A bit of a spinoff: When is a C-sec essential? - Page 3 - Mothering Forums

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Old 03-18-2004, 10:54 PM
 
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thanks Chava!
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Old 03-18-2004, 10:54 PM
 
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Originally posted by Mom2six

And if what you ladies describe as happening during your inductions was what was going on - well, somebody wasn't doing their job. One of the things you are supposed to check for is that the uterus is soft between contractions.
Right, this is what the ob and nurse fought over. My uterus was not relaxing at all. it remained hard (the same intensity) for 60-90 minutes (somewhere in between). This is why I had the c/b. They had decided that my uterus had been under too much constant stress that uterine rupture was a "real concern"

Like I said, I wish I wouldn't have been so naive with my first babe

Single Mom to 2 amazing little men. T(7) and B(5)
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Old 03-18-2004, 11:58 PM
 
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If anyone out there knows the rationale behind the No Turning Back The Pit No Matter What Even If It Means Surgery rule, clue me in.
In the hospital childbirth classes we were told that if pit was to be used, the mother would immediately be given the maximum amount. I asked "Why can't she just have a little bit and then see what happens?" The instructor said "I don't know, that's just not our policy.":

If they turned it off then they might actually have to WAIT for the woman's body to work on its own time!

Isn't it true that once the pit is started, a mother should never be left alone? Do they really stay with you?
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Old 03-19-2004, 12:15 AM
 
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Originally posted by Greaseball
Isn't it true that once the pit is started, a mother should never be left alone? Do they really stay with you?
It is not true where I work. Our policy require continuous monitoring and we have central monitors. We periodically check that the uterus is soft between contractions, esp. before considering increasing the amount of pitocin. This might have been true in a place without EFM or central monitoring, but I don't think it necessary any more than it is necessary with any other birth.
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Old 03-19-2004, 12:22 AM
 
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Originally posted by Greaseball
In the hospital childbirth classes we were told that if pit was to be used, the mother would immediately be given the maximum amount. I asked "Why can't she just have a little bit and then see what happens?" The instructor said "I don't know, that's just not our policy.":
This make no sense. I think there must have been a communication problem here b/c I've had women hyperstimulate their uterus (contractions too long and close together) with a resulting huge decel on small amounts of pitocin and woman that won't contract at all (esp. if they are preterm and being induced for other complications) on huge amounts. To manage a pitocin induction effectively you have to "titrate to response" - in other words it's an art, not a science. You turn it up slowly until you get the desired result- a regular contraction pattern that causes cervical dilation. Maybe what she meant was that they have an amount they start with (where I work it's 2 milliunits, but I've worked elsewhere where they start with .5 milliunits) and that is the "maximum" amount you get, no less - until they turn it up? :
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Old 03-19-2004, 12:26 AM
 
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She actually said "I don't know" in response to a lot of the questions I asked. She knew the rules of the hospital, but not the reasoning behind them.
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Old 03-19-2004, 12:32 AM
 
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I wasn't thinking about answering the question of "why can't you give a little bit and see what happens?", but I realized re-reading that "titrate to response" answers that question. You increase the amount until you get the desired response. However, this by definition doesn't produce a "natural" labor pattern. The pitocin, from my understanding, overrides the body's natural feedback mechanism (and hence the need if you are going to back off on it to back off at the same rate taht you increased) to release it's own oxytocin. That and we make you contract every few minutes right from the start - no slow build up, they want you contracting every few minutes right from the start.
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Old 03-19-2004, 04:07 AM
 
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Had an experience similar to what Greaseball's referring to.

1st baby, they gave me pitocin, and it was like going from zero to 60 in 5 seconds. From these gentle little happy contraction-like-thingies to these several-minute-long-seeming monsters that just barely had a break between them. Vroom. Horrific experience.

Changed OBs after that. (Do you wonder why? : )

Next baby, different hospital, different OB ... they did what Mom2Six posted, like a fine art, very slight, then slightly more, then slightly more, till the contractions became just a little stronger, and stronger, and then at some point just stopped the pitocin, and I continued on my own.

