Narrow pelvic arch?

[Jesseroo]

Hello! I'm four days overdue with our second little boy.... I was due on the 17th. I had a c-section with my first son after 17 hours of labor that stalled at 5 cm. He was 9 lb 8 oz and was born with a MAJOR conehead.... he definitely looked like he was trying hard to get through.



I had a doctor's appointment yesterday and my doctor informed me that I have a "narrow pubic arch". He said that could have been why my son couldn't be born vaginally. He's still 100% supportive of me trying for a VBAC, but didn't sound as optimistic that I'll be successful.



My concern is after researching this, it looks like I have a much much higher chance of shoulder dystocia and complications, especially because it's looking like this boy might be another 9 pounder.



Does ANYONE have information on this? I'm completely at a loss of what to do.... part of me just wants to schedule a c-section and get my little boy here safe and in my arms. But I have been striving for this VBAC for YEARS.... planned and researched since the birth of my first son. I'm quite frustrated that I wasn't informed about this narrow pelvic arch thing until just now.

I'm just getting so discouraged.... I'm officially losing all faith in my body. I keep having contractions, but they never usually get regular for a couple hours and then completely putter out. I just feel like my body is broken, and now hearing that I have this "narrow arch", I'm starting to feel like.... what's the point?


Thanks so much!

Jessica

[GoestoShow]

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Edited by GoestoShow - 1/3/11 at 12:10pm

[Phoebe]

I'm not quite sure what a "narrow pelvic arch" looks like but...
I am a 5foot petite woman who HBACed 2 babies(8.75 lbs, and 10 lbs). I have quite a time pushing these big boys out...3.5 hrs pushing for the first and 2.5 for the second. My tail bone "broke" both times(popped straight is really what happened), the second time audibly. But they came out. I have a pancake butt and what I imagine is probably a narrow pelvic region if my tailbone has to be straightend out to have let them move under my pelvic bone.

Anyway, you can do it. You need support from a dr. (probably better off with a midwife quite honestly)...lots of support.

1 year ago today was the due date for my soon to be 1 year old. He kept me waiting for 17 more days. They key to my success in every way is support support support. If you have to birth in a hospital I'd go grab yourself a doula right away. VBAC is not an easy thing to come by. Not becasue your body has a problem.

[MNHall]

I hope someone who is more knowledgeable can answer this better, but I'll tell you what I know. The number of women that have a pelvis that is truely too small for a baby to pass is INCREDIBLY small. However, a LOT of doctor's use it as an excuse when it comes to just scheduling a c-section. Or after a woman has a c-section after a "failed induction" or "stalled labor"....I put those in quotes because taht's just what the chart says, however, like the previous person stated, labor can slow down and speed up. I know a friend too that was stuck at 6cm for a long time (I guess it wasn't terribly long in the end, but she was at 6cm for at least 4 hours), then, all of a sudden, 30 minutes later she was 10cm and 2 pushes she was holding her baby boy! She's an ITTY bitty mama, one that you would look at and thing how on earth is a baby going to fit through there. Her baby was 7lbs 12oz, so not big, but she herself is less than 100 pounds, so big for her!

Anyway, to get back on track. My understanding is that the small percentage of women that really cannot pass a baby, it's usually due to childhood disease or an accident involving their pelvis. So, changes are very low outside of that.

At this point, don't give up!!!! Try to have confidence in your body that your body was made for birthing and this baby WILL come out in time! I know being overdue, you feel like time is not on your side, but there are SOOOO many women on this board and all over the country, world that have delivered around 42 weeks, not 40 weeks. The 40 weeks is just a guess as to when your baby is due. Every woman is different, every body is different and every baby is different. So, 40 weeks does not mean time is up! 40 weeks is just that guess of when your baby is pretty close...give or take a couple weeks!

Start talking to your baby, try some natural induction things (like walking, sex, spicy foods and so on), stay positive, and have faith that this little one CAN make it's way out!!!!

[lotus.blossom]

I feel like I have to respond, not to discourage you from your VBAC, but as from someone who has been where you are......

My first was also a stalled labor. after 30 hours and only 6cm's and major decels I too had a c/s. I was told in passing by my midwife that I had an android shaped pelvis (upon early exam) but they didn't seem worried about it at the birth center.

