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Are C-sections 'hereditory'..?

Posted by on Aug. 7, 2010 at 11:45 AM
  • 19 Replies
I was just sitting here thinking, and realized... My sister had to have her son by Csection. After being over due by 9days, she was induced, and had a hard labor and after pushing for over 2hrs the baby got stuck and she had an emergency c section.

My mom also had both her kids by c section. Not sure of the circumstances.
I a sure my gma had a couple if not all c sections with all 4 of her kids.

So do you think I'm more prone to have one?? I have VERY wide set hips. Everyone has joked since I was yonger that I have 'child bearing hips'...idk if wide hips make a dif in child birth or not...

So what are your opinions on c sections being 'hereditary' ??
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by on Aug. 7, 2010 at 11:45 AM
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doulala
by on Aug. 7, 2010 at 11:49 AM

It's so unlikely that a woman will need a cesarean because of her hips, but this is one rare circumstance.     True CPD can happen because moms have genetic birth defects, accidents, illness...

There is something called the pink kit--

doulala
by on Aug. 7, 2010 at 11:49 AM

Cephalopelvic Disproportion (CPD)

by Kelly Milotay


What Is CPD?

Cephalopelvic Disproportion (CPD) is the medical diagnosis used when an infant’s head is declared too big to fit through the mother’s pelvis. Often, this diagnosis is made after the woman has labored for some time, but other times, it is entered into a woman’s medical record before she even labors. A misdiagnosis of CPD accounts for many of the unnecessary cesareans performed in North America and around the world annually. This diagnosis does not have to impact a woman’s future birthing decisions. Many actions can be taken by the expectant mother to increase her chances of birthing vaginally.


Absolute vs. Relative CPD

Absolute CPD is very rare and may be diagnosed in the following circumstances:

  • The mother sustained a severe pelvic injury.
  • The mother suffered from malnutrition as a child (i.e. rickets).

Research tells us that the term "absolute," may be too strong. Many women who are told that they have "absolute CPD” go on to have vaginal births. Even women who have had damage to their pelvic structure from severe malnutrition or a pelvic injury can sometimes go on to birth vaginally. In one study, 68% of women diagnosed after labor with “absolute CPD” still went on to have a vaginal birth. However, in extremely rare cases, true absolute CPD does exist, usually in the context of severe malnutrition or a permanent injury.1



Relative CPD (also known as FPD - Feto-Pelvic Disproportion) is the supposed inability of a baby to navigate through the mother’s pelvis, perhaps due to one of the following reasons:

  • Position of the baby’s head - The baby may have his head straight or tilted back instead of flexed with chin to chest. The baby’s head may also be asynclitic (tilted to the side).
  • Nuchal arm or hand - The baby may have her hand(s) or arm(s) raised to her head.
  • Posterior position - Baby is facing mother’s front instead of back.
  • Other malposition of the baby’s head - The back of the baby’s head may be facing sideways and has arrested in that position (transverse arrest). Occasionally, this happens as the baby tries to turn during labor into a more favorable position. Also brow or face presentations, where other parts of the baby’s head present first instead of its crown, may cause the baby to not be able to descend.
  • Misalignment of the pelvis - The mother’s pelvis could be misaligned due to many factors (mild pelvic jarring due to falls, sports injuries, or car accidents). Many women report this to be generally well-treated with chiropractic care.
  • Restriction of movement - Limitations on mother’s mobility in labor are very common due to hospital policy, epidural anesthesia, and/or continuous fetal monitoring.
  • Rupture of membranes - The breaking of the mother’s waters, either naturally or artificially by her care provider, can cause the baby to drop into the pelvis in an unfavorable position. An arbitrary and artificial time limit being placed on labor may not allow the laboring woman’s body enough time to birth.