Don't know, maybe it's different OB's policies as opposed to the hospital itself ...
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Old 03-19-2004, 11:54 AM
 
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I delivered a 32 week preemie. It was never mentioned that a c/s would be needed or even recommended. I did have an episiotomy though. They said something about head trama during birth...forgive the lapse in memory, 144 of labor and labor stopping drugs will make you a bit incoherent. It's amazing really(considering ALL of the drugs that they pumped into me (mag sulfate, nubain and others), my daughter was born that early at 3lbs, 13 0z, 1min APGAR was 8, 5 min was 9 and at 20 min it was 10 (without needing any oxygen)...she was a real trooper.

Now, I do have a friend. Her first was a c-sec due to FTP (debatable, as we all have discussed before). Her second is a really sad story. It was discovered the day they found out she was pregnant (5 months and I still don't understand how she reached 5 months without a symptom ) that their baby had developed a diaphramatic hernia. At the birth, there was only 1/8 of one lung developed. The abdominal organs were inside of the thoracic cavity, causeing the underdevelopment of his lungs and displacing his heart up and to the right. The doctor told them that it was HIGHLY UNLIKELY that the baby would survive a vaginal birth. So, they agreed to the repeat c/s. It was funny really. They were told to expect a 2lb baby at term. Daddy said NO WAY, fed his wife as much protien (among other things) that she could tolerate, made sure that her diet was ABOVE the norm....they delivered a 6lb 8 oz baby. This baby was incredibly sick...as a baby would be without his lungs....but so very healthy. He actually set records in the hospital where he was born (in Flordia, a hospital and a doctor that specialize in this type of abnomality). He is home now, will be a year old in June. Truely a wonderful ending, when everyone was clearly expecting the worst.

Sorry I got so very T I am reading the nutritional section in Holistic Midwifery....and in comparing the text with this situation, I can completely understand where Ms. Frye states how nutrition can make such a difference in the outcome in a pregnancy and baby.



With my second birth, getting in the jaccuzi slowed down my contractions....I was lying in the bed and a nurse came to my IV machine with a needle. I asked her what it was. She said that the doc had ordered pit...my contractions went from 1 min apart to 3 min apart...talk about a doc rushing my birth. AND THEY WEREN'T EVEN GOING TO TELL ME THEY WERE GIVING IT TO ME...Luckily, (and somewhat strangely, if you ask me....) at that very instant, my contractions picked back up...and no pit. was administered.
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Old 03-19-2004, 03:57 PM - Thread Starter
 
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T sorta


Greaseball,

Quote:
In the hospital childbirth classes we were told that if pit was to be used, the mother would immediately be given the maximum amount. I asked "Why can't she just have a little bit and then see what happens?" The instructor said "I don't know, that's just not our policy."
Thats SO weird! I had a pit induction as well with my son and their policy was to start at a very low dose and then increase it by half every 20-30 minutes. When they'd got you into a *good* contraction pattern, they leveled off the dose there. In my case, I too experienced some 'unending' contractions. They first scaled the dose back a bit, and when the contractions didn't appreciably let up, they turned off the whole thing!

I wonder if each hospital has it's own different policy regard this stuff?

Mama to Thing 1 and Thing 2.
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Old 03-19-2004, 04:07 PM
 
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Just from reading threads, I get the idea that every hospital has a different policy, which to me says they are not truly concerned about babies. How can something that is good for babies in one state - or city - be bad for them in another?
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Old 03-19-2004, 04:11 PM
 
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I'm sure different doctors hold different philosophies about how pit. is administered. Some get really impatient and pump it up for that "Wham, bam, thank ya, ma'am!" birth effect.... maybe others are less rushed at that point, more patient, in a better mood, whatever, so they give the woman a much longer time frame in which to dilate.
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Old 03-19-2004, 04:15 PM
 
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Of course, if they really are patient, they won't use pit!
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Old 03-19-2004, 04:28 PM - Thread Starter
 
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Originally posted by Greaseball
Of course, if they really are patient, they won't use pit!
So true .

