Rant: The old "inadequate pelvis" routine

[AnditheBee]

Here's a rather lengthy rant if you're in the mood... ;)

Sooo...I'm planning an HBAC but I can't tell my OBs (a.k.a. "the unwitting backups") because of their malpractice insurance specifications. Early in this pregnancy, I saw one of them (the one who has kind of "taken me under his wing" a lot, of the two that I see) and told him my daughter's birth story, and he of course did a pelvic exam. He said something about the ischial (sp?) spines being "pointy" and said, "It's possible that you have a pelvis that's semi-android." (I researched the classifications of pelvises and think he's completely, utterly wrong about this--I am small and slender but I carry all my weight on my lower abdomen and butt, which is not a tendency of android-pelvised women...but anyway...) But he did not suggest that my pelvis could not birth a child; these were the only comments he made after the exam.

Later on, I saw an OB in another town at a practice that supposedly "supports VBACs," (but not really), and she did a pelvic exam and quite clearly said there was no indication of "inadequacy" and that my spines were nice and rounded! :nut

And then, last week, I got copies of my records from the local OBs (mainly for getting the babe's birth certificate after he's born) and read the note that the first doc had made on the day he examined me for the first time: He checked a little box that said "inadequate"!!!

Okay, so, first of all--no.

Second: Why didn't he say this to me? Because he knew I was wanting a vbac (elsewhere, of course--can't do them here) and didn't want to discourage me? He also checked the box that said my pelvis was gynecoid, not android. Why did he feed me a line of bull that didn't match what he wrote?? Makes no sense. Why see doctors at all if they won't tell you the truth? That's a form of malpractice, if you ask me.

And third: Why is this bothering me??? I think I must still have some fears from the first birth, that secretly-lurking fear that my pelvis really is inadequate, that all my feelings of being "defective" the first time around will come back--justified and in full force. Bleah. Why does something so natural require such depths of courage???

Thanks for reading, if you made it this far...has anyone else dealt with this sort of goofy doctor-ism?? Sometimes I really don't understand the profession at all...

[Apricot]

Android Pelvises provide passage to babies. It's not a diagnosis that makes me worry at all.

In general, failure to progress is about one mama, one baby, and one pelvis on one day in time. Change any one of those parameters and you change the scenario and potentially, the outcome. Some pelvises are tricky and some are forgiving - but they all birth babies. Some babies are stubborn and some are agreeable to changing their position.

Do you know what else could go in the box? There are three choices - unproven, adequate to XX, and inadequate for XX. So, if you'd vaginally birthed a 5 lb. 2 oz. baby, it would say Adequate to 5 lb. 2 oz - with no thought give to adequacy for any baby over that amount. It's just a word game that doctors play.

Have you read "Pelvises I've known and Loved" ?http://www.ican-online.org/resources/research/pelvises.php

On a related note, I've seen a woman give birth where I was really glad that I hadn't examined her first - she had a really unusual pelvic arch. I wouldn't have thought she'd birth easily, but her baby came out easily and joined his many older siblings.

And finally, if I had a concern about a woman with pointy ischial spines - I would make sure she had lots of ways to do squats, in case she wanted to do them. Tubs, a good stool, chairs for her partner to help with a supported squat, and maybe even a rebozo or rope for pulling her into a squat. I wouldn't be directive about things like lunges and stuff, but just have the environment available.

[AnditheBee]

Thanks, Apricot. I know--I truly do--that my pelvis is perfectly adequate (nor am I worried about my "pelvic type"--not even sure why the doctor's form has that on it, since they don't know anything about different positioning/what-not). My fears are not logical at all, and I really thought I'd gotten past them, but they are nagging at the corners of my mind. I'll probably need to do some journaling to exorcise them...no, mostly what I wanted to do was complain about a doctor telling me one thing and writing another in my chart--for no reason at all. Argh.

This is, of course, one of the big reasons I'm homebirthing this time. It is at least good to get more confirmation that it's the best choice. :)

[Apricot]

Ah, Gotcha. Rant away.

[JanetF]

I always wonder what it can be inadequate for, yk? Inadequate for birthing cars or horses perhaps? That doesn't seem like a big deal to me since horses have other arrangements, namely mares and cars seem to be largely artificially produced. Anything short of those you can probably push out ;) I have a friend who was told that crock with her 8lb baby, only to push out an 11lb baby at home over an intact perineum. Inadequate? I think not! Keep ranting, it does my heart good :D

[misseks]

Speaking of the too-big-baby bullsh*t line:

Isn't the diameter of the vertex of a 5 lb baby the exact same as the diameter of the vertex of an 11 lb baby? My understanding is yes! 11 cm for all of those babies' vertex.

It's about position, right? Right. You and your pelvis are great, fantastic, phenomenal, perfect.

[saritabeth]

Yeah, I have gotten this crap too...a pity, isnt it?

[AnditheBee]

It's about position, right? Right. You and your pelvis are great, fantastic, phenomenal, perfect.
Yes. What was imperfect was the knowledge of my doctor and nurses. Not that I think my mw is perfect, but she's a heck of a sight more prepared to deal with "variations of normal" than any OB! :thumb

[AnditheBee]

By the way...does anyone have any insight as to why the doc would have told me one thing and written another? It makes no sense at all to me...I understand that some OBs are under legal pressure in one way or another, but I still don't see how that would apply here. In fact, I would have thought it would work the other way--that he would have told me that he felt my pelvis was inadequate from the start so I'd be more likely to stick with him for a "safe" c/sec. It's very odd.

One thing's for sure--I no longer feel any compunction about lying to him regarding my HBAC plans! :p