Solicting opinions please, what would you do?

[KryptoAlley]

Hello everyone (newbie here), I would like to hear some opinions, here's the deal...

I'm pregnant with my second child (okay actually I'm not 100% sure just yet as I can't take the pregnancy test until Monday but I still want to know) and I've been doing some research on pelvis shapes because I have a narrow, android pelvis and because of that, my first birth ended up an emergency C-section. This was done after 2 hours of pushing, not making progress, and the baby was starting to show signs of distress. To elaborate on what happened to my son, my son ended up in the intensive care unit for a week due to trauma incurred while I was trying to push him out. Now, there's NO WAY I'd want a repeat of that with child #2 so automatically when I saw the condition my son was in after I gave birth to him, I figured on a scheduled C-section for the next one. I've read around here a bit and I see how everyone is very against C-sections and all the bad things associated with them. However, I have no complaints whatsoever about my C-section. I didn't even need any pain medicines once the epidural wore off. I had an excellent recovery, was more active and doing more than most and was back to lifting weights and doing my cardio just 4 weeks later, sex life unaffected, scar barely visible, etc. Now I do have some loss of feeling right around the scar but it's minimal and well worth it IMO to be able to have a happy and healthy 2 year old with me today. Having said that, if you were me, having had a good experience with a C-section and having gone thru seeing your son in distress as they rushed him off to the intensive care unit and hooked him up to an oxygen machine (and no he was not premature, not even close) etc, if you were me, would you schedule a C-section or would you chance having the second child vaginally and having the second child possibly going thru what the first one did (or worse) because he/she would not fit thru your pelvis?

I'm thinking that my case is one in which a C-section was really the best choice and will be again the second time around, what do you all think?

[KariM]

Who did your pelvimetry? Was it done during labor? Or did you use an MRI or X-Ray methodology?

I guess if I were in your situation I'd first determine if the pelvimetry was an accurate assessment of my body. After that I'd take into account relative risks of surgical delivery and vaginal delivery to both myself and to the baby. A decision would be made based upon all data.

[Jilian]

Is there any reason you would have a misshapen pelvis? Has it been verified on x-ray? Have you been to a chiro? I would probably try for a VBAC if I were you. I have a really hard time believeing that a woman would grow a baby that could not safely be birthed vaginally, unless there were some other factor making her pelvis misshapen.

Also, it may have been the cesarean (or any other interventions you may have had) that caused distress in your baby and resulted in the NICU stay. I hate to say it but when it comes to cesarean b irths some doctors will stretch the truth to make themselves look like heroes or to spare the mom from having any feelings of sadness over the cesarean.

[courtenay_e]

Tell me more about the birth. Was it induced? If so, using what induction techniques? Did you have an epidural for pain relief during labor? What position(s) were you in during the bulk of labor? What position(s) did you try while pushing? Did you feel the urge to push, or were you coached to push? Those things could all have an effect on how your body reacted and how the baby reacted to labor.

[blissful_maia]

There's no way your pelvis could be diagnosed as "android" except through an autopsy, (which I assume you haven't had ). I would get second, and third, opinions, see a chiropractor or osteopath and try for a VBAC. It is your decision, of course, but I happen to believe that women make babies that fit through their pelvises in most circumstances, and I think that your doctor made up that reason for doing a C/S. I've seen doctors do it before. Also, every baby/birth is different. Good luck researching and choosing.

[KryptoAlley]

Originally Posted by KariM

Who did your pelvimetry? Was it done during labor? Or did you use an MRI or X-Ray methodology?

The delivering doc told me that after the birth and I was not surprised, because my hips are very narrow. Even my speed skating coach told me I have "man" hips way before I even got pregnant. My dad was also not surprised knowing how I'm built. Not that that confirms anything, I'm just saying that it fits and I had no reason to doubt her diagnosis.

Originally Posted by Jilian

Is there any reason you would have a misshapen pelvis?

Why do you call it mis shapen? It's just one of the 4 types of pelvis shapes.

Has it been verified on x-ray? Have you been to a chiro?

Not verified by any tests that I know of, other than your normal exams like pap smears. Been to a chiropractor, at that time I was pregnant with my son, so I didn't know anything about pelvis shapes back then to even ask. And how would he know anyway? (Just genuinely wanting to know). All the info he gave about my pelvis was just that one side is tilted higher than the other.

Also, it may have been the cesarean (or any other interventions you may have had) that caused distress in your baby and resulted in the NICU stay. I hate to say it but when it comes to cesarean b irths some doctors will stretch the truth to make themselves look like heroes or to spare the mom from having any feelings of sadness over the cesarean.