Altho, I think some of us ladies need to be patient as well...or at least be told it IS okay (GOD FORBID) to go more than 10 days past the almighty due date. Or to at least educate ourselves as to this, and have it supported by medical care givers. I didn't know this, myself, at the time. They were telling me how with every day I was overdue, how much the risk of c/s went up. Scared the CRAP outta me. Of course, I did have a responsibility to educate myself as well....

I have an aquaintance who absolutely *REFUSES* to go beyond her due date. She goes to the hospital and begs to be induced and refuses to leave until they do. Make me wanna uke.

She's due with the latest babe the beginning of July and she says to me, "You know, I think this is gong to be an 'end-of-June' baby", meaning, she intends to be induced at the end of June. I CANNOT believe that self respecting Doc's would give in to this! Then again, maybe I can :

Mama to Thing 1 and Thing 2.
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Old 03-21-2004, 06:49 PM
 
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Originally posted by Greaseball
Just from reading threads, I get the idea that every hospital has a different policy, which to me says they are not truly concerned about babies. How can something that is good for babies in one state - or city - be bad for them in another?
They're concerned about their bottom line. Plus you have to take into account regional attitudes. For example...

There is a "Breastfeeding Friendly" initiative that hospitals have to fulfill a number of criteria to get this certification for. I delivered in such a hospital and it was a wonderful experience. EVERY nurse receives extensive BF training and advocates for BFing. There are lactation consultants available to you if you need one. There was a "shopping cart" that came by everyday with BFing supplies, like breast pads, lanolin, etc. Babies were actively encouraged to room in with their mamas. All mamas were allowed time with their baby following the birth (including C/S mamas) for at least 2 hours before the baby was taken for it's exam. During that time all mamas were encouraged to get the baby to latch. In fact, the one and only negative formula-pushing experience I had was with an OB who was visiting and not affiliated with the hospital.

So, this was Boston where people are pretty enlightened and where competition for your health care dollars is fierce b/c there are many hospitals there.

Compare this to a rural hospital where nobody in the region really BFs and the hospital sees no reason to spend the money changing policies. The nurses are all for formula and "giving mama her rest" by putting babes in the nursery all night with paci's and bottled water. There's no incentive for them to be certified as BFing Friendly b/c the mamas don't know any better and don't really have a choice of where to birth anyways.

So, that's my long answer to a simple question, lol.

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Old 03-22-2004, 06:06 PM
 
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Originally posted by Mom2six
You increase the amount until you get the desired response. However, this by definition doesn't produce a "natural" labor pattern. The pitocin, from my understanding, overrides the body's natural feedback mechanism (and hence the need if you are going to back off on it to back off at the same rate taht you increased) to release it's own oxytocin.
Maybe it's the terminology that I found to be misleading. I 'induced' labor with castor oil for my 2nd pregnancy. By that, I mean I used castor oil to kick-start a process that I hoped would continue on its own when the castor oil wore off. When *they* say 'induce or augment labor' what they're actually saying is substitute 'natural labor' with 'artificial labor' until the baby's born one way or another? Well that would have been some valuable information to have as part of my so-called informed consent, that the way they administer pitocin meant that I would be wholesale turning the laboring process over to the pump. At the time, I had no idea I would be committing to anything that drastic (or dangerous IMO). In a way, this illustrates the reason I gave up on having a natural birth at the hospital (with no hard feelings at all toward my 1st vbac team) and had my last baby at home. I doubt that we'd have ever seen eye to eye over what exactly constitutes a "needless risk."
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Old 03-22-2004, 08:51 PM - Thread Starter
 
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When *they* say 'induce or augment labor' what they're actually saying is substitute 'natural labor' with 'artificial labor' until the baby's born one way or another?


lollaleeloo,

Again, I think this is different for every woman. I had my labour started artificially, but my pitocin drip was turned off after two hours and my labour was 7 hours long. So, for 5 hours, I had no drugs and still had adequate contractions to change my cervix. I dunno if this could still be called "artificial labour". The nurse called me a 'whiffer'. She said that some women *need* to have the pit for the duration of their labours and some just needed a 'whiff'.

