Information on CPD (big baby fears look here!) - Mothering Forums

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Old 01-20-2010, 01:37 AM - Thread Starter
 
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I thought I would post some links about Cephalopelvic Disproportion, also known as CPD. This is what a lot of providers are referring to when they suggest inducing or scheduling a c-section for a baby that is suspected to be "too big," or they are afraid of growing too big. They may say that they think that they baby's head or shoulders are too big to pass through the birth canal, or that the mom is too petite or has an "inadequate pelvis."

I researched this a lot in my last pregnancy. My doctor was trying to tell me that my pelvis was too small and he wanted me to get an X-Ray to prove it. I got two second opinions, one from a perinatologist who I happened to be seeing anyway. She told me that true CPD is very rare and is almost always found in third world countries where a woman is suffering from malnutrition, or a woman who has been in an accident or was born with an obvious deformity. The most important thing I learned was that CPD can not be diagnosed in advance. The "prescription" for suspected CPD is a trial of labor, which means the woman goes into labor and they see what happens. Because the woman's pelvis opens up during labor and the baby's head molds to fit, you can't really tell in advance what is going to happen. A woman's pelvis is likely to open up the widest when she goes into labor on her own!

I left my doctor at 38 weeks and switched to another one. Unfortunately I did end up with a c-section, but it had nothing to do with the size or shape of me or my pelvis (or of the baby! she was 7 lbs 10 oz) and more to do with the fact that I was induced and my body was not ready to go to labor. Since then, I have become extremely active with the International Cesearean Awareness Network and met tons of women who had their c/s for "CPD" or "FTP" (failure to progress) and went on to VBAC, many of them VBACing bigger babies than the ones they had their c-section for! ICAN has a great, inspiring video called Question CPD.

Links
Ican's White Pages on CPD
Childbirth Connection's info of Cesarean Section--In case you or your provider are considering an elective c/s in the face of CPD
ACOG guidelines on Fetal Macrosomia

I thought this was interesting

Quote:
Cesarean Delivery. The role of cesarean delivery in suspected fetal macrosomia remains controversial. While the risk of birth trauma with vaginal delivery is higher with increased birth weight, cesarean delivery reduces, but does not eliminate, this risk. In addition, randomized clinical trial results have not shown the clinical effectiveness of prophylactic cesarean delivery when any specific estimated fetal weight is unknown. Results from large cohort and case-control studies reveal that it is safe to allow a trial of labor for estimated fetal weight of more than 4,000 g. Nonetheless, the results of these reports, along with published cost-effectiveness data, do not support prophylactic cesarean delivery for suspected fetal macrosomia with estimated weights of less than 5,000 g (11 lb), although some authors agree that cesarean delivery in these situations should be considered.

Induction of Labor. In cases of term patients with suspected fetal macrosomia, current evidence does not support early induction of labor. Results from recent reports indicate that induction of labor at least doubles the risk of cesarean delivery without reducing the risk of shoulder dystocia or newborn morbidity, although the results are affected by small sample size and bias caused by the retrospective nature of the reports. Results from one randomized clinical trial reveal similar cesarean delivery rates in the induction group (19.4 percent) compared with the expectant management group (21.6 percent), with five cases of shoulder dystocia in the induction group and six cases in the expectant management group.
And finally, since this is MDC after all I want to remind you to trust your bodies and trust that your body won't grow a baby you can't birth. Best wishes!

Blair, mom to the amazing Nora (8/06) ribboncesarean.gif, sweet Anneliese (2/10) vbac.gif, and super Henry (8/12) vbac.gif

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Old 01-20-2010, 02:26 AM
 
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Interesting...but here's my question...

I have currently had 3 vaginal births, babies ranging in size from 7.5 to 9 pounds. All of my kids have had a 90th percentile or greater head circumference at birth (and beyond) as well. I've been at the same OB practice for all 4 pregnancies, and my own OB personally delivered the last two (one of his associates delivered my first since she was the doctor on call).