Perhaps some, but two things tell me that there was also trauma caused by my trying to push him out and that was his cone-shaped head with pockets of blood under his scalp and they said everytime I tried to push that his vital signs showed distress via slowed heart rate and I forget what else they told me when I asked.

Also, they gave me all the info I asked for and waited for my final okay to go ahead with the C-section. Now I may have not known then what all the right questions were to ask but that's why I'm here now.

Originally Posted by courtenay_e

Tell me more about the birth. Was it induced? If so, using what induction techniques? Did you have an epidural for pain relief during labor? What position(s) were you in during the bulk of labor? What position(s) did you try while pushing? Did you feel the urge to push, or were you coached to push? Those things could all have an effect on how your body reacted and how the baby reacted to labor.

Nope, not induced. My water broke and I immediately started having contractions about 4 PM on the 27th of June. By the time I got to the hospital my contractions were less than 5 min apart and coming so hard that I could barely get my robe on that they gave me to put on. I had intended on having a natural birth but not long after getting on the bed I'd decided I had enough and asked for the epidural. I mean I always thought I was pretty good with pain and hated the thought of that long needle going into my spine but let me tell ya, I didn't give one hoot about that needle once those contractions were really going. I was pretty much like, "stick it in, stick it in NOW, HURRY!!!!" So yeah, I wussed out. After that I was so much more relaxed it was just wonderful. I was tensing up, gripping the bed rails, pretty much a mess, all the natural techniques taught to me during childbirth class went right out the window, I just couldn't even do ANYTHING but basically let the contractions totally take over. Anyway, so I don't know exactly how much time after the epidural it was til they told me to start pushing but at first, progress was being made but it was pretty short-lived, I don't remember how long I pushed that there was actually progress being made but I know that after 2 hours of no progress and the baby started showing signs of distress, then we went to an emergency C-section. Oh, and I was lying down on my back at first pushing until they said the baby was showing signs of distress then they had me moving around to see when the babies vital signs improved so I think then I ended up on one of my sides and stayed in that position until the C-section. Is that enough info?

Thanks so much everyone for your replies, I really appreciate it. I'm a big fan of doing things the natural way, it just didn't work out for me.

[alegna]

Okay- with the details I would say that the problem was pushing on your back and in bed. If I were in your shoes I would plan for a homebirth next time with a midwife experienced in plenty of delivery positions.

-Angela

[darsmama]

If I were you, I'd let my intuition - not fear - make my decision.

[pixiepunk]

a few things i took away from the information you provided...

1) your pelvic shape and situation were not actually diagnosed, it was a judgement made by the OB at the time. I know *many* women who were told during their first birth that they were too small to give birth vaginally, ended up with c-sections, and went on to have vaginal births with subsequent babies. So first thing i would do is find out what the situation with your pelvis *really* is, and try to make decisions from there. it does happen, but it is *extremely* rare, much more rare than OB's seem to suggest.

2) the blood pockets on your child's head are called subdermal hematomas. My son had a wicked one after his birth, which calicified and is now a small knot on one side of his head. during his birth, his head was not in proper position and not fully engaged when i tried to start pushing (he was born at home, and i had not had the midwives check me, just felt i wanted to push). after a bit of fruitless pushing, i knew something wasn't right and asked them to check me. they discovered his head position, and made me get up and rock my hips and walk in order to get his head to move. and move it did - i felt it pop right into place, and during that same ctx his head started to emerge. i had been upright and on a birth ball, and on hands and knees, etc. never on my back, and still it was only standing up and moving my hips that got him to move into place. it actually also happened during my daughter's birth, too, but not for as long - but again, just walking/moving hips popped her into place and i was able to push her out. i have always felt that if i had been in a hospital and had an epidural that both of them likely would have been c-section babies - if i wasn't able to stand up, walk, and move my hips, i don't think they would've gotten unstuck.

3) no one wants a traumatized baby, we all understand the fear and concern that surrounds that. and i think a VBAC is only going to be possible for you if you can find out whether you truly have this pelvic condition, and if you don't, work on releasing that fear before you give birth again. if you don't feel comfortable birthing outside of a hospital environment, can you find a CNM (certified nurse-midwife) who could attend your birth at the hospital? and either way, if you're birthing at a hospital, get yourself a good doula who can advocate for you and help you process everything they're telling you, and also to help keep you calm and focused during labor.

4) get your hands on a copy of The Thinking Woman's Guide to a Better Birth by Henci Goer, go in armed with knowledge this time, so you can ask the right questions and stand up for yourself and your rights.

