If they do a c section because the head is too big to exit the pelvis...

[Claire98909]

...at what descent station does the top of the head usually make it to before the call is made for a c section? http://smartimagebase.com/fetal-descent-stations-birth-presentation/view-item?ItemID=8741 This question applies to BOTH the true CPD cases and the false ones where some other factor is preventing the mother's pelvis from opening up enough (or the doctor is just lazy and wants to speed things up).

[pittsburrito]

I have no idea what "usually" is, but mine was called at 0-station after 5 hours of intense pushing and no further descent.  It was not a factor of my pelvis not opening up enough or CPD (baby was 7 lbs. 12 oz. with a proportional head).  It was a factor of my baby's malposition: posterior and asynclitic.  Had he not been trying to exit almost ear first, we wouldn't have experienced the physics problem.  Pulling on him in that position with a vacuum or forceps could have broken his neck, so we went the c-section route instead.  (Just wanted to point out that there are many variable reasons for c-sections, not just CPD, failure to dialate, or "doctor laziness".)

[CI Mama]

I made it to 10 cm and +2 station before my c-section. I pushed for 3 hours, but then I developed a fever,  and fetal heart tones, which had been stable & normal, were fluctuating. I was thoroughly exhausted and depleted since I hadn't eaten for 36 hours and hadn't slept for almost 48 hours.

The resident thought that vacuum-extraction would be an option, but the OB on call said that "I'd never be the same again" if I went that route. (Why he thought a c-section was different in that regard, I'll never know.)

Basically, through the fog of my exhaustion, I realized that a violent exit was pretty much the only option for my baby. And the thought of an incision on my belly just seemed better than ripping up my pelvic floor, at the time.

The birth records list CPD. I don't know what to believe. I may have been completely hoodwinked by my doctors. Maybe a vaginal birth was immanent or would have been possible with vacuum extraction, without extreme consequences for me or my baby. I have no idea if poor positioning was part of the problem. I might have just wimped out and not tried hard enough. Or maybe c-section really was the best choice at that time. Anything seems possible.

For the sake of my own recovery, I don't dwell on those possibilities much, as it's all in the past now, nothing to be done about it.

[Claire98909]

Why did the OB think that using a vacuum would result in you never being "the same again"?  Aren't vacuums pretty small?
 

Originally Posted by CI Mama 

I made it to 10 cm and +2 station before my c-section. I pushed for 3 hours, but then I developed a fever,  and fetal heart tones, which had been stable & normal, were fluctuating. I was thoroughly exhausted and depleted since I hadn't eaten for 36 hours and hadn't slept for almost 48 hours.

The resident thought that vacuum-extraction would be an option, but the OB on call said that "I'd never be the same again" if I went that route. (Why he thought a c-section was different in that regard, I'll never know.)

Basically, through the fog of my exhaustion, I realized that a violent exit was pretty much the only option for my baby. And the thought of an incision on my belly just seemed better than ripping up my pelvic floor, at the time.

The birth records list CPD. I don't know what to believe. I may have been completely hoodwinked by my doctors. Maybe a vaginal birth was immanent or would have been possible with vacuum extraction, without extreme consequences for me or my baby. I have no idea if poor positioning was part of the problem. I might have just wimped out and not tried hard enough. Or maybe c-section really was the best choice at that time. Anything seems possible.

For the sake of my own recovery, I don't dwell on those possibilities much, as it's all in the past now, nothing to be done about it.

[CI Mama]

Originally Posted by Claire98909 

Why did the OB think that using a vacuum would result in you never being "the same again"?  Aren't vacuums pretty small?
 

I don't exactly know the answer because I didn't press the OB for details when he made that comment.

The resident thought that the baby had descended enough that vacuum extraction would be possible. The OB was making it clear that in his opinion, the baby was still too high up. I believe I would have needed an episiotomy in order to do the vacuum (that's pretty standard), and when OB made his comment, I took it to mean that my pelvic floor could be pretty messed up if we went that route. But I wasn't exactly thinking all that clearly at that point in time, and I might have missed his point entirely.

[Claire98909]

I'm surprised that they do episiotomies in order to use a vacuum.  I thought that the vacuum tips themselves were pretty small.

[katelove]

Originally Posted by Claire98909 

I'm surprised that they do episiotomies in order to use a vacuum.  I thought that the vacuum tips themselves were pretty small.

You shouldn't need to in most circumstances, the vacumm cup does not add to the diameter of the head.

Edited by katelove - 1/20/12 at 4:32pm

[Claire98909]

Also, isn't the vacuum cup designed so it can be sort of "flattened" by the doctor to make for easy insertion and then resume its normal shape once it's inside the vagina?

