My pelvis broke at 20 weeks pregnant in the Joplin, MO tornado. I am now about 29 weeks and every specialist has been telling me that my pelvis will not be able to withstand the pressure and movement of a vaginal delivery. I am more open to the c-section because of the opinion of the orthopedic surgeons who all have said NO WAY for a vaginal delivery BUT am still skeptical.
Does anyone have any experience that would help? I have not been able to find any research that includes the time between break and vaginal delivery.
FTR, I have had 3 previous vaginal deliveries, all of them intervention-free and one of them at home.
Melody...Mommy to ds1, dd1, ds2, ds3, ds4, and dd2
If your fracture was at 20 weeks, this gives you approximately 20 additional weeks for the bone to heal. Generally, that should be completely reasonable for regaining nearly complete bone strength. Calcium metabolism is a bit altered during late pregnancy, but even so, this seems like plenty of time. Usually in young healthy people, about 90% of bone strength is regained after about 12 weeks. The problem is that the doctor can't really do any x-rays to evaluate how well the fracture has healed. Still, if there's no pelvic deformity from the fracture, and it has indeed healed well, it should be ok. Did they need to put any hardware in that might hinder pelvic mobility? Am specifically thinking about anything around the SI joints and symphysis? That would make a difference potentially, becsause your pelvis wouldn't be able to open and move as it normally would. Incidentally, I just looked on pubmed, and there is actually some anecdotal evidence that pregnancy *accelerates* fracture repair, so that's good news for you. See http://www.ncbi.nlm.nih.gov/pubmed/18261239 So major risk for all of this would be the possibility of re-fracturing. Is this something that you would find acceptable? At what point would you draw the line? If there were a 1% risk of this would that be fine? How about 5%? 10% Alternately, the risks of cesarean are medically quite minimal, but it is major abdominal surgery and obviously a completely different (not fun, IME) birth experience -- something to be avoided unless the benefits outweigh the risks. Another thing to consider is whether you plan to have any additional children. If you do (or might), this is yet another reason to avoid a cesarean. At the end of the day, you have to do what you think is best of course. If you think it's worth trying for a vaginal delivery I wouldn't personally argue with you (I am not a physician, but I am a research scientist/biomedical engineer and bone biomechanics is my area of expertise) but I would plan on a hospital birth just in case. If anything is likely to go wrong it will happen while you're pushing. Worst possibility is a re-fracture, which I imagine would manifest as a sharp and persistent pain at the original frx site. Questions I would ask - What is a typical healing time for a pelvis fracture? When is a hard callus fully formed and at near-full strength? - Is it likely that in another 10 weeks my own fracture will be at that point? -Is there a safe way to determine whether my fracture has healed? (ultrasound measurements of the bone can sometimes be used for this) - How likely is it that a vaginal birth would put stress on the fracture site? - If it were to re-fracture, how would that impact my physical function? (ie would you be laid up for antoher 10 weeks? Mobile? able to carry your baby and get out? this may be a major consideration) Best of luck with your decision.
Mom to James ( 5/2006), Claire ( 6/2008), furry kitties Calvin and Bob, and wife to Dennis.
This sounds like a truly exceptional situation and I would trust what your doctors are telling you. One doctor can be wrong, two probably aren't, and three who all agree are only rarely wrong. If everyone agrees, I'd start planning now for what you need to have as gentle a cesarean birth as possible. Thank goodness that you and your baby are alright in spite of all you've gone through, and good luck with your upcoming birth!