[Belabean Doula Services]
Sep 18, 2012 05:14 PM
I am actually sending this on behalf of a friend's sister... She was hoping for a VBAC for this pregnancy. Her first pregnancy ended in a cs because of 'failure to progress'. She was told it would be unwise to attempt a TOL because she has android hips... My understanding is labor can be more difficult & pushing can take longer but vaginal deliveries are possible with this shaped pelvis. Is this a reason to submit to a scheduled cs for this pregnancy? Are there any studies available to confirm or debunk the thinking that a pelvis with this shape will not allow a baby to pass?
Sep 21, 2012 02:12 AM
Let's start with the four basic shapes of the female pelvis. This is the best I could find showing them without spending too much time looking. It is true that the android shape is considered less favorable for childbirth as this article attests, but vaginal birth depends many factors. Even those that appear to be unalterable such as the size and shape of the woman's pelvic opening and the circumference of the baby's head are not fixed. The pelvis can flex open and the skull bones can mold to fit through it. I am not aware of any research specifically on pelvic shape and VBAC likelihood, but Lamaze's "A Woman's Guide to VBAC" can help your friend's sister make an informed choice about planning VBAC or repeat cesarean surgery. As the booklet makes clear, neither planned VBAC or cesarean guarantees a problem free birth nor need a woman be an ideal candidate to have a good probability of vaginal birth.
If she decides to plan a VBAC, I recommend that she find a caregiver who encourages VBAC, not just reluctantly agrees to it. If her care provider doesn't think she is able to birth vaginally, it is likely to become a self-fulfilling prophecy because it will affect her care provider's judgment. For example, I have a study that found that women were given less time in the VBAC labor if their prior cesarean was for delayed progress that if it was for a reason such as breech or fetal distress. Your friend's sister should ask what percentage of his or her patients with prior cesarean plan VBAC, and what percentage of them birth vaginally. The answers should be "most of them" to the first question and at least 70% to the second one. If she can't find such a person--or even if she can--I strongly recommend hiring an experienced doula. A doula can help with physical support such as ideas to help labor progress and with emotional support as well, which can be especially important for women and their partners in VBAC labors who are more than ordinarily likely to experience feelings of anxiety or discouragement. (More about doulas and how they can help can be found here.)
All Times America/New_York
Please note that this Forum is intended to help women make informed decisions about their care. The content is not a substitute for medical advice.