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Misshapen pelvis?

2962 Views 12 Replies 11 Participants Last post by  myniyer
I went to my regular OB/GYN today for my first prenatal visit and I had heard that she and the hospital she practices at are very anti-VBAC. To my surprise, she asked if a repeat C was what I was going for. I told her that I'd like to try a VBAC. She asked the circumstances of my first C-section and when I told her the baby was face up, she said that if one is face up, it's likely the next will be face up and it has to do with the way my pelvis is shaped on why that is so but that it occurs every time. I asked if my weight was an issue and she said not really. she said C-sections were "easier" and "you come in and an hour and a half later you have a baby, you aren't as tired. It's really nice." She did give me the opportunity to decide if I wanted to try a VBAC but said it wasn't her first choice of things to do and that if I wanted to deliver at the other hospital that she is on staff at (the nicer more private one) that they only do scheduled C-sections there and that's it.

Granted she is really nice, I like her personality and she is very caring, but the things she told me seemed a little off the wall.

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Y'know what? The OB I had with my first birth was really nice, I liked his personality and his manner, he had a respectful bedside manner, etc. He was even recc'd to me by a midwife.

Between him and the hospital, I got put through most of what I didn't want to happen (admitted to hospital unprepared on short notice because I was postdate and even though I passed the nonstress test I was there for, the doc "didn't like the look of the results", saying I had too much amniotic fluid.), induction, monitoring, bad response of baby to pitocin, and C-section.

It was very nice of him to follow my request and double-layer suture when he closed me up, but he cut me open in the first place, and I will NOT be going back to him looking to VBAC.
Amy -

My suggestion is that you find a new doctor. My first baby was also posterior. I was not very aware back then but there are plenty of things you can do during pregnancy to prevent a posterior presentation. One book I recommend is Sit up and Take Notice by Pauline Scott. I know that you can get it thru the ICAN website. There is also a great website called Spinning Babies. My doctor also told me that my pelvis was defective. I was told that I had a platypeloid (sp?) pelvis and that my chances of delivering vaginally were slim to none.. I left that doctor, found a new doctor who supported me and my VBAC delivery went off without a hitch. As I read your post, the writing is on the wall and believe me, there is no way this dr. is planning on letting you VBAC. She is just paying you lip service. Please do not let anyone tell you that you pelvis in inadequate. It is very rare that a baby cannot fit thru your pelvis. It is not a fixed organ. It will mold and shape and open to allow the baby to pass thru. There is also a great article called Pelvises I Have Known and Loved by Gloria Lemay. Take a look at that too. Ok - I will get off my soap box now but if you truly want to VBAC, I would start looking for a new doctor.
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Here's the article so you do not have to hunt for it.

Pelvises I Have Known and Loved
by Gloria Lemay

What if there were no pelvis? What if it were as insignificant to how a child is born as how big the nose is on the mother's face? After twenty years of watching birth, this is what I have come to. Pelvises open at three stretch points-the symphisis pubis and the two sacroiliac joints. These points are full of relaxin hormones-the pelvis literally begins falling apart at about thirty-four weeks of pregnancy. In addition to this mobile, loose, stretchy pelvis, nature has given human beings the added bonus of having a moldable, pliable, shrinkable baby head. Like a steamer tray for a cooking pot has folding plates that adjust it to any size pot, so do these four overlapping plates that form the infant's skull adjust to fit the mother's body.

Every woman who is alive today is the result of millions of years of natural selection. Today's women are the end result of evolution. We are the ones with the bones that made it all the way here. With the exception of those born in the last thirty years, we almost all go back through our maternal lineage generation after generation having smooth, normal vaginal births. Prior to thirty years ago, major problems in large groups were always attributable to maternal malnutrition (starvation) or sepsis in hospitals.

