Pelvises I have Known and Loved
Pelvises I Have Known and Loved by Gloria Lemay (pasted with permission of author)
(c) 2003 Midwifery Today, Inc.
[ note: This article first appeared in Midwifery Today Issue
Summer 1999 and is also available online in
Spanish<
http://www.cafemom.com/articles/pelvissp.asp>
.]
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.
Every woman who is alive today is the result of millions of years of natural
selection. Today's women are the end result of evolution. We are the ones
with the bones that made it all the way here. With the exception of those
born in the last thirty years, we almost all go back through our maternal
lineage generation after generation having smooth, normal vaginal births.
Prior to thirty years ago, major problems in large groups were always
attributable to maternal malnutrition (starvation) or sepsis in hospitals.
Twenty years ago, physicians were known to tell women that the reason they
had a cesarean was that the child's head was just too big for the size of
the pelvis. The trouble began when these same women would stay at home for
their next child's birth and give birth to a bigger baby through that same
pelvis. This became very embarrassing, and it curtailed this reason being
put forward for doing cesareans. What replaced this reason was the
post-cesarean statement: "Well, it's a good thing we did the cesarean
because the cord was twice around the baby's neck." This is what I've heard
a lot of in the past ten years. Doctors must come up with a very good reason
for every operation because the family will have such a dreadful time with
the new baby and mother when they get home that, without a convincing
reason, the fathers would be on the warpath. Just imagine if the doctor said
honestly, "Well, Joe, this was one of those times when we jumped the
gun—there was actually not a thing wrong with either your baby or your wife.
I'm sorry she'll have a six week recovery to go through for nothing." We do
know that at least 15 percent of cesareans are unnecessary but the parents
are never told. There is a conspiracy among hospital staff to keep this
information from families for obvious reasons.
In a similar vein, I find it interesting that in 1999, doctors now advocate
discontinuing the use of the electronic fetal monitor. This is something
natural birth advocates have campaigned hard for and have not been able to
accomplish in the past twenty years. The natural-types were concerned about
possible harm to the baby from the Doppler ultrasound radiation as well as
discomfort for the mother from the two tight belts around her belly. Now in
l999, the doctors have joined the campaign to rid maternity wards of these
expensive pieces of technology. Why, you ask. Because it has just dawned on
the doctors that the very strip of paper recording fetal heart tones that
they thought proved how careful and conscientious they were, and which they
thought was their protection, has actually been their worst enemy in a court
of law. A good lawyer can take any piece of "evidence" and find an expert to
interpret it to his own ends. After a baby dies or is damaged, the hindsight
people come in and go over these strips, and the doctors are left with huge
legal settlements to make. What the literature indicates now is that when a
nurse with a stethoscope listens to the "real" heartbeat through a fetoscope
(not the bounced back and recorded beat shown on a monitor read-out) the
cesarean rate goes down by 50 percent with no adverse effects on fetal
mortality rates.
Of course, I am in favour of the abolition of electronic fetal monitoring
but it would be far more uplifting if this was being done for some sort of
health improvement and not just more ways to cover butt in court.
Now let's get back to pelvises I have known and loved. When I was a keen
beginner midwife, I took many workshops in which I measured pelvises of my
classmates. Bi-spinous diameters, sacral promontories, narrow arches—all
very important and serious. Gynecoid, android, anthropoid and the dreaded
platypelloid all had to be measured, assessed and agonized over. I worried
that babies would get "hung up" on spikes and bone spurs that could,
according to the folklore, appear out of nowhere. Then one day I heard the
head of obstetrics at our local hospital say, "The best pelvimeter is the
baby's head." In other words, a head passing through the pelvis would tell
you more about the size of it than all the calipers and X-rays in the world.
He did not advocate taking pelvic measurements at all. Of course, doing
pelvimetry in early pregnancy before the hormones have started relaxing the
pelvis is ridiculous.
One of the midwife "tricks" that we were taught was to ask the mother's shoe
size. If the mother wore size five or more shoes, the theory went that her
pelvis would be ample. Well, 98 percent of women take over size five shoes
so this was a good theory that gave me confidence in women's bodies for a
number of years. Then I had a client who came to me at eight months pregnant
seeking a home waterbirth. She had, up till that time, been under the care
of a hospital nurse-midwifery practise. She was Greek and loved doing
gymnastics. Her eighteen-year-old body glowed with good health, and I felt
lucky to have her in my practise until I asked the shoe size question. She
took size two shoes. She had to buy her shoes in Chinatown to get them small
enough—oh dear. I thought briefly of refreshing my rusting pelvimetry
skills, but then I reconsidered. I would not lay this small pelvis trip on
her. I would be vigilant at her birth and act if the birth seemed obstructed
in an unusual way, but I would not make it a self-fulfilling prophecy. She
gave birth to a seven-pound girl and only pushed about twelve times. She
gave birth in a water tub sitting on the lap of her young lover and the
scene reminded me of "Blue Lagoon" with Brooke Shields—it was so sexy. So
that pelvis ended the shoe size theory forever.
Another pelvis that came my way a few years ago stands out in my mind. This
young woman had had a cesarean for her first childbirth experience. She had
been induced, and it sounded like the usual cascade of interventions. When
she was being stitched up after the surgery her husband said to her, "Never
mind, Carol, next baby you can have vaginally." The surgeon made the comment
back to him, "Not unless she has a two pound baby." When I met her she was
having mild, early birth sensations. Her doula had called me to consult on
her birth. She really had a strangely shaped body. She was only about five
feet, one inch tall, and most of that was legs. Her pregnant belly looked
huge because it just went forward—she had very little space between the
crest of her hip and her rib cage. Luckily her own mother was present in the
house when I first arrived there. I took her into the kitchen and asked her
about her own birth experiences. She had had her first baby vaginally. With
her second, there had been a malpresentation and she had undergone a
cesarean. Since the grandmother had the same body-type as her daughter, I
was heartened by the fact that at least she had had one baby vaginally.
Again, this woman dilated in the water tub. It was a planned hospital birth,
so at advanced dilation they moved to the hospital. She was pushing when she
got there and proceeded to birth a seven-pound girl. She used a squatting
bar and was thrilled with her completely spontaneous birth experience. I
asked her to write to the surgeon who had made the remark that she couldn't
birth a baby over two pounds and let him know that this unscientific, unkind
remark had caused her much unneeded worry.
Another group of pelvises that inspire me are those of the pygmy women of
Africa. I have an article in my files by an anthropologist who reports that
these women have a height of four feet, on average. The average weight of
their infants is eight pounds! In relative terms, this is like a woman five
feet six giving birth to a fourteen-pound baby. The custom in their villages
is that the woman stays alone in her hut for birth until her membranes
rupture. At that time, she strolls through the village and finds her
midwives. The midwives and the woman hold hands and sing as they walk down
to the river. At the edge of the river is a flat, well-worn rock on which
all the babies are born. The two midwives squat at the mother's side while
she pushes her baby out. One midwife scoops up river water to splash on the
newborn to stimulate the first breath. After the placenta is birthed the
other midwife finds a narrow place in the cord and chews it to separate the
infant. Then, the three walk back to join the people. This article has been
a teaching and inspiration for me.
That's the bottom line on pelvises—they don't exist in real midwifery. Any
baby can slide through any pelvis with a powerful uterus pistoning down on
him/her.
Gloria Lemay <
http://www.consciouswoman.org> is a private birth
attendant in Vancouver, B.C., Canada.
: Also read "Pelvi I have known and loved" by Gloria LeMay.
what can I do next time?
