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"had to have c-sec b/c head wouldn't fit through my pelvis"

post #1 of 25
Thread Starter 
i have a friend who recently gave birth and she said this to me, that she had pushed for 3 hours with an epidural and dr. told her that his head was so big that he couldn't fit through...

my first response to this is that docs say this all the time, and that this is only the case a tiny percentage of the time (right?). that a woman's body won't grow a baby that is too big for her...and also having the epidural and not feeling the urge to push can affect things...

but i know a few women who have used this doctor and had very good natural birth experiences with her.

one thing that was very interesting is that this was the one fear she had, and she told me about it throughout her pregnancy...that she feared birthing a baby that was "too big". (he was just under 10 lbs).

also, his head is over the 100th percentile. he's been checked out and his head is just naturally on the big side. no gestational diabetes.

what do you think?

eta that i'm interested in this not so that i can talk to my friend about it (unless she wants to), but i am interested in birth and am just wondering about this...
post #2 of 25
As a c/s mom, I hear that all the time from moms (well, them repeating what their DRs have said). I've heard that from moms who have gone on to have VBACs w/ even larger babies! You are correct in that it's very few women who cannot give birth to their own baby. This is usually associated w/ a pelvic malformation, malnutrition, or injury etc. I'm sorry your friend had to go through that and I do hope she looks into a VBAC for her next birth and what her DR said won't stop her. I just had my VBAC and I loved it!
post #3 of 25
Personally, I believe this to be true in a small number of cases but you hear it often. I'm curious about her pushing position - was she lying on her back or in a semi-sitting position? Squatting increases your pelvis size by around 30%, and not too many women are encouraged to squat in the hospital (especially if you've had an epidural or are tied to an iv or fetal monitor). If she didn't try pushing in the squatting position then I would think the "baby's head too big" statement is not definitive.
post #4 of 25
I was told a story by our Bradley teacher about a woman with true CPD - she labored for several hours (not sure the exact length, but with a fairly 'lenient' CNM group, and that was at home for quite a while and then at the hospital), and eventually it was decided that she was well and truly 'stalled' and not going to dilate farther - she had dilated to 5 cms very quickly, and then stopped.

When they did the c/sec, the baby's head literally had a small point at one place on his head, where he had been attempting to fit through the pelvis - a far, far cry from the 'conehead' typical of vaginal births. It turned out that the mother had, unbeknownst to her, had rickets or something else as a very small child that deformed her pelvis - hence she had true CPD. I think the CNM actually told her that she was the only real case that they had ever seen! So, yes, it can happen, but it's quite rare, and I think in your friend's case, it's much much more likely that she had difficulty due to position, as well as to the epidural.

(I hope this made sense, I've noticed the farther I get in this pg, the more the things I type sound funny. :LOL)
post #5 of 25
I pushed for 3 hours with my daughter, and her head was stuck on my pelvis. She was positioned posterior, as well, so this probably had more to do with it than the size of her head.

I know that she was stuck because she came out (via c/s) with an enormous bruise where she was stuck against my pelvis bone, and screamed in pain whenever I touched her head for about the first week.

I tried squatting, all fours, and side-lying pushing. She wouldn't come out in any of them. I do think that after the terrifying traumatic labor experience I had, I was really not in a good place to be pushing, but man, I was trying very hard.

So, yeah, I think that this can happen.
post #6 of 25
I personally believe this can happen. While I have read the "your body will not grow a bigger baby than you can have" I think that is not necessarily true. I've read where some peopl "brag" about having 11-12-13 pound babies vaginally, but I think more times than not, these babies cannot be born vaginally or if they are, can have complications. My MIL had a nearly 12lb baby vaginally that died at birth from many complications. She told me that her bottom was never the same and she pushed for over six hours. She said she was nearly standing for the last few hours and that two nurses and an orderly had to help her stay in that position she was so weak. She should have had a csection, but the area she was in, that was rarely performed and if it was, it was usually after a baby's demise.
post #7 of 25
The CPD diagnosis is indeed a common one. For years I thought this meant "head too big to fit in pelvis" and so for years I was quite irked with The Man (OB/GYN establishment) for this--HOW COULD all our babies' heads be too big?

Speaking in terms of evolution, wouldn't the people alive today have the smallest heads and the biggest pelvises, as most of us were born vaginally, with c-secs being avail. in the last 20 years?

But then I learned the rest of the "head too big to fit in pelvis" sentance: because this labor has been medically managed to an extent that the natural and most effective alignment of head and pelvis will not be experienced.

Think about it:

How many mamas go to the hospital in prelabor or early labor, and the bag of water is popped to 'get labor started?' What does this do? It eliminates a cushion of fluid that could allow baby's head to continue rotating/moving/settling into a better alignment for birth.

Stuck.

What about a mama who chooses to have an epidural placed in early labor? Now that mama is on her back, in bed, for hours. And hours. There is no gravity, no walking around, no pacing at home wondering "if it's time to go to the hospital yet", all things that allow the fetus to wiggle into a prime position for birth.

