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can my baby be too big for my pelvis? August 7, 2007

Posted by guinever in birth, health, labor, pregnancy.

I frequently get questions in the comment section of my article, cervical dilation 101, frequently asked questions. Every once in awhile, a question comes up that doesn’t have a simple, short answer so I’ll write a new article. The following comes from a pregnant reader:

Just an update,
I went to the doctor today, I am 38 weeks and 3 days. I am 3 cm dilated and 70% effaced. My cervix is still posterior, but the baby is head down and -2. My blood pressure has been slightly elevated the last 2 weeks and the doctor thinks the baby weighs around 7 pounds. He is also concerned that I could need a c-section because I have a small pelvis. All this in account we are inducing labor Thurs morning. Do you think it could be a long labor? Or could it be pretty quick given I am already 3 cm and this is my second child?

Thanks for all of your help, Christina

Dear Christina, Your pelvis is not too small. You do not need a c-section. A doctor has absolutely NO business telling a woman her pelvis is too small before she is even in labor and tries to push the baby out. (did you have a c-section for your first baby?) Your pelvis is not fixed in place. Hormones right now are working on softening the ligaments, loosening your pelvis so that it may move and widen and change shape to accommodate your baby. And your baby’s head is not hard and fixed in place either. Your baby’s skull has plates that move and mold to fit through your pelvis. These are the baby’s soft spots. This is why some babies are born with pointy heads; their heads have merely changed shape so they can be born and will quickly regain a more normal shape within hours. Please just be confident in your ability to birth your baby! Put the word c-section out of your head. There is a huge mind and body connection when it comes to labor. If you believe that you can’t birth your baby, or if your doctor’s words are in the back of your mind, then it might come true.

Also, why are you being induced in a couple days? High blood pressure, out-of-control blood pressure is definitely a valid reason for induction, but in your words, yours is “slightly elevated.” Although many doctors are quick to induce, most wait until the due date unless there is a medical reason and you still have a week to go. I hate to say this, but is your doc going on vacation? Sometimes, a doctor will induce his patients so they’ll give birth while he’s still in town and so that he will get paid for the births (rather than whoever is on call for him while he’s gone). He is getting you used to the idea of having surgery just in case you don’t have your baby before he wants to leave in the morning. He has already told you that you might need a c-section. He’ll have the induction started in the wee hours of the A.M. and be checking in periodically throughout the day with the nursing staff. He’ll go home for dinner and then come back and say you’re not progressing or your baby is just too big for your body so it looks like you need surgery after all.

Now having said this, this may not be the reality in your case, but you should consider it. Ask your doctor, why are you inducing me? What happens if we don’t induce this Thursday as planned?

To answer your question as to how long the induction may take, like I tell everyone, I have no idea! There is no magic formula that says a woman dilates 1 cm an hour even though some OBs like to tell us that’s the way it should happen. Read my article, what does being 2 centimeters dilated mean?

You are 3cm dilated and 70% effaced. With these numbers, a pitocin induction will most likely be successful and lead to a vaginal birth if given enough time. If your body and baby are ready for labor, you could have your baby in only a few hours or it could take all day. You also said the baby is at -2 station so your baby is still floating and very high.

Zero station is “engaged” or “dropped” where your baby’s head is fixed in your pelvis and not going anywhere. But at -2 station, your baby is still “floating.” It is common to break your water during an induction. Please know that if they break your water , called artificial rupture of membranes (AROM) before the baby is at 0 station or lower, then there is the danger of cord prolapse. This is a dangerous situation because the head will compress the cord, cutting off the baby’s oxygen supply. You do not want that to happen. So if you do get induced and if they talk about breaking your water, be sure that your baby has come down to at least 0 station.

To sum up, just trust in your ability to give birth! You can do it. To answer the question posed in the title of this article,

“Can my baby be too big for my pelvis?” Watch this inspiring video for the answer.

The answer is probably not! Be inspired by the pygmy women in Africa who are only 4 feet tall. Gloria Lemay writes for Midwifery Today that 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.

Birthing Blessings, Guinever

To read other pregnancy related articles, please refer to my welcome page .


1. Jessica - March 20, 2009

Hi there, I am now 39th week. My baby has not engaged into my pelvis area yet and I wonder is there anything I can do to help him get into the “lauch pad”? ^_^;

Jessica, walking is great for this purpose. ~blessings, Guinever

2. Lara Monzon - March 3, 2009

Thanks, Guinever, for such an inspiring article. I am 1 week+ overdue and have an induction scheduled but hope to go into labour naturally as I have been having contractions and I my cervix is soft. Whatever the case, you have inspired me to face events with a positive outlook and relaxed. You have confirmed some of my beliefs and now I know I can cope. I am very thankful. Can barely wait for the show to begin!

