size and have a different sized head. Every baby will mold differently while coming through the birth canal. I think it's a little known fact (I could be wrong- but I didn't know in the beginning with my first son!), that a babies head is made up of five plates rather than one bony structure. The plates overlap one another while the baby is being pushed through the birth canal, and UNTIL labor is happening, there is not really a true way to tell if your baby will fit or not (which it most likely will- even sometimes if you've been told otherwise).


If you are a small woman, you will have a harder time pushing a baby out and are more likely going to have CPD.


Au contraire, my good friends. I have a fantastic example of this (and actually the inspiration for writing this article).

I had a doula client that was a very small woman. She is probably a good 4'10". She seemed sure that she could push out her baby, and yet others were questioning her ability. People were saying things such as- "you're so small, don't you need a c section?" Shame shame- not only are these people undermining this womans ability to give birth, but they are planting seeds of doubt within her that could cause her to question herself. Women generally (and when I say generally I mean really MOST of the time)grow a baby that will be capable of being born to their mothers. It's really a great design...

Anywho, I wanted to note that this woman called me in labor one morning. She didn't realize she was in labor and sounded like she was calling to let me know that something weird was happening (but she wasn't convinced). I told her to contact her midwife to go in and have her fluids tested (I was under the impression her water broke). She had an appointment with her m/w within a couple of hours. (Just fyi- she said her contractions were 20 seconds long and 10 minutes apart- she's a first time mother and I assumed we'd have a baby late in the evening or early in the morning. You know what they say about assuming...).

I figured I would call her around five in the evening if she hadn't called me back needing me. I realized I had a voicemail at around three. The baby was born after 1 (she had arrived to see if the fluid was really fluid at noon!) This very tiny first time mother's baby practically fell out! And people doubted her ;)

The point is your size does not matter one bit for the most part. A small woman CAN give birth vaginally.

On an end note, I'd like to post a clip written by ICAN (international cesarian awareness network), and published by Midwifery Today:

Women have commonly been denied trials of labor if their first cesarean section was performed for failure to progress or cephalopelvic disproportion, the most common indications for primary cesarean. In a 1987 study published in the American Journal of Public Health, the largest percentage of women attempting VBAC had cephalopelvic disproportion or failure to progress cited as the primary indication for their initial cesarean. Of these women, 65 percent--almost two thirds--went on to have normal births; many of the babies were much larger than the baby for which the original cesarean section had been performed.
-ICAN Clarion, Sept. 1997

Reprinted from Midwifery Today E-News (Vol 1 Issue 50, Dec 10, 1999)
To subscribe to the E-News write:
For all other matters contact Midwifery Today:
PO Box 2672-940, Eugene OR 97402
541-344-7438,, Midwifery Today

Keep those babies coming ladies!



Ann said...

Very interesting...ya know practically everyone I know that has been pregnant lately has had a c-section. I swear I hear of no one that gives birth vaginally anymore. I understand that there are some circumstances where a c-section is needed but I feel like it's the "norn" nowadays. What do you think...

*Dani* said...

It's very true unfortunately. I believe that c/s rate is at something like 32% right now. So 1 out of 3 births will be a c/s. So if you have more than three children, chances are one birth will be a c/s (according to statistics that is). And it's also dependent on the hospital and the physician you're working with. I know of a certain infamous hospital in our area with something like a 65% c/s rate. Yuck.

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