Understanding the Mechanics of Birth

A woman’s pelvis is flexible and is made to open during birth. When there is interference with the birth process (induction before baby is ready, mother’s movement is restricted, etc.), the pelvis is not able to open to its maximum. The baby’s head molds (changes shape) during labor and delivery in order to fit through the pelvis. Neither the pelvis nor the baby’s head are fixed in one position; both expand and shift as labor progresses. A birthing woman’s pelvis is most likely to expand freely and accommodate the baby when the following conditions are present:

The birth takes place when the baby is ready and when natural birth hormones are present.The laboring woman moves freely to her comfort level.Adequate time is allowed for the molding of the baby’s head.

CPD Myths

Some care providers will tell women that the following factors may prevent their babies from fitting through their pelvises. Many of these statements lack valid research and some of them have been actively disproved. Many women have had vaginal births despite meeting one or more of these criteria. 2 3 4

  • Your sacrum is prominent, protruding, or flat.
  • You were previously diagnosed with CPD or Failure to Progress (FTP).
  • Your baby is too large.
  • You have a narrow pubic arch.
  • Your pelvic dimensions are too small.
  • You have an android/platypelloid pelvis.
  • Your partner is tall.
  • You are too short.
  • Your shoe size is too small.
  • You are petite.
  • You and your partner are different races.
  • You are obese and fatty tissue is padding your pelvis making it more difficult for your baby to fit through.

Many women who are diagnosed with CPD go on to birth larger babies vaginally. Click target="_blank">here to see ICAN’s "Question CPD" video.


Pelvimetry

If you have been previously diagnosed with CPD, your care provider may suggest pelvimetry. Pelvimetry is the measurement of the pelvis via clinical manual exam, x-ray, CT scan, or MRI. Many studies have debunked pelvimetry as a reliable indicator of the ability to birth vaginally. In one study of women diagnosed with an "inadequate pelvis" after one previous cesarean section, 67% went on to VBAC. 5 6 7 8 9 10


Suggestions Which May Help Lower Your Risk for a CPD Diagnosis


  • Some women report that chiropractic care throughout and between pregnancies is helpful in avoiding CPD. Look for a chiropractor who has experience working with childbearing women and utilizes in-utero constraint techniques.
  • If you want to be mobile in labor, listen to your body. Don’t remain strapped to the bed; insist on getting up and moving around.
  • Learn labor positions that aid in opening your pelvis.11 Consider reading & using The Pink Kit, a childbirth education tool useful for any woman planning a VBAC. It can help a woman find the best birth positions for her particular pelvic shape and size.
  • Learn the position of your baby and how to encourage your baby to be in the optimal position. Read the material at Spinning Babies website.
  • Have a doula. Research shows that a birthing woman with continuous labor support is more likely to have a shorter labor and a spontaneous vaginal birth.12

How Likely Am I To Birth Vaginally After a Cesarean for CPD?

Studies report two-thirds of women will have a successful VBAC despite a previous diagnosis of CPD. One study showed an 80% VBAC success rate for women who had undergone a cesarean for arrest during the second stage of labor (CPD). In another study of women who had undergone two previous cesareans for CPD/FTP, 56% delivered vaginally.13 14 15 16 17


Other CPD Resources: *

Sit up and Take Notice: Positioning Yourself for a Better Birth by Pauline Scott


Birthing the Easy Way - Learning the Hard Way by Sheila Stubbs


The Pink Kit by Common Knowledge Trust


Spinning Babies Website


* Your local ICAN chapter may have copies of these books & DVDs to loan you. Click here to find your closest ICAN chapter. They may also be available through the ICAN Bookstore.


References:

[1] Impey L, O’Herlihy C. First delivery after cesarean delivery for strictly defined cephalopelvic disproportion. Obstet Gynecol 1998 Nov;92(5):799-803.

[2] Mahmood TA, Campbell DM, Wilson AW. Maternal height, shoe size, and outcome of labour in white primagravidas: a prospective anthropometric study. BMJ 1988 Aug 20-27;297(6647):515-7.

