Is there REALLY Such a Thing as A Too-Big-To-Birth Baby? - Page 2 - Mothering Forums

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Old 07-10-2005, 04:38 PM
 
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I know of a few cases my midwives have had that both led to hospital transfer of the baby and stays in the nicu on a ventilator. The one was a big mom who kept stalling on getting an ultasound.She was measuring large so they thought maybe twins?Nope,just a big baby and a really tight squeeze through the pelvis.This happened in the last two deliveries to this mom.
The other case was borderline gestational diabetes,and the mom wasn't real good about going along with the nutritional guidelines offered by the midwives.this baby also ended up on a ventilator and a shoulder injury.
I'd say yes it can happen,but i don't think it's all that common.
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Old 07-10-2005, 04:42 PM
 
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one was an even odder position, occiput transverse, with the head also cocked to the side so it was almost presenting sideways (baby was 7 lbs 10 oz).
This was why I ended up with a section, no one even thought that it was CPD...she was positioned badly and didn't want out...silly girl...the doc who did the section told me I have a perfect pelvis for birthing, wide and everything in there is textbook...I DARE someone try to tell me that I can't deliver a baby vaginally, when even the c/sec doc (who is not the most natural minded doc in the world) told me that I would have no problem birthing any baby in proper positioning...
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Old 07-10-2005, 05:11 PM
 
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Originally Posted by doctorjen
...one was an even odder position, occiput transverse, with the head also cocked to the side so it was almost presenting sideways (baby was 7 lbs 10 oz)...
Out of (morbid) curiosity, what would be the probable outcome if a mom ended up delivering such a baby vaginally? That was the cause of my mom's primary c-section in '63 (my brother). If they hadn't done the surgery, I'd guess he wouldn't have made it...but what about my mom?

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Old 07-10-2005, 06:12 PM
 
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Well, there are 3 possibilities, I think.
1. Eventually, if we waited long enough the baby would have lined itself up better and been born vaginally, with no other issue.
2. The baby would have eventually, with good pushing efforts been pushed out in the same position, either with no problems, or perhaps with some injury to baby or mom, such as skull fracture, or bad vaginal tearing or something.
3. The baby truly would not fit like this, and eventually the stress of prolonged labor would have been fatal for the baby, and perhaps the mom, too.
No way now to know what would have happened, since we elected to intervene surgically instead.
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Old 07-10-2005, 09:39 PM
 
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I just add this: my sister had a c section with her first, and the baby was about 8 lbs. 3 oz.; doctor said CPD. Next she had twins (smaller), VBAC; second twin was breech. Third she had a big baby, 9 lbs. 12 oz., last she had an almost 9 lb. baby. All girls. I don't believe that CPD happens very often.
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Old 07-10-2005, 09:48 PM
 
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Originally Posted by boongirl
I've known two cases. In one case, a woman I know had her first child die in utero late term and the process of trying to delivery the baby revealed her pelvis is shaped such that she will never be able to get a child through it. So, with her second pregnancy, which she carried to term, she scheduled a c-section.

In case #2, I had a neighbor growing up who was 5 feet tall at best and slender. She had two babies, both over 10 pounds each and big and tried but could not vaginally deliver either one.
Problem is that people look at little women and automatically equate big baby with c/s. I'm 5'0 on a good day, when the planets are all in alignment and the wind is blowing in the right direction, yadda yadda .... yet I gave birth to a kid over 10 lbs. And I'm a fairly slender gal. About 105-110 lbs when not pregnant. I always tell women this story because it tends to affirm the belief that small pelvises can birth big ol' babies.

I think it is more about fetal positioning than size.
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Old 07-10-2005, 10:05 PM
 
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I have to agree that in most cases it is a "this mom, this baby, this day" issue. My MIL who is a short but sturdily built woman birthed three kids just fine vaginally, but when it came time to birth dh (last and biggest) he just wouldn't come out. They did a c-sec and told her baby was "too big" (he was 10.5 lbs) but I wonder if he just wasn't poorly positioned. My friend is a tiny girl. She is maybe 5 foot and weighed 93lbs soaking wet before she got pregnant with her first. Her boyfried was a big guy (6' 5") and she gained 90lbs during her pregnancy. She was able to birth her 10.5lb baby vaginally. She did need quite a few stitches, but i think that is because they had her coached pushing while lying down and when the baby didn't come fast enough she wound up with a big episiotomy. She probably wouldn't have needed as many if they would have just let her tear.
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Old 07-11-2005, 04:42 AM
 
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It can happen. An acquaintance of mine who is a midwife in New Zealand got very upset when someone told her CPD simply doesn't exist, she said they see it sometimes with Asian women married to Caucasian men. Although not a small woman herself, in fact, she has flirted with the issue, having had problems with shoulder dystocia with several of her children (she's on I think her 7th or 8th pregnancy), which led to one having its clavicle broken during birth. And as others have pointed out, there are occasional deformities of the pelvis to deal with. I don't think anyone is arguing that the overwhelming majority of cases of CPD translate out to things like poor positioning, much as the overwhelming majority of cases of "failure to progress" translate out to impatient doctors. However, to say that such things are a complete myth is also a misunderstanding of the issue.

