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Small Pelvis

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CARLY_JORDON
BabyPoints: 4820
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3/9/07 6:34 P

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I would say sort of. I am going to get a doula whether or not he likes it. But I have not told him how much doula's usually cost that might shock him also but I don't ask for much so he will definitely give me what I want.

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Amirra born June 2004 (39 weeks) 6 lbs. 5oz. (pre e, forceps, epi, vaginal)
Masen Alexander 8 lbs. 6.7oz born May 19, 2007 (39w 1d, induced preeclampsia) perfect induction without pain meds.

TTC-2011, I'm looking forward to my 1st home birth. In the meantime I'm trying to lose weight

ZOE1SMOM
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3/9/07 5:33 P

 
 
Carly, did you get DH to agree to a doula? I noticed on another post that he wasn't in favour...

CARLY_JORDON
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3/9/07 5:29 P

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I am so happy for you. I will have a doula at my birth also. I wish you luck on your VBAC

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Amirra born June 2004 (39 weeks) 6 lbs. 5oz. (pre e, forceps, epi, vaginal)
Masen Alexander 8 lbs. 6.7oz born May 19, 2007 (39w 1d, induced preeclampsia) perfect induction without pain meds.

TTC-2011, I'm looking forward to my 1st home birth. In the meantime I'm trying to lose weight

ZOE1SMOM
BabyPoints: 7918
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3/9/07 5:10 P

 
 
I'm so excited! I just spoke with one of the doulas I will be interviewing and she recommended a hospital and a few doctors that have the best VBAC rate and lowest interventions rate.

She was so encouraging and I felt better knowing there are doctors that I will have a better chance with. And it doesn't look like I will have to switch hospitals, which is wonderful because the one my current OB delivers at is only 5 minutes from my home, so then I don't have to go before I'm ready.

I'm really looking forward to having a doula, someone who knows what to look for in the various stages of labour. I think she will help DH feel more confident and comfortable, too.

_CARRIE_
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2/22/07 4:13 P

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OK. With a history of Failure to Progress (the term they normally use.. it's a catch-all for "we don't know why the baby didn't come out") baby not dropping and a larger then average baby with back labor...that just screams an OP baby to me. OP babies usually do turn, and usually do fit even if they don't turn however if you do have a narrow pelvis and it's immobilised by your position (you are in bed, on your tailbone) then the baby often won't fit if it's trying to enter the pelvis OP first.
Give me a few hours and I will scan in some information to you from a few books I have, they are pictures illustrating what I mean.

Since I plan to edit my website tonight anyways I will put them up there temporarily.

How far along did you get before the section (cms station), or was it just taking too long and they did a section? Have you requested your records yet? That might give you more information becuase the mom often doesn't know what the med staff was doing or recording.

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ZOE1SMOM
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2/22/07 3:40 P

 
 
Carrie, thank you for the information and for your encouragement. I will continue to do some more research, as I am leary of the small pelvis diagnosis as well.

I have a question that maybe you or someone else might know the answer to: With my first pregnancy, the baby never "dropped," as the books and so many others promised me she would. I was really looking forward to that, as I was hoping for some relief from my terrible heartburn. Would that be an indication of a small pelvis? Or due to her size (9 lbs, 1 oz)? Or just poor positioning? She & I were back to back and I had terrible back labour the whole 27 hours.

_CARRIE_
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2/22/07 2:39 P

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that's nonsense, Zoesmom. NO evidence supports your dr or the idea that a pelvic exam can give you any information about pelvic size. Even "pelivemetry" has been abandoned.

It's logic: are you going to give birth flat on your back with your knees in the air in the same position that the exam was done in? Yes, you may have what they call an android-type pelvis, which is smaller from rim to rim then the other types. This has no bearing on your body's ability to grow an appropriately sized baby for you.

If you belive in evolution, you have some searching to do because you muct have been destined for extinction after millions of years if it working right:) If you believe in the Creator, you need to ask him to guide your dr and if you should get a second opinion.

HURRY and RUN to a new dr, this one is grooming you for a section and he seeds have already be planted well IMO.

wishing you the best. I was also told I was too small to have a baby who was estimated to be 7lbs. He was NINE pounds and I had plenty of room, the birth was nearly painless. I have had four more since then (all 7-10lbs with 14-15in heads and larger chests and shoulders)

I just wouldn't want to see your life put at fisk on faulty information. At the very least, please research how the pelvis actually works to birth a baby, there is more to it then width.

