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    Find out what other moms-to-be are asking. Join in the discussion with Henci Goer, whose expertise is determining what the research tells us best promotes safe, healthy birth. If you would like to contact Henci outside of the Ask Henci forum, send an email to Goersitemail@aol.com.

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    Archived User
    I'm currently 26 weeks pregnant. The doctor told me my pelvis was small when he first checked in at 2 weeks pregnant. He said there's a possibility that I might need a cesarean if my pelvis doesn't grow. Are there any exercises or anything I can do to have a normal birth delivery? By: caslover1975
    Archived User

    Yes, there is. You can find another care provider. Unless you have a malformed pelvis, either because you were born that way or you had an illness, such as rickets, or an accident, there is no way a care provider can say that the baby probably won't fit through your pelvis. This is because it isn't a matter of fixed measurements. The hormones of pregnancy loosen the normally rigid joints between the bones of your pelvis so that by the time of the birth, the pelvis has "give" to it. In addition, the bones of the baby's skull have not fused together and there are openings where there is no bone. This allows the baby's head to mold to the shape of the pelvic opening. In addition, other factors having to do with labor management, such as pushing while lying on your back, can impede progress and lead to an unnecessary cesarean.

    Meanwhile, the fact that he is already planting the seed that you will need a cesarean is a red flag. If your obstetrician doesn't believe you can birth your baby, it will affect his judgment in ways that work against you. He may, for example, set arbitrary time limits on your making progress. It will also undermine your confidence. Labor is challenging, and you will need faith in your body. Imagine if you were trying to run a marathon with your trainer telling you beforehand that he doubted you could succeed.

    I suggest you ask your obstetrician his cesarean rate. A diplomatic way to phrase it is, "How often do you find it necessary to do a cesarean?" If you get a number higher than 15%, the percentage supported by studies that have looked at what constitutes a reasonable cesarean rate, you know that you cannot trust his judgment on whether cesarean surgery is necessary. If there is, in fact, some reason why your pelvis might be unusually small, seek a second opinion from a care provider who has a cesarean rate in this range or 10% or less if you are getting an opinion from a midwife. (The lower number is because midwives don't take care of high-risk women.) If your ob doesn't know his cesarean rate or won't tell you, that is another red flag. It's an important number. He should know it.

    Here are some sites where you can get additional information on cesarean surgery and on how to choose a care provider whose practices are in line with the best medical research:

    Care Practices that Support Normal Birth
    Choosing a Caregiver
    Cesarean Section
    The Rights of Childbearing Women
    Having a Baby? Ten Questions to Ask

    You can also find information on cesarean section and choosing a care provider in my book,
    The Thinking Woman's Guide to a Better Birth. It is available in book stores, but you can also order it from my personal website.

    Don't delay. Many care providers these days don't accept new clients past a certain point in pregnancy.

    -- Henci By: Henci Goer

    Archived User

    April 25th, 2007 I gave birth to a 8'7oz baby.  She was one week over due and I was not dialted to a 1 yet.  They started to induce me at midnight and decided on a Csction at 6:30 the following night.  I had patocin for 23 hours and did not dialate to a full 4.  I was efaced to maybe 70%.  When my water finally broke it was full of mirconium.  My water was broke at 3pm and I delivered via csection at 7:15pm.   I was advised my pelvic bone was not wide (front to back) enough to have her or any other babies in the future unless I were to deliver under 31 weeks.  I am asked frequently why they didnt know before hand though I dont know how they would.  I am 5'2 and weighed 135 at the time of conception so I am not extremely small though not large and was offered a chance at vag delivery and even though my contractions started the night of my delivery on their own I was unable to have her.

    I would be concerned as to why he is stating that though would have second opinion.  I come from a large family and I am the one and only to have issues delivering a baby.  I did not get the opportunity to push as she was unable to get into the birth canal at all.

