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Discussion Starter · #1 ·
Midwives and doulas, greetings <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile"><br><br>
Assuming that a woman has a platypelloid pelvis--or at least, a fairly broad, shallow pubic arch that is apparently reducing her anterior/posterior pelvic outlet space, what would be your plan for 2nd stage? Also assuming that no matter how straightforward dilation and descent to +2stn is, 2nd stage shows clear signs of slow and difficult progress, even with a 7lb baby in an otherwise healthy, average sized woman (as to her build, height, weight).<br><br>
Do you have positions you might recommend or avoid with this kind of pelvis? 'Kind of pushing' as to 'purple' or 'open glottis' or 'breathing through'? Anything aside from normal attention to FHT and so forth during 2nd stage? Anything you have noticed, or developed as protocol or options in dealing with this?<br><br>
Your input will be appreciated <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/thumb.gif" style="border:0px solid;" title="thumbs up">
 

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I find women with that broad and shallow pubic arch end up pushing on their backs or semi-reclined. It seems to help them move the baby under the pubic arch. A lot of clients I've seen with this pelvic shape start out pushing in upright positions, get tired, and end up in bed only the then FINALLY start making progress. I'm not to the point where I recommend that she get on her back or semi-recline, but I have noticed that it seems to be the opposite of what I'd expect...usually my clients who start out pushing lying down make progress when they get upright.<br><br>
In any case where baby takes a while to descend, I check heart tones more often and keep a good eye on scalp color, just because of the stress that prolonged head compression can cause. At my last birth, baby crowned for 10 minutes, but his heart rate was never under 110, so I didn't rush her through that crowning. <span style="font-size:xx-small;">(I did not, however, let him restitute) <img alt="" class="inlineimg" src="/img/vbsmilies/smilies/bag.gif" style="border:0px solid;" title="Bag"></span>
 

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Discussion Starter · #3 ·
Thanks, Charmie--<br><br>
That position makes sense to me for the reasons you gave-- and yes, paying attention to how baby is taking the compression.
 

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Thanks for this thread. Subscribing so I can see more responses if anyone is going to give them <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile">. I don't have enough experience with this to have anything to add, really.
 

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I have heard it suggested that moms with this type of pelvis should push standing, perhaps with the back arched. I wonder if the tipped pelvis helps the baby get beyond the sacral promontory.
 

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Discussion Starter · #6 ·
Thanks Defenestrator....I'm going to have think about that one, play with a visual of the pelvis/spine/baby I think, to understand the idea.
 

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I believe this is the shape of mine, and I can tell you what position my MW had me pushing in. DH was seated in a chair in front of me with his wrists crossed, I grabbed his hands, went into a deep squat and leaned back against the apprentice who was behind me so that my back was about 45 degrees to the floor, and my butt was just inches off the ground. It was not an easy position to maintain, and the apprentice wound up flat on her back for the next week. And even so, I had a 90 minute pushing stage with severe moulding. But I was not getting any descent past I believe +1 until I got into that position.
 

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Discussion Starter · #8 ·
Thanks, Cristeen--interesting! Because when seeing this kind of pelvis/birth, what you describe came to mind. Not in all details, but something that looks like semi-recline. 'purple pushing position' without any weight on the sacrum.<br><br>
I guess if someone is going to provide that back support, they better have some support themselves, eh? Ouch, poor apprentice....
 
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