Mama to Thing 1 and Thing 2.
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Old 03-22-2004, 10:00 PM
 
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Forgive me for not reading all of the posts...I read the first 2 pages and the last page. I am coming to this late, but I wanted to say a couple of things.

Ben was transverse breach and there was no way he was turning. The midwife tried, but he was 9 lbs., 14oz., and my water had broke.

I wouldn't want to go through it again, but I just wanted to say that a c section doesn't have to be the end of the world. Ben was healthy and alert and he nursed within 30 minutes of being born. I had some painful moments after that, but Ben was doing fine. The nurses barely noticed him, even tho they were checking on me a lot. My pediatrician came to see us the next day and commented on how we were bonding She found us looking at eachother in bed.

I felt really bonded with Ben, and I rose to the challenge of recovering as best I could. I'm sorry if this seems like a shameless ploy to retell my birth experience with Ben...

~Joan, Happy mom to 2 beautiful kiddos, one new puppy and 2 lovely felines
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Old 03-23-2004, 12:33 AM
 
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pumpkinhead - What you describe as your experience, a dose of pitocin until your own labor established itself, sounds perfectly reasonable, and it's gratifying to know that they're doing it right somewhere. And no, I wouldn't call that artificial labor. It was an induction of natural labor, not a replacement for natural labor. In fact, that scenario was exactly what I had in mind when I consented to my own induction. Certainly not that it would be turned on, then up to the highest setting tolerated, until the baby came. I was on pitocin for 2 days and they refused to even consider turning it off. Whenever I asked them, numerous times, to at least turn it down (to give me a break from the relentless slamming) their reply was always that turning off the pitocin would likely lead me to a repeat section, which turned out to be very effective in shutting me up btw. I told myself *this* was the labor I wanted so bad, and that in normal labor you don't get to control it with a dial, so I needed to stop being such a wimp and take it like a woman. Having never gotten the chance to labor with my first, I had no idea how fundamentally different a pitocin labor can be from natural labor. As far as I knew, contractions routinely peaking for 3 to 7 minutes was normal. I had nothing to compare it to.

It was only afterwards at one of my pp visits that I was told it was 'policy' that once the pit goes on, it stays on, end of discussion. That ran contrary to what I always thought was the standard for medically appropriate dosage: the minimum effective amount applied for no longer than is necessary. They had me convinced me that I needed it that high for the duration of my labor, when the reality was, they weren't assessing my needs at all, only my tolerance. Still, at the time I just shrugged if off, even though I was annoyed at finding out that despite all my vigilance, I'd once again become subject to yet another arbitrarily administered intervention. It's mainly through these boards that I've realized just how arbitrary. I'm constantly amazed at how much I took for granted that my childbirth options were dictated by my individual needs, when in fact, they had more to do with my randomly chancing upon the right (or wrong) ob/midwife practice (or pitocin pump, for that matter) than anything else.:
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Old 03-23-2004, 01:20 AM
 
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How is the pit connected? Can't the patient turn it off, or pull out her IV?
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Old 03-23-2004, 01:30 AM
 
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Quite honestly, it never occurred to me to do either, but then, I was led to believe that the main thing standing between me and another c-section was the pitocin.
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Old 03-23-2004, 02:04 PM - Thread Starter
 
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lollaleeloo,

How awful! It irritates me how keen the medical profession is to lump every woman into the same category. AS in, what works for one, will work for ALL! We all have different body chemistries. We are ALL DIFFFERENT!!

I think if your body and your baby are *truly* ready to be in labour, it won't really matter what you use to 'kickstart' it, it will work. (Wating another while will prob work as well, but that's a dif. story )My own personal belief (based on no medical fact whatsoever ) is that those women who aren't 'ready' are the ones who end up with C/S no matter what interventions are used to induce or augment labour.

Of course, this is *not* the only reason a woman might end up having a c/s.