[3] Walsh CA, Mahony RT, Foley ME, Daly L, O’Herlihy C. Recurrence of fetal macrosomia in non-diabetic pregnancies. J Obstet Gynaecol 2007 May;27(4):374-8.

[4] Wischnik A, Lehmann KJ, Ziegler M, Georgi M, Melchert F. Does the "fatty pelvis" exist? Quantitative computer tomography studies. Z Geburtshilfe Perinatol 1992 Nov-Dec;196(6):247-52


[5] Wong KS, Wong AY, Tse LH, Tang LC. Use of fetal-pelvic index in the prediction of vaginal birth following previous cesarean section. J Obstet Gynaecol Res 2003 Apr;29(2):104-8.

[6]Yamani TY, Rouzi AA. Value of computed tomography pelvimetry in patients with a previous cesarean section. Ann Saudi Med 1998 Jan-Feb;18(1):9-11.

[7] Ferguson JE 2nd, Newberry YG, DeAngelis GA, Finnerty JJ, Agarwal S, Turkheimer E. The fetal-pelvis index has minimal utility in predicting fetal-pelvic disproportion. Am J Obstet Gynecol 1998 Nov;179(5):1186-92.

[8] Krishnamurthy S, Fairlie F, Cameron AD, Walker JJ, Mackenzie JR. The role of postnatal x-ray pelvimetry after cesarean section in the management of subsequent delivery. Br J Obstet Gynaecol 1991 Jul;98(7):716-8.

[9] Abu-Ghazzeh YM, Barqawi R. An appraisal of computed tomography pelvimetry in patients with previous cesarean section. East Mediterr Health J 2000 Mar-May;6(2-3):260-4.

[10] Blackadar CS, Viera AJ. A retrospective review of performance and utility of routine clinical pelvimetry. Fam Med 2004 Jul-Aug;36(7):505-7.

[11] Michel SC, Rake A, Treiber K, Seifert B, Chaoui R, Huch R, Marcinek B, Kubik-Huch RA. MR Obstetric pelvimetry: effect of birthing position on pelvic bony dimensions. AJR Am J Roentgenol 2002 Oct;179(4):1063-7.

[12] Hodnett ED, Gates S, Hofmeyr GJ, Sakala C. Continuous support for women during childbirth. Cochrane Database Syst Rev 2007 Jul 18;(3):CD003766.

[13] Brill Y, Windram R. Vaginal birth after cesarean section: review of antenatal predictors of success. J Obstet Gynaecol Can 2003 Apr;25(4):275-86.

[14] Phelan JP, Ahn MO, Diaz F, Brar HS, Rodriguez MH. Twice a cesarean, always a cesarean? Obstet Gynecol 1989 Feb;73(2):161-5.

[15] Clark SL, Eglinton GS, Beall M, Phelan JP. Effect of indication for previous cesarean section on subsequent delivery outsome in patients undergoing a trial of labor. J Reprod Med 1984 Jan;29(1):22-5.

[16] Abu-Heija AT. Vaginal birth after one previous caesarean section: a Jordanian experience. J Obstet Gynaecol 1995 Feb;21(1):9-12.

[17] Jongen VH, Halwerk MG, Brouwer WK. Vaginal delivery after previous cesarean section for failure of second stage of labour. Br J Obstet Gynaecol 1998 Oct;105(10):1079-81.









A diagnosis of CPD (cephalopelvic disproportion) is where the baby’s head is thought to be too large to pass through the woman’s pelvis.

In the 18th and 19th centuries, poor nutrition, rickets and illnesses such as polio caused pelvic anomalies, which resulted in loss of life during childbirth. Indeed initially CPD was the most common reason for carrying out a caesarean. In modern times, however, CPD is rare, since our general standard of living is so much higher and true CPD is more likely to be caused by pelvic fracture due to road traffic accidents or congenital abnormalities.