What about the mamas who are directed on when and how to push? Okay, hold your breath, count to ten, now PUSH PUSH PUSH PUSH PUSH PUSH and cram that head into the vagina, perhaps in a more forceful way than that baby and mom need.....bmom doesn't have the chance to listen to her body, to feel, hey, it hurts to push this way--I want to lean against a wall, I want to squat, I want to lie on my side, I don't want to push now, I want to push now, etc.

Cram the head and make it stuck.

There's such a delicate way in which the fetal head navigates mom's pelvis. There is not a lot of room for error, as we know--we know (or are) mamas who have had c-sections because "baby wasn't presenting properly" or was posterior or was just not going to 'fit.'

All I'm saying is, maybe baby could've fit if baby had been given a chance. It's not CPD...it's often CPD secondary to typical obstetrical management of labor.

I think of my second baby, when I had regular contractions for a solid day, a few days before the due date. It was so 'serious', I sent my dd away, and my midwives drove 1 hr to my house, sleeping on my living room floor, waiting for my contractions to continue.

But they fizzled out.

A vaginal exam at my request revealed a dissapointing 2-3 cms dialated, but a transverse head--which is not how my baby had been oriented a few days earier.

10 days later, my son was actually born. I often wonder, what would've happened had I chosen an OB for my care provider? Would my OB have popped my bag, after all those regular contractions, regular enough to trick my midwives into a thinking it was go-time? Would that have interferred with the positioning of my son's head for birth? And a final concideration: had my labor been augmented at that time, 10 days before nature determined it was time, would my ds have been born 'early'?
post #8 of 25
If she only pushed for 3 hours, how does anyone know the baby wouldn't have been born vaginally an hour later? Two or three hours later, maybe? As long as the baby is not in distress, why did they not allow the mother to continue?

With #2, I pushed for 2 hours and the head did not even engage. I was telling the midwives I thought I had a true case of CPD. They assured me I did not; that everything was normal. I pushed for three more hours and she was born. I'm sure in the hospital I would have been sectioned, since there is this belief that a second-timde mom should not have to push for more than 2 hours.

Again, there is no way to prove the head would have not eventually fit in the OP's case, and the only reason not to try is fetal distress.
post #9 of 25
Oh, Greaseball, bless you. That is a long time!
post #10 of 25
Great post, tinyshoes, ITA. I recently had a mom that would have regular, strong cntxs that would start and stop for days. She asked me to come and do a vaginal, and she was dilated to 6-7cm, but the baby's head still was a little bit "bouncy". I stayed the night, but she went to sleep about 3 or 4 am and everything stopped, so I left that morning. After days of this, she was exhausted and very frustrated, so she asked me to come again and check her. Well, instead of a baby's head, there was a little fist there. I tickled the baby's fingers, and she moved her hand and put her head back down into the pelvis. Due to the lack of pressure on the cervix, the mom was only dilated to about 4cm. No wonder things were stopping and starting like that! Well, she did go on to have a wonderful birth the very next day. I just can't help but think that at the hosp, she definitely would've at least ended up with a pit drip after being that dilated. However, for whatever reason, her body/baby needed a few more days to be ready.
post #11 of 25
With my ds I was a transfer from a homebirth because of blood pressure. The ob on call had been on call (and I think in the hospital) for 24 hours when I was admitted (I asked him how long he had been there, he looked exhausted).

He used the worst ultrasound machine in the hospital to look at the baby (he described it as such) and you could barely see anything. He then said that the baby was "over nine pounds" and that I would never get the baby through my pelvis and I should just "get this over with" (have a section). I said "no way". The baby was not in distress, the heartbeat was steady and strong.

He continued to bully me into getting the section for the next 8 hours. Even as I was pushing I could hear him saying to the nurse, in a matter of fact kind of way, "shoulder distocia (sp?)".

Well, my "over nine pounds" baby was exactly seven pounds. He had a noucal (sp?) hand and presented in a strange position (not anterior, but not posterior either - kind of on the side), but was small enough that I got him out with no problems.

I have no idea if a baby could grow too big to fit in a non-injured pelvis, but I do know that an ultrasound is not necessarily the way to determine the size of the baby.

Ellen
post #12 of 25
Tinyshoes, that was a great post! I concur.
post #13 of 25
Quote:
Originally Posted by OnTheFence
I've read where some peopl "brag" about having 11-12-13 pound babies vaginally, but I think more times than not, these babies cannot be born vaginally or if they are, can have complications.
I often share my experience with giving birth to an 11-6 baby vaginally just because I want people to see the other side--sometimes it is possible. Not that I believe that my experience is in any way indicative of what another person will experience, but I put it out there for consideration. In my case I only pushed for 20 minutes and she had a 15" head that had very little molding. The hardest part was getting the shoulders out and that is where I ripped and needed stitches. My first daughter was 2 lbs smaller, but had quite a conehead and was much harder to get out. Things were different in that situation, however.