My last baby was the biggest - 9 pounds at 38 weeks and a head circ off the top of the charts. I was already very much dilating/effaced when I had my induction, and instead of starting with pit we broke my water to try and get things started more "naturally". Despite the fact that it was my third pregnancy, second induction (first was done because of concerns about her cord), and I was an "excellent" candidate things were slow to progress - essentially baby was not descending into my pelvis properly. I was told that it was because it was such a tight fit and he had to be positioned "just right" and was told a baby any bigger than he was would likely have problems coming out vaginally.

So fast forward to now...another 90th percentile boy, and one who looks like he'll be of a comparable size to his brother. Looking at another induction (albeit at a later gestation because of new hospital regs) for size to help avoid a c/s and delivery problems like shoulder dystocia. Now since I've had three births my pelvis has had its "trial" so-to-speak - so does it make sense to go along with the thought that a larger than average baby would not make it down, or is it possible my pelvis would/could spread more on its own than it has in previous births?

Nicole, Mommy to Jasmine (7/05) , Athena (2/07) , Shane (3/08) , Caleb (1/10), and 2 angels (4/06 & 4/09)
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Old 01-20-2010, 04:04 AM
 
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Thank you for this. Just today I received my surgical/doctor's report from my first pregnancy/delivery. Right on the front page, under final diagnosis, in all caps, was CEPHALOPELVIC DISPROPORTION. Talk about a punch in the face for someone at 38 weeks, shooting for a VBAC. Of course I know it's not true, but seeing it was just crappy. I'm pressed for time now, but I'll be back to this thread to read some more. Thanks!

Wife to dh and mommy to dd1 (3/07), ds (1/10), and dd2 (any day now)!

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Old 01-20-2010, 01:36 PM
 
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Thank you for posting this information. I have no fears about this myself. But then again, I've had no real medical interventions (no u/s, so I have no clue 'how big' this baby is).

I think the "knowledge is power" mantra is failing women here. Instead of giving out facts, it's all guestimates... and women begin to doubt the abilities of their own bodies.

I hope a lot will read this.

Judy, wife to my Catholic deacon husband ... homeschooling mother to my four girls, a boy, and someone new in May '15! Forever remembering our loss (8/11) .
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Old 01-20-2010, 01:47 PM
 
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great information folk girl!

Courtney and Cree, baby made 3, added one more then there were 4, sakes alive, then we had 5, another in the mix now we have 6!

A Momma in love with her Little Women-Jewel Face, Jo Jo Bean, June Bug, and Sweet Coraline.

 

 

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Old 01-20-2010, 11:22 PM
 
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Thank you for sharing this info. Having a "too big baby" is something I fight worrying about. My last baby was 11.3oz (he was two weeks over due) and while I didn't tear it was very frightening getting to a point where I was pushing and pushing and nothing-he wasn't going anywhere. He ended up having shoulder distotia-my midwife used tons of tricks to get him out. Once born he was not breathing. He did start breathing on his own after a few min but he was rushed by abulance and spent 5 days being watched. The whole thing was so tramatic for me, the sheer panic of feeling like I couldn't push him out.....anyways needless to say I don't want this happening again. even in writing this I know that what I need to focus more on his having this baby more on time with my due date. I am taking a 6 week thing to help with this but....yeah I still worry about it.

ok that was a huge ramble.
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Old 01-20-2010, 11:48 PM
 
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I went to get the 'ok' or whatever from the OB, as required by state law for HB, today. He is nice enough and his wife is a midwife, so he supports natural birth, etc. But, he told my midwife and I that if the baby was over 8lbs it was going to be a really tight squeeze and that if I went early, that would be better. MW is not worried about it, and neither am I really, but it's in the back of my mind now. Neither of my mom's babies hit 8 lbs, even though I was a 41 weeker and I'm measuring a little small anyway.

Kara: on a journey with DH, Mama to DS 2/2010
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Old 01-21-2010, 12:34 AM
 
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Thanks for posting!

Mama to three

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Old 01-21-2010, 01:12 AM
 
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Thanks for posting this! I love ICAN.

My medical record can't decide what my issue is. On various pages, as reason for the c/s, they have listed:

CPD
FPD (Fetopelvic Disproportion)
tachycardia
FTP
and the kicker?
FOOTLING BREECH - for the baby whose head was wedged so far into my pelvis that a nurse had to push it back up while the doctor pulled.