Often CPD is implied rather than diagnosed. In cases where labour has failed to progress or the baby has become distressed, medical staff commonly assume that this is due to physical inadequacies in the mother rather than look towards circumstances of the mother’s care. These problems frequently occur when CPD is not suspected and there are many other causes such as fear and uncertainty, difficulty adjusting to a medical environment, lack of emotional support and non-continuity of carer.

Many women worry about how something as big as a baby will come down such a narrow vaginal passage, so implications of pelvic inadequacy can confirm personal fears, lower self-esteem, affect the progress of any subsequent labour and add greatly to feelings of failure.

CPD is also sometimes suspected when the baby’s head fails to engage, although both this and failure to progress have proved unreliable indicators.

When CPD is suspected, x-ray pelvimetry may be suggested, either ante-natally or post-natally. This is when the mother’s pelvis is measured by taking x-rays to assess pelvic adequacy. Quite apart from the health risks of x-rays, this method of pelvic assessment has been criticised since it has been shown to be inaccurate and because often the results do not influence the way that the delivery is managed.5 Due to concerns over x-ray exposure of women and babies, some hospitals offer pelvimetry by computed tomography (CT) scan which uses a much lower dose of radiation. However, there is no reason to believe that the resulting measurements will provide a more accurate diagnosis of CPD than conventional x-rays for the same reasons.

A woman’s degree of motivation to achieve a vaginal delivery along with the level of support she receives are likely to be more influential on the outcome than her pelvic measurements. Even in undisputed cases of CPD, it should still be possible for a mother to go into labour without compromising the safety of her baby. In fact, a period of labour prior to caesarean section is believed to reduce the occurrence of respiratory distress and can therefore be beneficial for the baby.

In any case, CPD is difficult to diagnose accurately since there are no less than four variables that cannot be measured:

1. The pelvic girdle is not a fixed, solid structure

During pregnancy and labour the hormone relaxin softens the ligaments that join the pelvic bones, allowing the pelvis to give and ‘stretch’. The degree of pelvic expansion achieved will vary from woman to woman and from pregnancy to pregnancy.

2. Babies’ heads mould into shape

Babies’ heads are made up of separate bones which move relative to each other, allowing the baby’s head to ‘mould’ and thus reduce its diameter during passage down the birth canal. No-one can predict the capacity of an individual baby’s head to mould and, as this is a feature of the normal birth process, should not adversely affect the health and well-being of the baby.

3. The position that a woman adopts during labour and delivery makes a difference to pelvic dimensions

Squatting, for example, can increase pelvic measurements by up to 30%. One of the most common positions in which women give birth, that of being semi-reclined where the mother’s weight is on her coccyx, restricts movement of the coccyx, which can severely compromise a below-average pelvis.

4. Baby’s position

The position of the baby can be crucial, and whether its head is well flexed or tilted can mean the difference between an easy delivery and delivery being impossible.

What if I have had a previous diagnosis of CPD?

When a diagnosis of CPD has been made, many people still believe that this constitutes a reason for elective repeat caesarean section in future pregnancies, despite the wealth of evidence to the contrary. Indeed, there have been many documented cases where women have been diagnosed as having CPD and then gone on to deliver vaginally a larger infant than the one that was delivered surgically.

Karen, whose first baby remained high and was caesarean born due to failure to progress in labour, was diagnosed as having CPD following a CT scan. She went on to deliver a healthy 9lb 7oz baby vaginally. The likelihood of vaginal birth is not significantly altered by the indication for the first caesarean section (including “cephalopelvic disproportion” or “failure to progress”).

Some women will be able to accept and concur with a diagnosis of CPD, perhaps even preferring the caesarean way of birth, whereas others will want to be able to come to their own independent conclusions, and some of these may wish to labour again under more conducive circumstances, to have the chance to give labour their ‘best shot’.

The above information on cephalopelvic disproportion (CPD) was excerpted from our article, Caesarean Myths Exploded.

Stories & Experiences From Australian Midwives

“I met a woman who told me she had had a caesarean section for CPD with 1st bub. Had a homebirth with 2nd, who was 2lb heavier. I believe CPD does occur, but is very rare.”

