Was this true CPD?

[paintedbison]

My best friend had her baby by c/section three years ago. This question has been plaguing me for awhile. I have worked antepartum and postpartum as an RN, but never L&D.

She was induced at 38 weeks for a "big baby"... had an epidural and everything which was how she wanted it. She labored mostly flat on her back.

She dilated quickly to ten cm. The nurse said she could feel the baby's head coming down with contractions and going back up between contractions. The nurse said that meant the baby wouldn't fit. She never tried to push at all. An hour or so later they sectioned her.

Was this really CPD? The baby was 9.5. I just have always wondered what would have happened if they had let her try to push. Any thoughts?

[MsBlack]

No, I would definitely not call that true CPD! It is just not that uncommon for babies to descend and then go back, repeatedly after full dilation--especially with first vag delivery. I've seen it a fair few times--and never saw it result in csec for CPD. With time to mould and position, babies always came down. Amazing that they didn't even let her push--although we don't know from your story what else might have been going on. Do you know if anything else seemed to prompt csec prior to pushing attempt--such as signs of fetal distress?

[DCDoula]

On the few occasions I've seen CPD, the moms never got to 10cm. They would stall out around 6, and then the cervix would swell up.

[jengacnm]

True CPD is when the mother has congenital dwarfism or a misshapen pelvis from rickets or a pelvic fracture.

[paintedbison]

Originally Posted by MsBlack

No, I would definitely not call that true CPD! It is just not that uncommon for babies to descend and then go back, repeatedly after full dilation--especially with first vag delivery. I've seen it a fair few times--and never saw it result in csec for CPD. With time to mould and position, babies always came down. Amazing that they didn't even let her push--although we don't know from your story what else might have been going on. Do you know if anything else seemed to prompt csec prior to pushing attempt--such as signs of fetal distress?

Nope... nothing else going on. She was in a labor room for about an hour and a half after they decided to do the c/section. I even heard the nurses saying "that's a big baby she's got in there". I was actually cross-training in L&D when she had her baby... so I was able to sit at the desk and watch the monitors the whole time. I was straight outta nursing school though... didn't feel like I knew enough to really question anything. I had worked as a tech on antepartum for a while so I knew how to read monitors though. But, definitely no distress.

[loudmama]

Sounds to me like baby wasn't in a favorable position.

L

[nashvillemidwife]

Originally Posted by jengacnm

True CPD is when the mother has congenital dwarfism or a misshapen pelvis from rickets or a pelvic fracture.

I have issue with that. In my career I have seen only one case of true CPD and the mother had no pelvis deformities. She was just petite with a large baby. No prenatal ultrasound weight assessments, but got to 42 weeks with Leopold's revealing baby's head was overriding pelvis and would not descend, even when I had her raise up.

Now, I've also seen plenty of small women birth big babies just fine, but in this particular case it just wasn't happening.

[lalazap]

Originally Posted by nashvillemidwife

baby's head was overriding pelvis and would not descend, even when I had her raise up.

nashvillemidwife, what do you mean by "raise up"? I am picturing some sort of belly lifting?

[eastkygal]

CPD and malpositioning are two different things. I have to agree with the pp who said true CPD is only when a woman has pelvic deformities. Otherwise, it is probably malpositioning causing the baby to be too large of the pelvis. Malpositioning does occur more often with women who have large babies because of there being less room in the uterus to move around. If I were your friend, I would totally question whether or not that c-section was necessary. It is a normal occurance for a child to move two steps forward and one step back with contractions and pushing. I would wonder whether or not they gave her enough time to labor, and the baby enough time to move itself into position. If the baby wasn't in distress I really don't believe anything was wrong. I also agree with the pp who said that alot of folks with malpositioning will have a labor that stalls out around 6-7 cm and swollen cervix, or they will dialate to 10 and have a cervical lip, and anything in between. Often that is accompanied by seeing meconium, or the baby not responding well to contractions. I just really think it is important to keep women aware of their posture during pregnancy, as our sedentary lifestyles keeps us from using our bodies, often, in the way they were intended.

[nashvillemidwife]

lalazap, I have her sit up a little while I keep my hands on the baby's head. You should feel it sink into the pelvis.

[Ruthla]

She was induced before her body was ready to go into labor on its own, had an epidural, and labored flat on her back.

I can't say definitely that it WASN'T CPD because she never had the opportunity to move around during labor and try different positions. Perhaps if she'd done all those things, the baby still wouldn't have been able to come through the birth canal. But we'll never know, will we?

[paintedbison]

Thanks everyone for the responses. I wanted to gently encourage my friend to think about her next delivery. At this point she wants a repeat section so she won't have to go through labor for nothing again. I don't know that I can get her to see things in a different light... but, I'm going to try.

I just didn't want to encourage her to use a midwife if the doctor had really been right and she can't birth a bigger baby.

[cathicog]

Originally Posted by paintedbison

Thanks everyone for the responses. I wanted to gently encourage my friend to think about her next delivery. At this point she wants a repeat section so she won't have to go through labor for nothing again. I don't know that I can get her to see things in a different light... but, I'm going to try.

I just didn't want to encourage her to use a midwife if the doctor had really been right and she can't birth a bigger baby.

Sounds like if she had been home and able to move about freely, she might probably have birthed that baby fine on her own. But flat-on-the-back positioning and epidurals given like candy, I feel are two of the largest contributors(besides inductions) to c/s.