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.

Miconception:

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

Truth:

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).


Misconception:

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

Truth:

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: enews@midwiferytoday.com
For all other matters contact Midwifery Today:
PO Box 2672-940, Eugene OR 97402
541-344-7438, midwifery@aol.com, Midwifery Today

Keep those babies coming ladies!

Blessings.

If You Should Need a Cesarian Section

I wrote this a little while ago for a woman that was interested in what she could do to make her c-section more memorable with the help of a doula- or what the point of having a doula at a planned c section. She didn't want to have a c section, but unfortunately her child was breech and they'd done everything they could to turn her, with no avail. It's very difficult to find a physician willing to deliver a breech vaginally.

I hope this can help women who are having a c section against their want. I had to have one after 60 hours of laboring naturally at a birth center. I wish at that time I would have known more of this. I suggest even if you are not planning a cesarian birth to read this.


Here is a list of some things that can make cesarian birth more comfortable/ special. These things can be done by your partner, but I highly suggest having a doula. I think a lot of people forget that this is a birth for the father also, and when the father is expected to do all of the leg work, he can maybe feel like it's less about him and more about mother and baby (which are of course very important!)

*A doula can tell you what to expect during a cesarian birth, which can be invaluable. As someone who didn’t know anything about cesarians, I was deathly afraid of everything that happened to me because I didn’t know what was normal. Being in the know can make you more comfortable with what’s happening.

*Almost always they will let you play music in the operating room (this is something that I was completely unaware of until recently. I don’t think that they will offer it to you unless you ask. Perhaps you can play a song that you’ve sang to your baby during your pregnancy!)

*You can bring in some essential oils for aromatherapy during surgery. Peppermint oil is great for nausea, which is a common occurrence during cesarian.

*They will generally allow you to take picture of the surgery if you wish. If you are unsure, I would recommend doing it anyway. You can always throw pictures away, but you can never get the moment back.

*You can have your partner or a doula describe what’s happening during the surgery if you’re comfortable with that. It’s sometimes nice to know right when the baby is being born, and that they can see the babies head, and what color the hair is, etc.

*Once the baby is born, they will take he/she over to a side table to do their normal routines. It’s nice to have someone go over to the table with the baby and talk to him/her and let the baby know- we love you, welcome to the world, you’re beautiful, etc (don’t forget pictures!!!) The issue that arises when the father goes to do this (which isn’t a bad idea), is that the mother is left alone for part of the sewing up process. Cesarians are not comfortable, and it’s good to have someone doing your focus/breathing exercises during this (as well as throughout) surgery.

*A doula can advocate for you, and remind the staff that you’d like the father to hold the baby while the repair work is being done. She can also remind the staff that you would like to hold the baby as soon as humanly possible. They should be able to get the baby to you as soon as you’re out of surgery.

*A doula can also help you with breastfeeding if you’re a new mother. It can be trickier than it seems.

Please feel free to post any questions you may have :)