[JanetF]

Try this for some pics of pelvises and articles on how they work. Unless you have rickets, or have had your pelvis smashed in a car accident, it works fine. If there are 4 kinds of pelvises that means that 4 kinds of pelvises have developed over millions of years of evolution thus making yours welltested and fine to birth. If it wasn't, you couldn't have inherited it from your ancestors.


forum thread on inadequate pelvises

And these are really good explanations of how pelvises really work:
Pushing and Pelvises - a must read guide!! Wainer and Lemay articles

--------------------------------------------------------------------------------

http://www.midwiferytoday.com/articles/pushing.asp

Gloria Lemay's essential article on understanding pushing and a lot of other things.

Little excerpt:


Quote:
Let's take a typical scenario with an unmedicated first birth at home. The mother has been in the birth process for about twelve hours. The attendants have spelled each other off through the night. Membranes ruptured spontaneously with clear fluid after eight hours in active phase and mother and baby have normal vitals. There is dark red show (about two tablespoons per sensation) and mother says, "I have to push!" This declaration on the part of the mother brings renewed life to the room. The attendants rally and think, Finally, we're going to see the baby. The long wait will be done. We'll be relieved to see baby breathe spontaneously. We can start the clean up and be home to our families. Typically, the midwife does a pelvic exam at this point to see if the woman is fully dilated and can get on with the pushing now. It is common to find the woman eight centimeters with this scenario. The mood of the room then turns to disappointment.

Another brilliant Gloria Lemay article, "Pelvises I have Known and Loved."

http://www.midwiferytoday.com/articles/pelvis.asp

Little excerpt:


Quote:
What if there were no pelvis? What if it were as insignificant to how a child is born as how big the nose is on the mother's face? After twenty years of watching birth, this is what I have come to. Pelvises open at three stretch points—the symphisis pubis and the two sacroiliac joints. These points are full of relaxin hormones—the pelvis literally begins falling apart at about thirty-four weeks of pregnancy. In addition to this mobile, loose, stretchy pelvis, nature has given human beings the added bonus of having a moldable, pliable, shrinkable baby head. Like a steamer tray for a cooking pot has folding plates that adjust it to any size pot, so do these four overlapping plates that form the infant's skull adjust to fit the mother's body.

Nancy Wainer's article on pelvises and the lies women are told about CPD.

http://midwiferytoday.com/articles/dozen.asp

Little excerpt:


Quote:
Don't we get it? Women have babies! Even when there are situations that arise! There are billions of people on the planet—they get here without being cut into the world! All our ancestresses had babies or we wouldn't be here, and they all birthed outside of the hospital. I will say it again and again and again until I no longer have the breath: Hospitals are for sick people, and birth is not an illness. Every study that has ever been done has shown that planned homebirth is as safe (safer, I think safer) as hospital birth. Best kept secret in the country, wouldn't you say?
Oops. I'm sorry. Please pardon the sarcasm—it just slipped out.

[Jilian]

I agree that it may have been your pushing position that made it hard to push your baby out. I also have a "narrow pelvis" but I've vaginally birthed two children. The first I was laying on my back for and it took 2.5 hours to get him out. The second I was sitting and on all fours most of the time and finally squatted to get him out - it took 45 mins. Position makes all the difference. When you squat it increases the diameter of your pelvis greatly, I forget the exact number but I want to say by 30%

You are a woman, you are made to birth a baby, don't let some OB tell you otherwise. Your pelvis is not faulty. How big was your baby BTW? And how far along were you when labor began?

[Jilian]

Forgot to add: the fact that the heart rate was dropping during pushing makes me wonder if it were a cord compression issue rather than a distress issue. Decels are ok during pushing as long as the heart rate recovers in between pushes. The cord could have been getting compressed during pushing making the heart rate drop. Do you know how low the heart rate went? Did it recover in between pushes?

DS1's heart rate dropped quite a bit during pushing and the MW started rubbing the top of his head to stimulate him and bring the heart rate up. I think it is fairly common when you push for that long for the baby's heart rate to react a little bit.

I think it is great that you are doing the research for your next birth

[KryptoAlley]

Originally Posted by alegna

Okay- with the details I would say that the problem was pushing on your back and in bed. If I were in your shoes I would plan for a homebirth next time with a midwife experienced in plenty of delivery positions.

-Angela

Unfortunately, I don't think that'll be an option for us, I don't think our insurance would cover that but I can check, highly doubt it though.

Originally Posted by Jilian

...
You are a woman, you are made to birth a baby, don't let some OB tell you otherwise. Your pelvis is not faulty. How big was your baby BTW? And how far along were you when labor began?

He was 7 lbs 15 oz and I went into labor on the 27th and his due date was the 29th.