“Not really a story, but a lot of the cases of ‘CPD’ where I work, I notice the babies either have asymmetrical moulding, or bruising that is not right where it should be. Most of these babies are asynclitic presentations, it seems, and are being labelled as CPD, scaring the women into future caesarean sections without the facts.”

“There is a dishonesty and lack of true understanding of the abilities of women’s bodies, let alone birth, by those who readily use terminology like CPD to justify forceps and vacuum deliveries, not birth, in this instance! Where is the logic that the head will only fit when pulled out?”

Some Tips If You Are Worried

1. Grab yourself a copy of the Pink Kit

Myself and my clients who have borrowed it, loved the Pink Kit. It is a DVD/book combination which teaches you about your pelvis and how to find out which unique shape your pelvis has. It provides suggestions on positions based on that shape and as a result reduces fear and increases confidence in your body’s ability to birth well. Of course, other birth topics are covered but it has a strong self-education focus which I think is essential.

2. Read about optimal fetal positioning

BellyBelly has an article HERE or check out the fabulous site, Spinning Babies – which all pregnant women should read. I have heard from many doulas and midwives (as well as having seen it myself) that women get sent off for caesareans due to CPD or ‘failure to progress’ when the baby was simply in a posterior position or not in an optimal position, as one of the midwives commented above. It is believed that modern lifestyle (more sedentary than it once was) could be a reason for babies in posterior or other less optimal presentations.

3. Get a second opinion.

If you are not happy or convinced being told your body is not able to give birth vaginally then it’s definitely worth seeking a second opinion. Don’t give in to pressure or a carer who is not willing to listen to your concerns or give you the change to birth vaginally.

4. Hire a private midwife or doula

By hiring your own private midwife or doula, you will have someone to listen to your needs and concerns and they will advocate for or with you. You can locate a private midwife by contacting the Maternity Coalition and you can find a doula in BellyBelly’s Directory.

5. Attend private birth education classes

Contact the National Association of Childbirth Educators (NACE) which are external to hospital classes and offer a good range of information specific to giving birth as actively as possible. Hospital classes are often limited and are more specific to basics and pain relief options. Private classes are not bound by policies and protocols and offer the best education for a couple wanting honest and accurate information.

Watch me!

A great clip on YouTube from ICAN about CPD here.

Also, you can view a link in our forums which contains images (nudity) of birth – small women and large babies – you’ll be amazed at what women are capable of.

Ultrasound Says You Have a Big Baby?

Then did you know that the Australasian Society for Ultrasound in Medicine in their policy, ‘Statement On Normal Ultrasonic Fetal Measurements,’ states the following: “No formula for estimating fetal weight has achieved an accuracy which enables us to recommend its use.”

Some Studies On Pelvimetry and CPD

1. Impey L. and O’Herlihy C. First delivery after caesarean delivery for strictly defined cephalopelvic disproportion. Obstet Gynecol 1998;92:799-803.

68% delivered vaginally in the next pregnancy, 47% with a larger baby. Of 15 women previously delivered by caesarean at full dilatation 11 (73%) delivered vaginally. In 19 patients pelvimetry had been performed. In 11 (63%) dimensions were judged to be abnormal. All underwent trial of labour and 6 (55% – including two with larger babies) delivered vaginally.

2. Phelan et al. Vaginal birth after cesarean. AMJOG 1987;157:1510-5.

“Previous indication for cesarean birth bears only little relationship to the subsequent successful vaginal delivery”.

75% of women with previous cesarean for CPD/failure to progress delivered vaginally.

3. Jongen VHWM et al. “Vaginal delivery after previous caesarean section for failure of the second stage of labour”. BJOG 1998;105:1079-81.

82 (80%) of 103 women with previous delay in descent in second stage delivered vaginally, including 41 (75%) of 55 who had a history of failed instrumental delivery.