Twenty years ago, physicians were known to tell women that the reason they had a cesarean was that the child's head was just too big for the size of the pelvis. The trouble began when these same women would stay at home for their next child's birth and give birth to a bigger baby through that same pelvis. This became very embarrassing, and it curtailed this reason being put forward for doing cesareans. What replaced this reason was the post-cesarean statement: "Well, it's a good thing we did the cesarean because the cord was twice around the baby's neck." This is what I've heard a lot of in the past ten years. Doctors must come up with a very good reason for every operation because the family will have such a dreadful time with the new baby and mother when they get home that, without a convincing reason, the fathers would be on the warpath. Just imagine if the doctor said honestly, "Well, Joe, this was one of those times when we jumped the gun-there was actually not a thing wrong with either your baby or your wife. I'm sorry she'll have a six week recovery to go through for nothing." We do know that at least 15 percent of cesareans are unnecessary but the parents are never told. There is a conspiracy among hospital staff to keep this information from families for obvious reasons.

In a similar vein, I find it interesting that in 1999, doctors now advocate discontinuing the use of the electronic fetal monitor. This is something natural birth advocates have campaigned hard for and have not been able to accomplish in the past twenty years. The natural-types were concerned about possible harm to the baby from the Doppler ultrasound radiation as well as discomfort for the mother from the two tight belts around her belly. Now in l999, the doctors have joined the campaign to rid maternity wards of these expensive pieces of technology. Why, you ask. Because it has just dawned on the doctors that the very strip of paper recording fetal heart tones that they thought proved how careful and conscientious they were, and which they thought was their protection, has actually been their worst enemy in a court of law. A good lawyer can take any piece of "evidence" and find an expert to interpret it to his own ends. After a baby dies or is damaged, the hindsight people come in and go over these strips, and the doctors are left with huge legal settlements to make. What the literature indicates now is that when a nurse with a stethoscope listens to the "real" heartbeat through a fetoscope (not the bounced back and recorded beat shown on a monitor read-out) the cesarean rate goes down by 50 percent with no adverse effects on fetal mortality rates.

Of course, I am in favour of the abolition of electronic fetal monitoring but it would be far more uplifting if this was being done for some sort of health improvement and not just more ways to cover butt in court.

Now let's get back to pelvises I have known and loved. When I was a keen beginner midwife, I took many workshops in which I measured pelvises of my classmates. Bi-spinous diameters, sacral promontories, narrow arches-all very important and serious. Gynecoid, android, anthropoid and the dreaded platypelloid all had to be measured, assessed and agonized over. I worried that babies would get "hung up" on spikes and bone spurs that could, according to the folklore, appear out of nowhere. Then one day I heard the head of obstetrics at our local hospital say, "The best pelvimeter is the baby's head." In other words, a head passing through the pelvis would tell you more about the size of it than all the calipers and X-rays in the world. He did not advocate taking pelvic measurements at all. Of course, doing pelvimetry in early pregnancy before the hormones have started relaxing the pelvis is ridiculous.

One of the midwife "tricks" that we were taught was to ask the mother's shoe size. If the mother wore size five or more shoes, the theory went that her pelvis would be ample. Well, 98 percent of women take over size five shoes so this was a good theory that gave me confidence in women's bodies for a number of years. Then I had a client who came to me at eight months pregnant seeking a home waterbirth. She had, up till that time, been under the care of a hospital nurse-midwifery practise. She was Greek and loved doing gymnastics. Her eighteen-year-old body glowed with good health, and I felt lucky to have her in my practise until I asked the shoe size question. She took size two shoes. She had to buy her shoes in Chinatown to get them small enough-oh dear. I thought briefly of refreshing my rusting pelvimetry skills, but then I reconsidered. I would not lay this small pelvis trip on her. I would be vigilant at her birth and act if the birth seemed obstructed in an unusual way, but I would not make it a self-fulfilling prophecy. She gave birth to a seven-pound girl and only pushed about twelve times. She gave birth in a water tub sitting on the lap of her young lover and the scene reminded me of "Blue Lagoon" with Brooke Shields-it was so sexy. So that pelvis ended the shoe size theory forever.