I just remembered another detail about the birth... His head was right there at the opening, I could feel and see his head (they gave me a mirror). So I'm thinking that if he was THAT far down, perhaps just being able to stand up and squat would've been all that was needed? Arrgghhh, now in hindsight that's bugging me, I mean if you open up that much more when you squat (I know, they taught us that in childbirth class), then why in the heck didn't they let me try that first?!

Anyway, rest assured I'll be researching this heavily before I give birth. I'd really rather not be cut open again even if I did have a good experience the first time around. I mean it still took me a long time to gain my ab strength back!

Thank you pixiepunk and JanetF for all your very helpful info and suggestions! That was a lot to type up! Much appreciated! I will be taking the info and suggestions into consideration, reading up, etc. I'm for sure planning on pursuing finding out my true pelvis shape and size for starters then I'll go from there.

Originally Posted by Jilian

Forgot to add: the fact that the heart rate was dropping during pushing makes me wonder if it were a cord compression issue rather than a distress issue. Decels are ok during pushing as long as the heart rate recovers in between pushes. The cord could have been getting compressed during pushing making the heart rate drop. Do you know how low the heart rate went? Did it recover in between pushes?

Don't know how low the heart rate went, don't remember, but it did recover between pushes, at least in the beginning. Towards the end maybe not as well because I remember them telling me to stay lying on my side cause they said he didn't seem to like the back position.

[alegna]

Originally Posted by KryptoAlley

Unfortunately, I don't think that'll be an option for us, I don't think our insurance would cover that but I can check, highly doubt it though.

As long as you have a PPO, and are in a state that allows midwives to attend homebirth, most insurance can be forced to pay for homebirth.

It won't be listed as such, but if they cover midwives, they can not dictate where they practice

-Angela

[hapersmion]

:

Some insurances cover it without a fight, even. When we were planning to go to a free-standing birth center, it was covered, in-network, and everything. Then we had to switch to a midwife halfway across the state because he was breech.

Even if insurance doesn't cover it, I think it's the best money you'll ever spend. I paid $4000 out of pocket for my birth, and only got $600 back (didn't know back then about the Gap Exception that alegna is talking about, I might have been able to get a lot more), and it was completely worth it. I would start saving my pocket money right now, if I thought that is what it would take to get me a homebirth next time.

Sorry you had a rough time with your first birth! : I think it's great that you're finding out all you can now, even though it may be painful. And wow, you say in your new post that you could see and feel the head? I would have to look things up, but wouldn't his head already be past your pelvis then? Sounds kind of weird. Sometimes babies are just really slow to come out, and doctors often don't have the patience to wait for them.

[SublimeBirthGirl]

Whether you could push the baby out with an epidural is no indication of whether you could push one out without one. I can only tell you what I would do, and I would plan a homebirth.

[KryptoAlley]

Originally Posted by hapersmion

... And wow, you say in your new post that you could see and feel the head? I would have to look things up, but wouldn't his head already be past your pelvis then? Sounds kind of weird. Sometimes babies are just really slow to come out, and doctors often don't have the patience to wait for them.

Yeah, his head was right at the opening of my vagina, they gave me a mirror just so I could look. So yeah, good question, I'm gonna look around on the internet and see if I can find anything about whether he would have been past my pelvis or not. As far as the wait goes, I was wondering what was taking so long too though cause at first they said I was doing great and he was really moving along well but then for 2 hours there was no significant movement/progress. My family was actually upset that they waited even a whole 2 hours to get him out via C-section, they actually wondered why they waited so long if he was becoming distressed.

[alegna]

FWIW I pushed for at least 6 hours.

-Angela

[KryptoAlley]

Originally Posted by alegna

FWIW I pushed for at least 6 hours.

-Angela

Oh my goodness!! So how was the baby during all this? Okay I assume? And what position were you in and did you change positions at all? Just curious. Is there any specific reason that it took 6 hours to push your baby out?

[alegna]

Originally Posted by KryptoAlley

Oh my goodness!! So how was the baby during all this? Okay I assume? And what position were you in and did you change positions at all? Just curious. Is there any specific reason that it took 6 hours to push your baby out?

It's a variation of normal. I did change positions some (standing, side, all 4s etc). Though through a lot I was just floating in the pool. *I* think it took so long because she was wrapped in her cord and it needed to stretch. It was around her neck twice and shoulder once.

She was fine through all of it. It is not really outside the norm to have a long pushing stage, especially for a first baby. The system just doesn't like to wait. If I'd been in a hospital I would have been sectioned- for no good reason. Who knows, maybe someone would have blamed it on the shape of my pelvis

-Angela