[Monkey Keeper]

Originally Posted by Claire98909 

Why did the OB think that using a vacuum would result in you never being "the same again"?  Aren't vacuums pretty small?
 

Just my personal experience, I had a vacuum assisted birth with DD1, and even WITH an (unconsented to) episiotomy, I tore in a starburst. While they were "only" 2nd degree tears according to my incompetent OB, it took a good half hour and two full packs of sutures to put me back together.  I was still quite sore at my 6w appointment.  Perhaps it was something along those lines?  I also have some pretty gnarly pelvic floor/piriformis/psoas issues that probably go back to that birth.

[LiLStar]

my dd's head was at +2 when I had surgery. She was OP/asynclitic or im sure i could have pushed her out. 

[katelove]

Originally Posted by Claire98909 

Also, isn't the vacuum cup designed so it can be sort of "flattened" by the doctor to make for easy insertion and then resume its normal shape once it's inside the vagina?

Depends on the brand being used. Some of them are rigid but others have more flexibility.

[Claire98909]

What's piriformis/psoas?

[katelove]

Originally Posted by Claire98909 

What's piriformis/psoas?

They are muscles of the pelvis. The piriformis connects to the top of the femur (the long bone of the thigh) to the pelvis. The psoas muscle runs from the lower back, around the pelvis and connects to the femur lower down. There is quite a good diagram here.

[Claire98909]

Does anybody know when the "pliable", or "flexible" vacuum cups came into use (i.e. 1980s, 90s, etc)?
 

Originally Posted by katelove 

Depends on the brand being used. Some of them are rigid but others have more flexibility.

[lvingmommy]

I understand how you felt in regards to feeling hoodwinked by your doctor. I felt and somewhat still feel the same way.

I was in labor for 22-23 hours when my doctor asked me about going c-section. I really did not want to go that far. I was determined to have a natural birth.

The details of the night: I stopped dialating at 8cm and stayed that way for many hours. Nurse thought I was dialated and had me pushing. I wasn't at 10cm yet. Long and behold, exhaustion.

I had to sign paperwork, which I do not remember, in order to have the c-section. The nurses told me I had to walk to the operating room. I told them it was not happening with the amount of pain I was in because I vouched to have local anethetic in the hand so I could feel the contractions. (Horrible pain but you can get through it by meditating and counting 1-10 over and over again.) So, they wheeled me to the operating room. As the nurses are getting me ready, I had finished dialating once I got off the delivery table/bed, and it felt like my daughter was trying to come out of my skin and not coming down and out.

After delivery details: My daughter's head was approximately 13-13 1/2 inches around at delivery. Her head was also starting to warp from not being able to pass. Resulting in possible CPD.

After becoming pregnant with my second child, I discussed everything from my delivery with my new doctor. Without the hospital records, my doctor believes the c-section revealed CPD.

Hearing that from the doctor actually made me feel better along with the realization of how big my daughter's head was at birth. It made sense and fit into the puzzle.

 

Originally Posted by CI Mama 

I made it to 10 cm and +2 station before my c-section. I pushed for 3 hours, but then I developed a fever, and fetal heart tones, which had been stable & normal, were fluctuating. I was thoroughly exhausted and depleted since I hadn't eaten for 36 hours and hadn't slept for almost 48 hours.

The resident thought that vacuum-extraction would be an option, but the OB on call said that "I'd never be the same again" if I went that route. (Why he thought a c-section was different in that regard, I'll never know.)

Basically, through the fog of my exhaustion, I realized that a violent exit was pretty much the only option for my baby. And the thought of an incision on my belly just seemed better than ripping up my pelvic floor, at the time.

The birth records list CPD. I don't know what to believe. I may have been completely hoodwinked by my doctors. Maybe a vaginal birth was immanent or would have been possible with vacuum extraction, without extreme consequences for me or my baby. I have no idea if poor positioning was part of the problem. I might have just wimped out and not tried hard enough. Or maybe c-section really was the best choice at that time. Anything seems possible.

For the sake of my own recovery, I don't dwell on those possibilities much, as it's all in the past now, nothing to be done about it.

[LiLStar]

13.5 inches is actually a very normal circumference for a newborn. Small end of normal, even. The "warping" is very normal too. The bones in the skull overlap to pass through the pelvis, which is why many babies are born with a "cone head". If the molding was atypical, it would indicate a malposition, perhaps posterior (facing your front instead of facing your back) or asynclitic (tilted to the side) It may be that your daughter was having a difficult time coming out in the position she was in. Whether more time would have made a difference, who knows? My first was malpositioned and I was in labor for over 48 hours before the c-section. We had tried so much, that I'm certain if we had kept waiting for her position to resolve, either she or I would have gone into distress necessitating an emergency c-section before she would have been born. I was fully dilated for over 24 hours before the c-section. And pushed on and off for several hours. She was 8lbs 14oz with a 14inch head. It wasn't true CPD though. It definitely wasn't her size. It was position. I do think the molding on her head looked a little different. That does not indicate CPD though, it just means that she was trying to fit any way she could! I've had 2 vbacs since and the pregnancies keep getting longer, the labors shorter, and the babies bigger! My most recent (2 month old) was 11lbs even, 15 inch head at 41 weeks in a 6 hour labor. There's no reason you shouldn't be able to vbac!