Anyway, much research later and a planned homebirth vbac with VERY supportive midwives, and no vaginal exams during pregnancy....... Went into labor, dilated very quick! So excited! Pushed for 5 hours and not much progress. Midwife checked me in sort of a hanging squat and determined that there was not enough room for my POSTERIOR baby to get through my arch. It wasn't for lack of trying or support. The puzzle pieces just didn't fit for me.
I don't think it matters if you are 100 lbs or 500 lbs sometimes the puzzle pieces just don't fit. When my baby was born he had a cephalohematoma which has calcified into a nice goose egg.

I said all that to say this.......do everything you can do to have an anterior baby! (Although again, some womens pelvises just send them through posterior. Both of mine were and the second not until well into labor, till pushing really)
And I realllllly hope that you get your vbac! But if not then go easy on yourself. I've been through months of mourning that my body is broken and I just didn't prepare myself for the possibility that I would need another c/s. If you need a c/s then be thankful that you have the option!!

[jess152]

I don't have much to contribute, just some support! Don't let the due date throw you off. Like the others said, babies come when ready. Not to discourage you, but you could be pregnant for another week and a bit. Use this time to get in a positive frame of mind and maybe find a doula (like someone else suggested). Even finding one who has had her own VBAC might be really helpful, just so she knows where you are coming from!

Since you've done lots of research, you likely know not to get an epidural (at least not until labour is well under way). I think they want you to be able to feel as much as possible in case of a rupture. If the baby is posterior and isn't making progress, being immobile in bed isn't going to help turn him. Ina May also says squatting opens the pelvis (I think it's) 25% more than laying on your back. There are some interesting threads on the Birth Professionals board about shoulder distocia. It seems to be a consensus that injuries arising in baby is often the result of an impatient doctor and the SD resolves itself in a short time. It's worth a read to see what they think...it's not likely what you'd hear from any doctor.

I've got my own VBAC coming up some time in the next week or two, so we may go at the same time, who knows! Good luck and don't despair in your body. You can do it! Read some inspiring birth stories, there are lots of VBAC birth stories on this board to check out. Most of these mamas have been given the same kind of dire prediction you were...you aren't alone.

Good luck!

[catspage]

My first OB told me that I had a narrow pelvic arch also. (trigs) I miscarried that baby at 12 weeks and then switched doctors because I couldn't bear to see that doctor again since I could only remember my loss.

With my next pregnancy (DD1) I was in labor for 22 hours (got an epi right away, they broke my water), stalled at 7cm, baby had decels, and I ended up with a c/s for fetal distress. She was 5 lbs 13 oz, so she was not a large baby by any means! I was 39 weeks along when she was born and have a strong suspicion that she might have been posterior.

With DD2 I switched doctors again so that I could have my VBAC. I went into labor at 39 wk 3 days and had another long painful labor of 22 hours (epi did not work). They were afraid that I was stalling again at 8 cm but once they gave me some pain meds in my IV I was able to relax and birth her just fine. She was 7 lbs 2.6 oz.

I don't truly believe that your pelvis can been too narrow unless you've sustained some kind of trauma. The pelvic bones are designed to move during birth. Just try not to lie on your back during your whole labor as that can narrow the birth canal too.

Good luck!

[cairomama]

My friend used a homestudy childbirth prep kit called the Pink Kit which shows you how to map your pelvis and work with your anatomy to get the baby out. She said it really helped her when she got stuck in labor. I think they have a digital version so you could get it right away. Might be good to have some strategies.

http://www.thepinkkit.com/

Here is a recent post from someone who had a successful VBAC with small pubic arch:

http://www.mothering.com/discussions....php?t=1158428

[anotherpeanut]

i was told by my doctor that the reason for my last c/s was narrow pelvic arch and that i had a 2% chance of delivering vaginally this time due to that as well. i already have my appointment scheduled with another provider and i've done some searching on the subject as well. i received this info from a doula. hope this helps. i also posted a question recently on the ICAN website and people posted some valuable information there. i'm wondering what the midwife i'm meeting with next week will have to say on the subject. good luck! i'm really hoping for VBAC too.