However, that isn't to say that it NEVER happens that a baby doen't fit or has a really tight fit, despite positioning. Usually this is due to undiagnosed GD or pre-diabetics that gain alot. It can also happen when the parents have a large size difference. (asian woman following an american diet with maybe a giant husband of Latino or Swede descent, both are known for big babies)

Edited by: _CARRIE_ at: 2/22/2007 (14:46)

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ZOE1SMOM
BabyPoints: 7918
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2/22/07 11:24 A

 
 
I don't know how I could get stuck with a small pelvis... it just doesn't seem right. All the women in my family have their babies vaginally. When I say "all the women," I mean, my mom has 11 sisters. I was the smallest of my sisters at 8lbs 4oz and my mom pushed us all out.

How can an OB do a quick pelvic exam and come up with small pelvis? I asked her, "isn't that what all the hormones are for? like relaxin and stuff?" She said they can only move so far...

I don't know. I mean, in the back of my mind, I'm prepared to do what's best for my baby, but I really would like to avoid surgery and all the complications that go with that.

NONSEQUITUR
Posts: 31117
2/22/07 10:55 A

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Edited by: NONSEQUITUR at: 2/22/2007 (13:56)

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Tempus fugit.

MILLGIRL
Posts: 318
2/22/07 10:39 A

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Hi all--

Don't you think in some cases, the small pelvis thing might be true? My best friend has always had to have the 'small' speculum for paps and stuff but no one mentioned to her that she might have trouble giving birth. She delivered her baby at 32 weeks so he was only 3 pounds and his head was greatly compressed. Honestly it was the biggest conehead I had ever seen! She has to see a neurosurgeon since it wasn't going back to size (although everything seems fine now). So now, her Drs and she are wondering if she would be able to have a full term baby vaginally.

Also-she is 5'7 and average build, so I don't think it always relates to size of mom.


m/c Nov. 3 '05
LO #1 EDD June 8/07, arrived by homebirth June 11/07. BF 1 year after numerous complications.

ZSERABEAR
Posts: 13196
2/19/07 2:21 A

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My OB said that I had a narrow pelvic arch when I had my first ( I was 15) and I didnt have any complications whatsoever. I believe that your body can get you through it and knows what you can and cant handle. My aunt is about 11o pounds and about 5'4 and all 3 of her kids were over 9 pounds and she had them vaginally. You can do it girl!!!

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MCCARTHYHOME3
Posts: 1936
2/17/07 2:44 P

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Can i join-in hear? I cannot stand it when i hear "Im sm framed" so ill probably have to get a c-section or "the babies measuring big".
1st the measurments of the baby are "ESTIMATES" they can be up to a pound off either way,I know more than 1 person who was told IT GONNA BE A BIG BABY and ended up with an average sized baby. And since when can a DR tell if you have a sm pelvis just cause your sm framed??? My cousin is 4'11" 95lbs and pushed out a 10lb baby(she has the same DR as I do,hes sooo great!) Sorry to rant,its just so annoying!
Your body will do what it can,Dont let anyone discourage or scare you.


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ZOE1SMOM
BabyPoints: 7918
Posts: 1477
2/15/07 11:26 A

 
 
I found the link to a chapter in my city (thank God we moved to a bigger city) from the ICAN website. There's a section in there for both US and Canada chapter search.

Thank you! I'm on my way. I really appreciate your encouragement.

LTLFAERY
Posts: 9492
2/14/07 6:55 P

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Your welcome. I know ICAN has a Canada chapter now, but I'm not sure of the website.


*remembering the triplets*

ZOE1SMOM
BabyPoints: 7918
Posts: 1477
2/14/07 4:01 P

 
 
Thank you, Marcy, for the article and all the info. I will certainly do some more research and I am feeling even stronger about getting a doula. I haven't looked into how midwifery works here with our hospitals and such. I think my DH might be a little leary of using a midwife, especially with how worried he was during our last labour. He was so thankful for the c/s, just for labour to be over, and the baby to be ok. The fetal monitoring (stats dropping) really freaked him out.

