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.

http://www.midwiferytoday.com/articles/pelvis.asp

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Comments:

p2of9
Jun. 1, 2008 at 2:19 AM It was all good till I read up to "Every woman who is alive today is the result of millions of years of natural selection."   Then she starts talking about short women and pygmys?  No offense, but Gloria Lemay sounds a little too Aryan/Darwinian for the popular list.

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infin...
Jun. 1, 2008 at 2:22 AM

What an uplifting article on natural birth vs artificial birth. However, it was too one-sided. It doesn't acknowledge the very necessary c-sections surgeries out there. My first being a prime example. My hips are very wide, but my pelvic is very narrow. Even the nurses who checked me over remarked in surprised tones at how small my pelvic was, as I was hard at work laboring my first child. During the active stage of labor, it stalled. I underwent an emergency c-section, after which a grape-fruit sized cyst (I have a polaroid pix of it) was discovered. It was partially blocking my DH's huge head from progressing down the canal. All the pushing I did inflicted great pain upon my DH. She was in pain for weeks after birth. I realized then that natural birth must be undertaken by the very educated and knowledgeable. I was ignorant to the risks of natural birth in the event of lack of preparation, cysts, and everything else that can make natural birth dangerous. Of course, I wanted a natural birth experience. I was depressed for many years over not being able to birth my DH naturally and for choosing to have a planned c-section with my DS. But I was even more depressed over the fact that my DH suffered through my attempt to have a natural birth. It is not a easy experience for babies. One must be fully prepared and to have all the help they can get from doulas and midwives. My DS recovered wonderfully after my planned c-section. I bf'd both kids. The first for only 3 months and the second ongoing. (he's now 19 months old, so I'm in the extended bf'ing stage).

 ~Lisa

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Quayla
Jun. 1, 2008 at 4:28 AM I always find these things interesting.  I myself had the "what about me?" attitude towards natural birth.  My first child was a completely uneventful pregnancy with great birth.  The second time around however was a different story.  Among other things I had a very large fibroid tumor, the size of a large grapefruit, located on the lower left side of my uterus.  It was actually pushing my sons head into the right side of my pelvis at the end of pregnancy.  Sometimes I could wiggle his head straight down to my cervix with hip circles and such, but he wouldn't stay there long.  I was very concerned that because the tumor was located so close to the os that even if dilation went well, that there simply wouldn't be enough room for the baby to pass through.  Well a couple doctors that I went to automatically wanted to do a c-section, they didn't want to let me "try" to give birth.  I found a doctor who was pretty sure things would be fine.  She couldn't say for sure of course, but that she in her 20+ years of experience, including all of her collegues experience, had never seen or heard of a tumor or cyst of any kind actually cause a problem with giving birth, the baby just pushes them out of the way.  She said that giving birth might take more effort but it could be done.  She was right it did.  It took 40 minutes of painful pushing instead of 7 minutes and an orgasm:) but I did it.  Knowing that I had an obstical to push past I chose the same postition that I used for my first birth; a modified hands and knees position.  I can not imagine giving birth any other way, and I feel for all the moms that have been stuck flat on their back. 

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Tanya...
Jun. 1, 2008 at 10:39 AM

infinite lady: The only women who's pelvis' will not allow a child through, are those with deformities due to rickets or injury. The ligaments loosen up during labor to allow the baby through. There is no way to determine how wide the pelvis will open. Pushing while lying on your back, as most American women in hospitals do, closes to pelvic opening by 30%. A woman should be allowed to follow her instincts and move around in labor, which is nearly impossible practically strapped to a bed with an IV, epidural, catheter and CFM. A woman allowed to follow her instincts will often end up in an upright position, squating or on her hands and knees. I suggest you watch The Business of Being Born, read some books such as Pushed and check out the group Birth is Normal on cafemom.

 

Cindy-great article! I will be voting it popular. Women need to know the truth!! 

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SlapI...
Jun. 1, 2008 at 11:06 AM Great article, thanks for sharing!!

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wendy...
Jun. 1, 2008 at 6:19 PM

What a great article :D 

Of course youre going to get responses that say "Good article but MY C-section was necesary" because a lot sectioned moms cant admit to the fact that MAYBE they were lied to in order to be rushed out of the birthing suite at the hospital.

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cali4...
Jun. 1, 2008 at 7:09 PM wendy, you couldn't be more right. no one wants to believe that they had unnecessary major surgery, it's a hard pill to swallow. once they open their eyes to how corrupt the maternity health care system is they can no longer just be another statistic with another sad birth story that could have been prevented.

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