    I do not feel as though I failed though I am worried about having another.  If I am somewhere we are unable to get to a hospital I would be very worred about labor.

    Henci Goer

    I have interwoven my responses with your post.

     

    Posted By n/a on 11/11/2007 4:15 PM

    April 25th, 2007 I gave birth to a 8'7oz baby.  She was one week over due and I was not dialted to a 1 yet.  They started to induce me at midnight and decided on a Csction at 6:30 the following night.  I had patocin for 23 hours and did not dialate to a full 4.  I was efaced to maybe 70%.  When my water finally broke it was full of mirconium.  My water was broke at 3pm and I delivered via csection at 7:15pm.   I was advised my pelvic bone was not wide (front to back) enough to have her or any other babies in the future unless I were to deliver under 31 weeks.  I am asked frequently why they didnt know before hand though I dont know how they would.  I am 5'2 and weighed 135 at the time of conception so I am not extremely small though not large and was offered a chance at vag delivery and even though my contractions started the night of my delivery on their own I was unable to have her.

     

    It is difficult to say why you progressed so slowly. There are other reasons aside from your pelvis that might have contributed. First, being induced, in and of itself, doubled your risk of cesarean surgery. (One week past your due date, is not, by the way, overdue. It is the average length of pregnancy in a first-time mother. The 40 weeks commonly accepted as the length of pregnancy was made up by a German obstetrician in the late 1800s.) Second, performing a cesarean in early labor for slow progress is not recommended because slow progress in early labor does not predict how likely it is that a woman will be able to birth her baby vaginally. Finally, your baby may have been occiput posterior (OP), that is, the occiput, the back of your baby's head against your back. Babies in this position do not fit well in the pelvis. Typical of "posterior" labors are strong, irregular contractions with little progress. The contractions and the mother's posture changes and movements will eventually coax most babies into the more favorable anterior position in time, but breaking the bag of waters can keep the baby from doing this. As long as there is a cushion of fluid in front of the baby's head, the baby has room to maneuver. With the release of the waters, the baby's head can surge down into the pelvis and get stuck. Having an epidural in early labor increases the likelihood of persistent posterior baby as well. You do not say if you had one, but with so many hours of induced labor, I would be surprised if you didn’t.

    It is also, I am sorry to say, not uncommon for women to be told that they would not have been able to birth the baby vaginally so as to convince them that their doctors did the right thing. Many women have subsequently birthed babies, even babies much bigger, than the one they were told they could not birth in the first place.

     

    I would be concerned as to why he is stating that though would have second opinion.  I come from a large family and I am the one and only to have issues delivering a baby.  I did not get the opportunity to push as she was unable to get into the birth canal at all.

     

    I am not quite clear here about your concern about a second opinion. Could you tell me more?

     

    I do not feel as though I failed though I am worried about having another.  If I am somewhere we are unable to get to a hospital I would be very worred about labor.

     

    I am not sure why you would be worried about getting to a hospital should you decide to labor with your next baby. Based on your history, it would seem unlikely that labor would be so short as to prevent you from getting to the hospital in time for the birth.

     

    If you want to know more to help you in your decision to plan a vaginal birth or a repeat cesarean next time, I recommend that you find a doctor with a low cesarean rate (less than 15%) who normally encourages vaginal birth after cesarean (VBAC, pronounced “Vee-back”), and have him or her evaluate your case. That way if this doctor says you are not a good candidate for vaginal birth, you can trust the doctor's judgment. The problem will be finding such a person. The doulas (women who do labor support), childbirth educators, and midwives in your community are your best bet.

     

    -- Henci

     

    P.S. If you think it would be helpful to talk with women who have been through your experience and to get more information on cesareans and vaginal birth after cesarean, I recommend getting in touch with the International Cesarean Awareness Network (ICAN)

     

    Archived User
    Gotta love this article http://midwiferytoday.com/articles/pelvis.asp?q=drugs

    All Times America/New_York

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