Another pelvis that came my way a few years ago stands out in my mind. This young woman had had a cesarean for her first childbirth experience. She had been induced, and it sounded like the usual cascade of interventions. When she was being stitched up after the surgery her husband said to her, "Never mind, Carol, next baby you can have vaginally." The surgeon made the comment back to him, "Not unless she has a two pound baby." When I met her she was having mild, early birth sensations. Her doula had called me to consult on her birth. She really had a strangely shaped body. She was only about five feet, one inch tall, and most of that was legs. Her pregnant belly looked huge because it just went forward-she had very little space between the crest of her hip and her rib cage. Luckily her own mother was present in the house when I first arrived there. I took her into the kitchen and asked her about her own birth experiences. She had had her first baby vaginally. With her second, there had been a malpresentation and she had undergone a cesarean. Since the grandmother had the same body-type as her daughter, I was heartened by the fact that at least she had had one baby vaginally. Again, this woman dilated in the water tub. It was a planned hospital birth, so at advanced dilation they moved to the hospital. She was pushing when she got there and proceeded to birth a seven-pound girl. She used a squatting bar and was thrilled with her completely spontaneous birth experience. I asked her to write to the surgeon who had made the remark that she couldn't birth a baby over two pounds and let him know that this unscientific, unkind remark had caused her much unneeded worry.

Another group of pelvises that inspire me are those of the pygmy women of Africa. I have an article in my files by an anthropologist who reports that these women have a height of four feet, on average. The average weight of their infants is eight pounds! In relative terms, this is like a woman five feet six giving birth to a fourteen-pound baby. The custom in their villages is that the woman stays alone in her hut for birth until her membranes rupture. At that time, she strolls through the village and finds her midwives. The midwives and the woman hold hands and sing as they walk down to the river. At the edge of the river is a flat, well-worn rock on which all the babies are born. The two midwives squat at the mother's side while she pushes her baby out. One midwife scoops up river water to splash on the newborn to stimulate the first breath. After the placenta is birthed the other midwife finds a narrow place in the cord and chews it to separate the infant. Then, the three walk back to join the people. This article has been a teaching and inspiration for me.

That's the bottom line on pelvises-they don't exist in real midwifery. Any baby can slide through any pelvis with a powerful uterus pistoning down on him/her.

Gloria Lemay is a private birth attendant in Vancouver, B.C., Canada.
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That's a great article, Penny. I used to give it to all my clients whenever their "pelvis structure or "how narrow their hips" was called into question.

I am going to be a bit blunt and say this...

I have known many OB's who have fantastic bedside manner. And all of the women that had these wonderful OB's wound up with csection... Me included. It is nice to be treated kindly by the health care provider you are choosing to attend you at one of the most intimate times in your life... but is this person actually treating you like a grown woman, who is an equal partner in the decisions or are you getting a little pat on the head, as though you are a 8 year old child who needs to remember to behave?

I didn't think there was a difference until I was on the table having my baby surgically removed and being told that I should be thankful that I hadn't delivered vaginally. The RN actually saying for all to hear "It's a good thing that the doc did it this way... that baby would have torn Mom (me) to shreds."

And yeah it "isn't her first choice of things to do" -- to be present at the hospital from the time you come in until you deliver. I mean that is just ridiculous to think that an OB might actually be present while their patient is giving birth
and "that if I wanted to deliver at the other hospital that she is on staff at (the nicer more private one) that they only do scheduled C-sections there and that's it." read: if you want to be cushy at the "nice" hospital you are just going to have to suck it up and take one for the team by having a repeat c/sec??

I'm not trying to be mean but I can pretty much predict that if you were to stay with this Dr, you'd wind up with a 2nd scar across your belly. Take the time and examine what you truly want. If you don't feel comfortable with the Dr's explanation as to why your DC was posterior.. go explore the information on the internet. "Optimal Foetal Positioning" by Sutton and Scott is a great book! And finally OP babies do get born!! A good friend of mine gave birth to her first child who was COMPLETELY OP. He didn't turn at all and was born "star gazing". It was a longer birth and she required a lot of support but SHE gave birth.
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Just as a side note: my baby was also face up....which led to the c-section. However, when I discussed vbac with my ob she was confident that i could go vbac next time without any hesitation. The "face up" scenerio was not that likely to repeat....or due to a misshaped pelvis!! I find that odd that your dr. would say that?
I just wanted to come back and lend support to the OP. I was very blunt when I posted my first reply and may come off as insensitive but if I had a nickel for every time I have heard that women were told it was their fault that they had a c/sect or that a vaginal birth is SOOOO horrible or that c/sects are no big deal or that VBAC-ing is a sure way to kill yourself or your baby or that........ you get the idea.