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Old 07-11-2005, 09:30 AM
 
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About the malpositioning factor...

Experienced midwives, when they were the NORM, not the EXCEPTION, could manipulate babies so they could safely be delivered vaginally. So, for example, if the baby's skull was wedged against the mom's pelvis and couldn't pass through, she would maybe put one hand in and manipulate gently internally while the other hand helped externally, that sort of thing. Simple body mechanics. This sort of thing is a lost art, now that we can just hop into the ER for surgery, tho
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Old 07-11-2005, 01:24 PM
 
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LASTLY, this thought: perhaps this current generation of birthing mamas contains a good handful of women who were born via c-section circa 1975-1980. That's entirely possible.
What do you mean by this?

If it's that they'd be more likely to think they need a C-sec, I can see that.

But if it is some sort of evolutionary argument (about head size, whatever), I don't think so... That would imply that all or most of these women would have died if they hadn't been delivered by C-sec. We know that's not true, so they shouldn't have any genetic problem (e.g.: huge heads) that makes them more likely to have babies with the same problem and need C-secs.

Unless choice of interventive OBs is a heritable trait!
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Old 07-11-2005, 01:59 PM
 
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Originally Posted by tinyshoes
I learned from my ped that a person's head size is a paternal trait. And whenever I think about "big babies" being born, I ignore the fat stats, and am more interested in the size of the fetal head, or the size of DAD'S head.
Oh, great...dh comes from an unusually large-headed family. : My family is a bunch of pea-heads, OTOH! Well, dh was a little smidge of a baby (6 lb 2 oz; even smaller than me at 6.6)--maybe his family has small babies to make up for their disproportionally large heads. :LOL
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Old 07-11-2005, 03:42 PM
 
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I read about study done on cadeavers pelvis' stating that the average woman can birth a 14lb baby . Thats the only part of the study I remember.


I naturally birthed a 9lb babe, I think her head was 14 3/4", she was facing to the right-but not right at my hip,sorta the space between hip and belly button (like I was when I was born,though I was 6lb). Im 5'4", no hips.
Her head was fine, but those big ole Irish farmer shoulders she inheritated from her sd did a bit of damage, and she fractured her right clavicle.

I suppose it depends on the woman, the baby, the time and the place lol
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Old 07-11-2005, 04:43 PM
 
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Originally Posted by tinyshoes
LASTLY, this thought: perhaps this current generation of birthing mamas contains a good handful of women who were born via c-section circa 1975-1980. That's entirely possible.

HOWEVER.....most every woman birthing today, still, was born vaginally, which would imply that the women birthing today are the result of hundreds and hundreds of years of adequate pelvises. The math is simple; if your great-great grandmother's pelvis wasn't big enough two generations ago, you probably aren't here. And neither is your "too small" pelvis, so your c-section is truly unnessary.

When my dd is having babies, and if we hear this "CPD" nonsense spewed from the OBs of tomorrow, that diagnosis would at least have a shred of science to it, since 15% of birthing women will have been born via c-section themselves (I'm taking today [2005's] stat of 28% c-secs and dividing by 2, half for boys, half for girls.)
This is a very good point. The deathrate during childbirth dropped considerably before the huge increase in c/s started. So where did all these inadequate pelvises or big headed babies come from? My guess is interventions.

Also my babies with big heads come from my side not dhs. My small headed babies came from his side. So its probably whatever is the dominate trait...Perhaps big heads are dominate and small heads recessive.

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Old 07-12-2005, 11:54 AM
 
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Originally Posted by mmaramba
What do you mean by this?

tinyshoes said: "LASTLY, this thought: perhaps this current generation of birthing mamas contains a good handful of women who were born via c-section circa 1975-1980. That's entirely possible."

If it's that they'd be more likely to think they need a C-sec, I can see that.

But if it is some sort of evolutionary argument (about head size, whatever), I don't think so... That would imply that all or most of these women would have died if they hadn't been delivered by C-sec. We know that's not true, so they shouldn't have any genetic problem (e.g.: huge heads) that makes them more likely to have babies with the same problem and need C-secs.
Sorry to be unclear. I agree with what you are saying, and I was attempting to make a similar point in so many words.

It's not that my great-great grandmother had to have a c-sec, and so did my great-grandma, and my grandma, and my mom, and so now today in 2005 I can say when I'm pregnant and the OB is telling me my "big baby" won't fit, that I'll believe that bs and go ahead with a c-sec for CPD.

It's not even that the mamas birthing today in 2005 get to say "well, I was born via c-sec so there's a remote possible a chance of CPD."

So I was trying so say that the handful of women today who were surgically removed from their mother's wombs make too small a minority for OBs to even use this totally bogus "head size vs. pelvis" debate! A minority that certainly does not reflect the actual quantity of c-secs performed because of CPD.

Am I making sense yet?