I am in Canada and thankfully, our doctors do not go through as much litigation as is sounds like they do in the US. My OB is still willing to see me through a VBAC. If I go into labour after business hours, I will be with whatever OB is on call, and they will all (apparently) see me through a VBAC. I think having a doula there will really help, both me and DH.

I'm going to be doing lots more research and asking lots of questions. I'll have to be just as fiesty as my OB, I guess.

SWISSMISS2584
Posts: 1140
2/14/07 2:31 P

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I loved that article...I have a friend that says she has a small pelvis and will probably need a C-section because both of her sisters did. It's so sad that she automaticlly assumes that.


Amelia Jean Kyungsoon Costa arrived July 27, 2008 at home!

Home birth, No vax, Cloth Diapers, and Attachment parenting.

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LTLFAERY
Posts: 9492
2/14/07 1:03 P

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i'm sorry your confidence has been somewhat stripped away. Don't let it happen! Your body works, your pelvis works, your uterus works.

Regarding your last birth, unfortunately it is very hard to say "why" you had a cesarean, and 'why' the baby's stats where deceling. It could have been the lenght of the labor itself and stress on the baby, it could have been a cord, it could have been how you were positioned during pushing...etc. One of the harsh realities we have to come to terms as cesareans moms is that we will most likely never know. Sure, you can request your records (which i do recommend you do) and look at your chart, but still it is subjective. Mine says "failure to progress", though I was completely dilated. I know DD was malpositioned, but the chart does not reflect that.


Secondly, there is NO way a dr. can tell you you have a small pelvis, without extensive pelvimetry work, and even then, things are subjective. as the article explains, amazing things happen in labor and birth.


Now, if you do want a VBAC, i recommend a couple of things:

www.ican-online.org
go on the site, look at the frequent questions, the research, the white papers (excellent articles) and try to find a chapter in your area. If there's no chapter in your area, there's a great email support list on there as well. But a local chapter can provide support, and info about your town, the drs that are truly pro-vbac (there's a lot of lip service and scaring women into cesareans out there), excelent vbac doulas etc.

www.plus-size-pregnancy.org
it has great VBAC info, and info for healing form a past traumatic birth experience, letting go of issues we may hold on from our last births etc.

there's also books you can get:
the thinking woman's guide to better birth
silent knife
the vbac companion
rebounding from childbirth
mother's intention: how belief shapes birth.

there's also a 'hopeful vbac' mommy team in this site

Your best weapon is information. Don't believe anything just because a dr. said it, or a midwife said it...look around, ask, research, and come to your conclusion. Your BS meter has to be on, because a VBAC journey isn't easy. It takes determination, conviction, and a lot of work.


*remembering the triplets*

LTLFAERY
Posts: 9492
2/14/07 12:54 P

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Pelvises I Have Known and Loved
by Gloria Lemay
© 2003 Midwifery Today, Inc. All rights reserved.

[Editor's note: This article first appeared in Midwifery Today Issue 50, Summer 1999 and is also available online in Spanish.]
Here's a good article that may cheer you up. I'll post my personal comment separately.

"pelvises I have known and loved"

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.




*remembering the triplets*

ZOE1SMOM
BabyPoints: 7918
Posts: 1477
2/14/07 12:37 P

 
 
I saw my OB yesterday for the first time. After she examined me she said I have a small pelvis. She is not the same OB that delivered my first. She assumed that the reason I had a c/s with the first one was because she was so large (just over 9 lbs) and my pelvis is so small that she wouldn't fit through my pelvis. This is the first time that I have been told I have a small pelvis. No one mentioned anything about that when I was pregnant with my first, during 27 hours of labour, the decision to go with a c/s, nothing.

The reason we opted for a c/s was because the baby's stats were dropping during pushing. They thought the cord was wrapped around her chest or something. I never found out in the end why her stats were dropping, if the cord had actually been around her chest or what. All I knew was I had a healthy baby girl, then I fell asleep.

The OB said I wouldn't be able to get a big baby through my small pelvis. I have been trying not to gain as much weight and to exercise to keep my baby from getting so big. But what else can I do?

Now I'm not feeling as confident about a VBAC. I'm really not eager to go for another c/s, especially with a toddler at home in addition to the new baby.

Anyone else with a small pelvis or know anything about that?


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