I know how hard it is... trying to be treated normally when you've got the "Scarlet C" plastered all over you medical records as well as the scar across your belly. But believe me, having a VBAC is sooooo much easier than a repeat c/s. I was up and walking within an hour of the birth. I took a shower w/in 2 hrs of the birth. Eating food as soon as I wanted. Holding my newborn son without having to guard my incision site... even though unconsciously I did whenever I coughed or laughed too hard just because I had to when I was recovering from my c/s.

In my opinion what your Dr said to you the last time you saw her was a HUGE RED FLAG. She was essentially telling you that your body is defective and that she expects you to schedule a ERCS because VBACs are not convenient for her. This is not about her... this is about you, your body, your baby and your desires for this birth. If you want a VBAC, my suggestion would be to find a MW (or even a TRULY supportive OB) that isn't afraid of VBACs. And arm yourself with the information about baby's positions and how the affect labor and birth. Enlist a doula that is passionate about birth. Tell your DH what it would mean to your to give birth to your baby rather than be recovering from major abdominal surgery with a newborn in tow...

I hope that you pursue and are able to go onto have the birth you want.
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I gotta be quick, cause dd wants me to play... but

In a nutshell, what this "nice" OB is telling you is that you have no chance of a peaceful VBAC with her. I am glad it is out there and obvious. If she is pushing it now, she will push it later. What she is telling you about your body and your baby, and about the ease of cesarean surgeries is Bullshit. Your babies past position does not mean that your body is built wrong for birth. Nor does it mean that this baby will present in the same way.

Please don't go to McDonalds requesting an organic hummus sandwhich. They just don't offer them regardless of how much you would like them to.

Your body is built for birth. Vaginal birth is safer than repeat c/s. THis baby has a birthright... Get a supportive care provider, strong mama!
It really sucks when you find a nice ob.... but you disagree on something so important. I had the nicest, friendliness ob practice. They were so kind and syphathetic when I miscarried. I never dreamed I could want to leave them.

Then I went to a party and found 3 other women with babies near my dd's age who had delivered with that practice. 3 out of 4 of us had c-s. One women barely got to the hospital when they said c-s.

I just noticed your location... the vbac climate is really bad there right now. Can you look into a midwife?
I think you should run from this one. She will either con you into scheduling or plant so much doubt in you that she will probably sabatage you in other ways.

Your pelvis is awesome. Don't let her mess with your head!
I too think you should look for another OB or a midwife. Babies can be born posterior and one posterior baby doesn't mean another. With the VBAC world like it is today you need someone who is 100% supportive of your VBAC plan.
Good luck and keep us posted!
The once a posterior baby always a posterior baby is ludicrous. My first was posterior (didn't turn at all, born sunny side up) and it was an agonizing, LONg labor with 4+ hours of pushing. My second was not posterior, and I pushed exactly twice. My third was frank breech, LOL! each pregnancy is different, and what happened in one will not automatically repeat in the next, and she's trying to make you tow the party line by telling oyu any different.
I agree - run, don't walk, from this OB. She is telling you she is going to give you a C no matter what. As PPs have said, at least it is out in the open and you can leave her now while it's still early enough to be easy to find another provider.

And you know what, it doesn't matter if the shape of your pelvis IS contributing to a posterior lie. I was a posterior baby, my first DD was posterior (and we both came out face up and were delivered vaginally) but it does take longer, and I had no desire to repeat that experience if I could have an easier one.

With this pregnancy I sought chiropractic care. The chiro showed me x-ray proof (a series of slides from the same patient) that chiro care can reshape pelvises. It makes sense: since they reshape during birth, why not over months of manipulation? It only took her two weeks of my visiting regularly to effect enough difference in my pelvis to turn my posterior-lying baby.

I suggest you find a new HCP, and a chiro to boot, start seeing him/her regularly, and as others have suggested follow OFP guidelines too. You have the power within you to have a wonderful VBAC birth of an anterior baby. Seize the chance! If nothing else think how satisfying it will be to look up that OB after the fact and tell her how wrong she was, and that you told her so
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