4. Flamm BL and Goings JR. “Vaginal birth after caesarean section: Is suspected fetal macrosomia (large for dates baby) a contra-indication.”

4000-4499g range, 139 of 240 patients (58%) delivered vaginally. Greater than 4500g, 43% delivered vaginally. Comparison with control group of 301 women with no previous uterine surgery and macrosomia, showed no significant difference in perinatal or maternal morbidity.

from:   http://bellybelly.com.au/articles/birth/small-pelvis-big-baby-cpd

lilblu399
by Bronze Member on Aug. 7, 2010 at 11:49 AM
Nope, they do happen more often but that is not because of genentics. My one sis had 2, my other had none and has 3 kids, my mom and grandma has 6 and neither one had a C. I had one and gonna do my best to avoid another.
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lilblu399
by Bronze Member on Aug. 7, 2010 at 11:49 AM
Nope, they do happen more often but that is not because of genentics. My one sis had 2, my other had none and has 3 kids, my mom and grandma has 6 and neither one had a C. I had one and gonna do my best to avoid another.
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doulala
by on Aug. 7, 2010 at 11:50 AM

I love this:

 

 

Pelvises I Have Known and Loved

by Gloria Lemay

[Editor's note: This article first appeared in Midwifery Today Issue 50, Summer 1999 and is also available online in Spanish.]

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.

doulala
by on Aug. 7, 2010 at 11:53 AM


Who you hire might be your biggest risk, too.   
An OB is a high-risk specialist, a surgeon, trained to find illness.  

Treating normal labors as though they were complicated can become a self-fulfilling prophecy. ~Rooks

And midwives are Normal Birth Specialists.     If you prefer to avoid a cesarean, using the care provider who is more likely to help is a great start!

:-)


The U.S. cesearan rate is at a record high of 31.8%;   in 1970 it was 5.5%.




sissychristi
by on Aug. 7, 2010 at 12:15 PM

No. Needing a c-section is not hereditary. Each person has different circumstances for needing a c-section. It has nothing to do with your size, the size of your hips, the size of the baby, or what your family did.

My sister is 4'11" and a size zero and she birthed a 9lb baby vaginally with no tearing. I attended a birth for a woman 5'10" with wide hips who couldn't push her baby out.

The difference in the two labors was that my sister had no meds and was not tethered to monitors during her labor so she moved around freely and did not push on her back. The other mom was on her back the whole time and got pitocin/epidural for induction.

There are many ways to free a "stuck" baby, but if you have an epi and are stuck on your back in bed, you might not have enough feeling in your lower half to move and will possibly need a c-section.

The biggest factor in avoiding a c-section is to walk, squat, get on your hands and knees, rock on a birth ball, and get into the tub. These will all help baby get into the perfect position to come out easily.

sissychristi
by on Aug. 7, 2010 at 12:16 PM

Doulala...you are freaking awesome! ;-)

doulala
by on Aug. 7, 2010 at 12:17 PM


Quoting sissychristi:

Doulala...you are freaking awesome! ;-)

lol

thanks.





hurleydoll18
by on Aug. 7, 2010 at 12:22 PM

Absolutely not.  It may seem like it mostly because so many women are getting c sections and the majority aren't necessary.  It will depend highly on the OB you have and the hospital you go to.  If an OB or hospital prefers doing C sections, they will give pregnant moms an excuse as to why they need a C section.  Many times they pull the excuse out of their asses or cause the reason themselves, by inducing and such.  It is likely that your sister may not have needed a C section if she hadn't been induced.  If labor would have started naturally, chances are very likely it would have ended in a vaginal birth.  Induction causes a lot of C sections and so many women are being induced before the baby is ready to come out. 

If there is a hereitary medical problem in the family that really requires a C section, then I guess you could call it hereditary in that circumstance but not in most.  Some hospitals have over a 50% section rate and some OBs have close to 100% section rate and I can guarantee that all of those were not necessary, not even most of them. 


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