I give credit to the optimal foetal positioning website because my second baby's head was really down and in a good position. Plus I had a homebirth so didn't have an epidural which I had with my first who was posterior.

My feeling is that it might be true that nature doesn't make a baby too big to be born vaginally, but it might mean death for the baby, mother or both. I do think there are times when a c-section is the better option.

In any event, I'm not too anxious to try for another baby because I have a fear that I might have an even bigger baby and end up with a true shoulder dystocia if I tried to have the baby vaginally. Not to mention I would have to find a different man for the father as my husband is done procreating. I thought that my second daughter would be smaller because I exercised more and only gained about 11 or 12 lbs in the pregnancy, but that turned out to to be the case. She was very long, however, so that might have been part of why she weighed so much.
post #14 of 25
i was told my baby was stuck and i should hae sc by both midwife at home and OB at the hospital.....but i insisted and believed that my body and my baby will work together....after 40 hours of hard and painful labor my son was born vaginally....
post #15 of 25
Isn't it true that the majority of these big babies born vaginally with complications were born in hospitals? There may not have been complications at home.

I had a stuck shoulder for about 2 minutes at my home birth (baby was only 8/9) and I'm sure in the hospital they would have kept me in a position that led to a true dystocia and a nasty tear. Assuming they would have "allowed" me to deliver vaginally at all...
post #16 of 25
i didn't have CPD with my c-birth, she was hung up on a short cord wrapped twice around her neck and couldn't get down past a certain point. but, my doctor who did the surgery had a long talk with me about my pelvis while i was in the hospital ... she said while she was in there, she noticed that i have a V-shape more than a bowl-shape (she drew pictures for me, it's too hard to explain here) and that she wants me to get pelvimetry done before i think about getting pregnant again. just so we can know for sure if CPD would ever be an issue. i do have unusually narrow hips for my size, i had a lot of pituitary problems growing up. but it's the shape of the "pelvic door" that matters, not the size of the hips. anyway, pelvimetry is the only way to tell for sure if CPD would be an issue. it's an xray so they can't do it during pregnancy. but i'm thinking that a woman who's had a c-birth because their doctor said it was CPD could ask for pelvimetry afterwards. hmmm, or even tell the doc they're going to have it done afterwards, i wonder if that'd make a lot of docs stop pushing c-sections??
post #17 of 25
Quote:
anyway, pelvimetry is the only way to tell for sure if CPD would be an issue.
Pelvimetry cannot predict how the pelvic ligaments will stretch, or to what extent the fetal head will mold. It would only be useful if the pelvis were a solid ring of bone.

If the cause of a baby not engaging is a short cord or a cord that is wrapped around the neck a lot, I think some fetal distress would show up in the heart tones. Maybe a midwife can answer this?
post #18 of 25
Oddly, we were just talking about this this weekend.

A friend delivered a relatively small baby (7/something and like 17 inches long). The mom is very small herself. She has the hip width of a young girl (like before puberty young). I know that says nothing for the abilities of her pelvis but she had been slightly "concerned" her entire pg that this would be a factor. Everyone else was "concerned" as well :

Anyway, she dilated fast, having a natural labor in the hospital with a CNM. I guess she fully dilated pushed for 2 hours. An OB stepped in to "help".

The story goes that they tried forceps for an hour and the vaccum for 5 or 6 tries. The babe wouldn't move.

She was sectioned after about 5 hours of attempting to push and pull that babe out. His head has a ring around the top where he had dropped and got "stuck" on her pelvis.

I don't know if this is a true case of CPD but it sounds like it.
post #19 of 25
Short cord or cord around the neck is a very unusual cause of baby not engaging or dropping. It is claimed as the cause a lot more often, though. I had a mom deliver by repeat cesarean a couple weeks ago that I think might have actually had the cord too wrapped around the baby to allow descent - and this is the first one I've seen in my career where I thought that. The cord was wrapped around the upper arm once tight, and the leg also once tight. It was difficult to even get the baby out of the abdominal incision due to the loop of cord being so tight, and the length of cord extending from the part wrapped around the baby to the placenta was so short. I've never had that situation before, though, and in fact posted on another thread about cords some time ago that I didn't think it could happen!
post #20 of 25
Quote:
Originally Posted by Greaseball
If the cause of a baby not engaging is a short cord or a cord that is wrapped around the neck a lot, I think some fetal distress would show up in the heart tones. Maybe a midwife can answer this?
I have only seen this once. The baby was breech and wrapped in a short cord, almost like a noose. From what I remember (it was very early on in my training), the baby's heartrate was fine, but the mws were concerned about bright green thick meconium in the water. The mother was obese, so they didn't even realize that the baby was breech until she had an u/s at the hosp. She had a c/s and the baby was fine.
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