I'm Kellie :, married to Chris , and mom to one baby girl (7/12/09).
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Old 01-21-2010, 05:47 PM
 
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Thanks for the post, I am a lil on pins and needles because I have a measuring u/s on Tuesday and my last 2 visits I have measured large....like I am 35 weeks and measuring 38....anyway with the GD it certainly makes it more scary because they will be throwing that out at me.....also they look at the fact I had 9.15oz baby and so they think I am even at more risk, never mind my other 3 were around 7.13 or so each......anyway I am planning to not give in to induction or c-section.....if I can help it......

Mom to 5 little angels in Texas and expecting another blessing in Summer 2012!!:

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Old 01-23-2010, 02:06 AM
 
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Quote:
Originally Posted by NicoleS View Post
Interesting...but here's my question...

I have currently had 3 vaginal births, babies ranging in size from 7.5 to 9 pounds. All of my kids have had a 90th percentile or greater head circumference at birth (and beyond) as well. I've been at the same OB practice for all 4 pregnancies, and my own OB personally delivered the last two (one of his associates delivered my first since she was the doctor on call).

My last baby was the biggest - 9 pounds at 38 weeks and a head circ off the top of the charts. I was already very much dilating/effaced when I had my induction, and instead of starting with pit we broke my water to try and get things started more "naturally". Despite the fact that it was my third pregnancy, second induction (first was done because of concerns about her cord), and I was an "excellent" candidate things were slow to progress - essentially baby was not descending into my pelvis properly. I was told that it was because it was such a tight fit and he had to be positioned "just right" and was told a baby any bigger than he was would likely have problems coming out vaginally.

So fast forward to now...another 90th percentile boy, and one who looks like he'll be of a comparable size to his brother. Looking at another induction (albeit at a later gestation because of new hospital regs) for size to help avoid a c/s and delivery problems like shoulder dystocia. Now since I've had three births my pelvis has had its "trial" so-to-speak - so does it make sense to go along with the thought that a larger than average baby would not make it down, or is it possible my pelvis would/could spread more on its own than it has in previous births?

I wanted to respond to your question. YES, you can absolutely have the baby, vaginally, after you go into labor on your own. Your body is not going to grow a baby you cannot birth. Now, there are some catches, if you are birthing on your back or in other positions that narrow your pelvic opening, then that changes things, it's a lot more likely you will not be able to. If you push in normal, birthing positions that your body will tell you to get in (hands and knees, squatting, upright, etc) then those WIDEN your opening, then you don't have to worry. Now, if you have an epidural, it's going to be a lot harder to get in these positions, if you have pitocin, you are more likely to need an epidural, and if you have both, you are more likely to need a cs at the end of it all.

Also, if you don't have an epidural or other movement inhibiting interventions (cEFM, IVs, etc) then you can get into positions and move around to help baby descend into pelvis properly, and during pushing, if you do run into shoulder dystocia, you can use the gaskin maneuver, or the maneuvers that get the baby out without episiotomies or other trauma.

Also, when you wait till you go into labor on your own, your relaxin hormones are at their highest and those are what relaxes your ligaments for your pelvis to open up.
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Old 01-23-2010, 01:33 PM
 
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Thanks so much for posting! I agree with other PPs, that it is a matter of misleading info that is making women doubt themselves.

Also to a degree we have to remember how much intervention is really taking place, even in a 'normal', unmedicated vaginal birth. There is a lot of interference into the physiology of what would be a truly natural birth. All the hospital procedures and protocols, AROM, EFM, lithotomy position, externally-directed pushing--in addition to the more obvious epidurals and pitocin...all these things inhibit labor's natural progression and therefore increase the 'need' for more and more interventions. So while true CPD may be rare, on paper it will look much more common just for the fact that labor and birth are taking place within the medical framework.

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Old 01-30-2010, 02:12 AM - Thread Starter
 
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Bumping this because I just read a great blog post called Big Baby Bull. It has a lot of the same info/links available in this thread, plus much much more.

Blair, mom to the amazing Nora (8/06) ribboncesarean.gif, sweet Anneliese (2/10) vbac.gif, and super Henry (8/12) vbac.gif

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