Myles Midwifery textbook says the following:
" the examination is usually carreid out after the 36th week of prgnancy when the vagina and pulvic floor are softer and maximum pelvic joint relaxation has occurred" ....
" it is usual to avoid diagnosing cephalopelvic disproportion until either x-ray evidence is unequivocal or until after the onset of labour. The reason for this is that the force of labour contractions encourages flexion and moulding of the fetal head and the relaxed ligaments of the pelvis allow the joints to give."

Myles lists rsik factors arising during pregnancy. They are change in fetal movement pattern, anemia, poor weight gain, proteinuria, glycosuria, bacilluria, BP over 140/90, uterus large or small for dates, excess or low amniotic fluid, malpresentation, vaginal bleeding, premature labour, vaginal infection and head not engaged in primigravid woman by 38 weeks. There is nothing about provider thinking pelvis feels to small. remember also each provider has different hands and different training, having learned on different women.

Varney's midwifery has an entire chapter on all the exact measurements of the pelvis, but it also points out that pelvimitry to make decisions about labor has been replaced by just having a trial of labor (except in cases of planned vaginal breech delivery). Varney also point out that before you ever attempt to evaluate a woman's pelvis with your hands, evaluate your hands. Just like pelves, hands are different too. In otherwords, this is very subjective.

Finally, here is a reply from one mom to another mom on a forum I visited:

"Not only was I told I had a platypoid pelvis, but the ob also told me I had a narrow pubic arch and would never birth a baby vaginally. Well, if you look at my signature, you'll see that was a bunch of bunk. Not only did I birth a baby vaginally, but he was a full 10oz bigger than his brother. Just remember a couple things, first off, pelvimitry is very subjective depending on who's looking, and second, what your pelvis looks like right now, is in no way the same as what it will look like when that baby is coming down and out (relaxin will change the shape to help mold for your baby). the majority of a baby is squishy and built to go around a pelvis. I'll bet you'll have no problem. I definately think the chiro is important though if you do have any narrowing as it will help keep everything as close to perfect as possible and give you the best chance for success. "

[RunnerMommy]

I didn't get a chance to read through what everyone else has said, but I was told the same thing after my first c-section (pushed for 2+ hrs/major conehead) and had my second at home, pushed for 30 mins max. There is a thread with his entire birth story posted here too (Henry's birth story- HBAC/Unplanned UC). Please don't be discouraged by this Dr.!!! You can do it!!

[DocsNemesis]

Also keep in mind that those risk factors still don't mean that you WILL have a problem. It just means its more likely.

The head not engaged by 38 weeks thing I find highly suspect, just fyi. I've had 5 babies (4 of my own and a surrogate baby). All but the last were born vaginally. My eldest was 42 weeks and still not engaged, so I was induced. He was 8lbs 5oz. The next was induced at 39w4d and again, not engaged. She was almost 9lbs. I also found out after the fact, when I had my next without induction that I was actually IN labor with her as well, I just have an atypical labor pattern.

My next was born at 37.5 weeks, naturally (tried EPO earlier than before and it worked a little too well, oops!). Again, she was not engaged. In fact, as I said, I had a very odd labor pattern, very very mild contractions, every 10 minutes (never closer). I got to 9cm's and was stuck there for hours and hours. She still wasn't engaged at that point. Now, I honestly could've just stayed like that for..well, probably days. My water was intact, she was fine, and especially concidering how mild the contractions were, I really could've gone home and just waited. In a hospital, I would've been labeled as failure to progress at that point and probably told I *needed* to have my water broken or get pit. I had midwives however, so I was given the choice. I decided I wanted to get it over with and we broke my water manually. I walked around for another 30 minutes with no change and then bam! Felt her move WAY down and into my pelvis and felt my first real contraction. She was born 15 minutes later.

My 4th was 39 weeks, had PROM so it was a bit different. Labor was much faster and seemed like a typical labor, unlike my previous one. She was born 3 hours after my water broke but again, was very high up and it wasn't until I felt the need to stand there rocking that I felt her move down.

My point being? 4 babies all of which didn't move down until labor-almost until labor was over. They also never moved down far until pushing-they stayed at -2 station or so. Yet I have no pelvic issues.