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Originally Posted by mmaramba
Unless choice of interventive OBs is a heritable trait!
funny...but it might be...:LOL
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Old 07-12-2005, 06:41 PM
 
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Am I making sense yet?
Got it. We're totally on the same page.
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Old 07-13-2005, 09:45 PM
 
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Originally Posted by Storm Bride
I don't find race obvious, even in the sense it's used most often. I couldn't begin to tell you what race most people I meet are...I completely agree that "race" is a very vague term.


I'm not really talking about height, though - I'm talking about size. Asian women aren't really a great example (I know I'm the one who brought them up in the first place), as most of them seem to have very wide pelvises for their height. But, I've known quite a few small women of west European background who have very small builds...not just short, but very slight. I really have to think that when they do hook up with the 6'3" (that's not that big, imo...most men in my family are over 6') Norweigan, there is potential for problems with a big baby. But, I did say in my original post that I think this is an occasional issue.

One of the things that got me thinking about it was that my first baby was 7lb., 12oz. - right around the "average" mark. His father was within a couple of ounces of the same birth weight. My second baby was 10lb., 2oz...and her father was 9lb., 13oz at birth. This suggests to me that the father has a lot to do with the baby's size, and it does make sense to me that a woman who comes from a genetic heritage of generations of 6lb. babies could possibly run into problems if she has a baby with a man who comes from a genetic heritage of generations of 10lb. babies. I'm not saying she will have problems - just that if her pelvis could be too small to accommodate a baby that size. (In fact, substitute head size everywhere I mention weight...it's more relevant, imo.) That's really all I meant.

Hmmmm.... My first baby, whose father was Filipino, was much bigger than my second baby whose dad is Polish. My 2nd weighed almost a lb more, but his length and head size were much smaller. And as we all know, fat squishes. I barely had to push and he came flying out (9lbs 4oz, btw.)

Also, I am of mainly Celtic descent (w/ a little German thrown in, but I definitely don't take after that side of the family--I'm 5'3 and definitely on the small side) and I have, to quote my midwife, "a pelvis you could drive a truck through."

IMO, race has absolutely NOTHING to do w/ it. I agree w/ those who said it has much much more to do w/ your nutrition while growing. I was bf for 15 mos and always had enough to eat after weaning. No junk food in the house either. I have a friend who is much taller and bigger than me, big-boned and all that. She had a c-sec for true CPD. She is also of mainly celtic descent, with a little German, BUT she was abused and starved as a child and then spent many years in foster care where she wasn't treated much better. Her dh is Portuguese.
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Old 07-14-2005, 12:46 PM
 
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rarely. I know personally a 4'10" lady who gave birth vaginally to a 9 lb baby, and many homebirthers have 10# and up babies just fine. Nora Lam, whose testimony created the movie "China Cry" had her first baby vaginally (docs had given her up for dead, due to baby's large size, almost 11 lbs on a tiny woman) and had 2 vaginal births after that. btw, her first birth was UC in the hospital. She asked the Lord to give her strength after something like 40+ hrs of labor, and He did, and she pushed with everything she had and she felt her pubic bone separate, and the baby came out...she stimulated him and the nurses were shocked to hear a baby's cry in the room!(she had been wheeled to a storage room, because she was expected to die....HA!)
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Old 07-14-2005, 07:17 PM
 
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I wonder if the lady was afraid to let the baby out, if she had been sexually abused? I had a client that had this happen to her at 7 cm...I tried to prepare her for the feelings she might encounter, but she froze(litterally) and then the baby started having decels.(might have also had cord problems.) There was a "halo" on top the baby's head. She ended up with a section...but was grateful, and I tend to agree with her...
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Old 07-14-2005, 07:47 PM
 
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time to have this baby at home, eh? Avoiding that doc again might be a good idea!
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Old 07-14-2005, 08:28 PM
 
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along the same lines, and I understand where you're coming from: one doesn't breed a shetland pony mare to a quarter horse stud...the mare could not birth a foal that big, and i think the same basic biology principle applies to humans...shape and size are generally inherited...until the big financial/legal push for sections in the 1970's, the c/s rate was about 5 % or so, which is where the World Health Organization feels it should be...improved nutrition and antibiotics are the real reason the death rates for moms and babies dropped during the mid 1900's.....
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Old 07-15-2005, 10:05 PM
 
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Originally Posted by cathicog
I wonder if the lady was afraid to let the baby out, if she had been sexually abused? I had a client that had this happen to her at 7 cm...I tried to prepare her for the feelings she might encounter, but she froze(litterally) and then the baby started having decels.(might have also had cord problems.) There was a "halo" on top the baby's head. She ended up with a section...but was grateful, and I tend to agree with her...
We never discussed the type of abuse, but I wouldn't be surprised if it included sexual. But no, I don't think that's what it was w/ her. She actually pushed for quite a while and when they finally did the section, they had a hard time getting the baby's wedged head out of her pelvis, it was really stuck in there. She had a VBAC w/ her 2nd, but was induced early to ensure a smaller baby. She went into it knowing that just being induced greatly upped her chances of needing another c-sec. But she also knew she couldn't deliver a big baby. Her first's head was the same size as my first's (I think 37cm? I looked it up when we talked about it.), and her 2nd's was 35. I think.
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