[lvingmommy]

My daughter was malpositioned facing up. I'm still waiting for the hospital records to see if there was anything else that I do not know of because my original doctor came back after delivery and before my 1st visit to the gyn office. She had no clue what happened and I cannot locate my delivery doctor. Major question was and still is has to do with once I was fully dialated, why wasn't I allowed to push. I was pushing because my body wanted to but the nurses and doctor did not want me to. I do not get it.

I am afraid of going VBAC because of the possibility of having to go through the same trauma from my first delivery. So far, it has taken almost 4 years for me to get passed the emotions from it.

[LiLStar]

Ugh, how awful, sounds like once the surgery was decided on they just wanted to get it over with. My guess is moving from the delivery tableand the change of position helped your progress. They didn't "let you" push (and feeling the urge to do so!" Because they didn't feel like it. You did not have cpd, not at all. you had impatient staff handling your care. Your body has already dilated to 10. Next time, there's a good chance it will do so even faster becauseit remembers how. (I had a 50 hour labor and a 6 hour one myself!) With a supportive care provider, I bet you coul vbac easily. Well, as easy as any birth you sound like an excellent candidate. Have you heard of ICAN? Www.ican-online.org. on the right there's a link to find a local chapter. (The international yahoo list is great as well) the members should be able to point you to a respectful care provider. Even if you decide a repeat cesarean is the best choice for you, ican is a good resource for help making it an easier experience. If nothing else, if you can attend a meeting you'll be surounded by women who "get" the trauma and will lend a listening ear.

Sent from my SPH-D700 using Tapatalk

[irishmamacat]

I had a scheduled c-section for relative CPD.

My first pregnancy, at 39 weeks and my daughter, whilst head down from 32 weeks, wasn't engaged in my pelvis, at all, and was spinning  between OP, OT and OA at every visit (as confirmed on scans)

I have a wonky pelvis, from a congenital spinal condition, and in my case it looks like there is an issue with the pelvic inlet, never mind the outlet.

I personally wasn't willing to bet that she would be able to find her way out of my pelvis, because it looked like she didn't have much luck at finding her way into it!

Oh, and she was 6lbs 3oz, so it wasn't about being objectively too big, just too big for me.

[womenswisdom]

Originally Posted by lvingmommy 

I understand how you felt in regards to feeling hoodwinked by your doctor. I felt and somewhat still feel the same way.

I was in labor for 22-23 hours when my doctor asked me about going c-section. I really did not want to go that far. I was determined to have a natural birth.

The details of the night: I stopped dialating at 8cm and stayed that way for many hours. Nurse thought I was dialated and had me pushing. I wasn't at 10cm yet. Long and behold, exhaustion.

I had to sign paperwork, which I do not remember, in order to have the c-section. The nurses told me I had to walk to the operating room. I told them it was not happening with the amount of pain I was in because I vouched to have local anethetic in the hand so I could feel the contractions. (Horrible pain but you can get through it by meditating and counting 1-10 over and over again.) So, they wheeled me to the operating room. As the nurses are getting me ready, I had finished dialating once I got off the delivery table/bed, and it felt like my daughter was trying to come out of my skin and not coming down and out.

After delivery details: My daughter's head was approximately 13-13 1/2 inches around at delivery. Her head was also starting to warp from not being able to pass. Resulting in possible CPD.

After becoming pregnant with my second child, I discussed everything from my delivery with my new doctor. Without the hospital records, my doctor believes the c-section revealed CPD.

Hearing that from the doctor actually made me feel better along with the realization of how big my daughter's head was at birth. It made sense and fit into the puzzle.


 

I just wanted to say that a "stall" at 8cm is sooo typical for a posterior (face-up) baby. That was the reason I had my c-section also. I had dilated to 10 and pushed for 3 hours and he was not budging. During surgery, he was cut across the nose, so we are 100% sure he was face-up. Next baby, I did not have my water broken artificially, which allowed my daughter to rotate into a good position after being posterior during labor and I was able to push her out with no issues. She was the exact same size as my son. Position means EVERYTHING. I took positioning very seriously during my vbac - saw a chiropractor regularly, paid more attention to how I was sitting, etc. so that I wouldn't have another posterior labor.