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Old 03-23-2004, 03:21 PM
 
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You are right, of course pumpkinhead. "Failed induction" is one of the leading contributors to C-section rates being so high. If the baby is really not ready to be born it's like an unripe fruit on the tree... shake all you want it is likely to hang on. Of course when they induce they often break the waters so then you are committed one way or another.
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Old 03-24-2004, 03:34 AM
 
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Originally posted by kama'aina mama
Has anyone read Ina May's new book? She talks about a midwife in the Netherlands who practiced from 1693-1745 named Schrader. Of the just over 3000 births she attended 10 were placenta previa and in 8 of those cases she was able to deliver a live baby to a live mother. It's astonishing really!

I am not advocating attempting vaginal birth with a previa, just noting this amazing accomplishment.
that is amazing. i want to read this book now. however if i was told there was a 25% chance my baby would die if i tried birthing vaginally, i'd go the surgical route.

i might also add that in so many of these types of statistics they only record who lives and who doesn't. what is difficult to count are the living babies who suffered a brain injury because of lack of oxygen on the way out.

Quote:
Originally posted by stafl
I think what bothers me the most is the language used. Saying that a c-section, in retrospect, was or was not necessary does absolutely no good. What I think we should be discussing is whether or not c-sections are avoidable instead.
i'm not sure i understand this. okay, for every instance that is listed in pumpkin's original list i'm sure that there is someone who birthed vaginally with each one and everyone turned out just fine. that's an interesting discussion too and perhaps someone can start yet another thread on this subject, however i am quite happy with the original tone and intent of this thread.
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Old 03-24-2004, 11:56 AM
 
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CPD - cephalopelvic disproportion
or Chicago Police Department

I recall reading *somewhere* that the only true case of cephalopelvic disproportion results from a case of rickets, which is rarely seen these days, or extreme pelvic injury as from a car accident.

"The great enemy of the truth is very often not the lie, deliberate, contrived and dishonest, but the myth, persistent, persuasive and unrealistic."
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Old 03-24-2004, 02:18 PM
 
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That is not true, about cpd being so rare and only due to rickets, etc. I know LOTS of women whose drs have told them they'll never get a normal to large sized baby out!
And I *know I have cpd, because my doctor TOLD me I have it during my second c-section! He told (actually, screamed at) me that my babies and I would have DIED without a cesarean!

...Of course, I didn't have it with my midwives when I pushed my third, fourth, and fifth children into the world... ROFL


This is a tongue-in-cheek (but true,) post for anyone wondering...
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Old 03-24-2004, 02:30 PM
 
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Copslass, it's a shame they don't have a high-five smilie.
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Old 03-24-2004, 04:07 PM - Thread Starter
 
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Originally posted by copslass
And I *know I have cpd, because my doctor TOLD me I have it during my second c-section! He told (actually, screamed at) me that my babies and I would have DIED without a cesarean!

...Of course, I didn't have it with my midwives when I pushed my third, fourth, and fifth children into the world... ROFL



:LOL :LOL :LOL

Good to know.

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Old 03-24-2004, 04:44 PM
 
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Yes, the human pelvis is remarkable. Although it's often too small to birth a 7-lb baby, for some reason it will be big enough for a 10-lb baby in the future.

I think it comes with the unacceptable sizes stamped on it, or something. Or maybe it periodically expands and shrinks, just to play a joke on us.
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Old 03-24-2004, 06:31 PM
 
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But isn't part of the conundrum about CPD is that it can really only be diagnosed at the time of birth? In the absence of the conditions cited above, rickets or pelvic injury, from what I understand it can't be diagnosed with xrays or exams, because the pelvis changes so dramatically during birth.

And couldn't the diagnosis change from one pregnancy to another, as the mother's body changes and of course, her babies are not all identical. For example, a 42 week delivery in a first time mom might be CPD, where the same woman could deliver her third at 38 weeks easily. Even if the baby is bigger, its head might mold more, and her pelvis stretched out more. ( This is just a generality, I am sure there are women who have had the opposite experience.)

I do think that it is overdiagnosed, and that the majority of cases are probably nothing more than the baby in a less than ideal presentation. But it does seem to me that it is impossible to second guess this accurately. The mistake OBs and women make, IMO, is to not try again with subsequent births. An open-minded, supportive caregiver is pretty essential as well.
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