3. Lyne - March 1, 2009

I am pregnant with my second baby and I’m wondering if I should go for a c-section or not. First birth ended up in an emergency c-section. I thought I was doing really well but after 24 hours I had fully dialated but bub just wasn’t coming out. I spent the majority of the labour standing in a shower or walking around and did not use any drugs. Once I was fully dialated they suggested we try some drug to increase the strength of the contractions. 1 or 2 hours of this made no difference to bub’s progress and then bub got distressed so we stopped the drugs and had a c-section about an hour later. Doctore said it was a good thing because of position and size bub wasn’t going to come out on his own. She was head down but her shoulder was caught somewhere ? my hip bone ?? Not really sure. By the time the c-section was over I was pretty out of it. So I’ve go the choice of C-section now and most of me says lets try natural and part of me say no c-section. I’m 41 and I am worried about the increase risk of still birth which can happen in bub over 40 weeks in older moms. Where can I get unbiased opinion and facts on c-section risks?

Just wanted to add one thing. During the birthing class the midwives agreed that I was the only women in the class that had the potential to have a bub that was to big for my pelvis. They appeared to base this on looking at me and my husband. We were about 35 weeks pregnant at the time.

It sounds like your last cesarean was done because your baby was malpositioned which has nothing to do with the baby you are carrying now. Also, it sounds like the pitocin caused the distress in your baby which ultimately led you to the c-section. I think you should try for a VBAC. If it doesn’t happen, then you’ll know that you tried your best for a vaginal birth and it just wasn’t meant to be. I highly recommend What every pregnant woman needs to know about Cesarean Section. This is a free download and has the answers you’re looking for about risk and benefits. There is other helpful info at the website as well. ~blessings, Guinever

4. Malena - August 3, 2008

I just had an ultrasound at 35 weeks and 3 days that shows that my baby is already 6 lbs…The technician mentioned that he might be around 8 lbs or more by the time he is born. I am worry about having him being pulled out with forceps, vacuum or even worst having his collarbone broke (shoulder dystocia) at birth.
Would a c-section be a better choice in this case?

Malena, RELAX. You can birth your baby. Ultrasound is not accurate in determining the weight of a baby. Furthermore, your body will grow a baby that you can birth. The baby’s head can mold to fit your pelvis and your pelvis can open up to birth your baby. So, no a c-section would not be a good choice. Wait for labor to start. ~blessings, Guinever

5. Aimee Nicole - June 4, 2008

Hello. I’m pregnant with my first child. My due date was May 26th, 2008. I don’t have insurance so I go to a clinic where they seem to treat everyone the same. As kind as everyone is there, I feel like an automobile when I’m seen. My last OB appointment was this past Monday, a week after my due date. I was told that I was 1cm dilated, and that the baby had “dropped”. I was also told that if I didn’t go into labor on my own by Saturday, that I was to be induced, with the possibility of a c-section due to the baby’s size. I went for an ultrasound on that same Monday, with another ultrasound scheduled for this Thursday. The ultrasonagrapher told me on Monday that based on her calculations the baby was 8lbs 7oz (she also noted that that weight could be off by 1lb up or 1lb down). This was up from my last u/s performed about three weeks ago when they said the baby was guesstimated at 8lbs 2oz. I spoke to the nurse practitioner briefly and all she said when I voiced my concerns over being induced and a c-section planned — because I’d planned on doing this “naturally”, no drugs for induction or pain, etc. — was “well what if the baby’s shoulders get stuck, then what do you do?” My blood pressure is fine. The baby’s heart rate is fine. The baby is moving around every day, every hour like a wild man. I don’t want to be induced if it leads to a c-section. Now a little update, the nurse practitioner just called me. She said that according to the doctor, the baby’s weight is fine and she doesn’t think a c-section would be needed. They still want to induce though because I’m almost at 42 weeks. She added that I am 50% effaced and my cervix is soft. She seems to think that I just need a little “push” to get things started, but that the doctor thinks I’m “ready”.

I guess that’s it…

Thanks for reading.

Dear Nicole, good for you for refusing an automatic c-section! Believe in your ability to birth your baby vaginally! ~birthing blessings, Guinever

6. Laurie Morris - April 16, 2008

Please help! My best friend is 39 weeks 4 days very excited to be having her first baby for she was told she would never have children and low and behold he is due soon. She has been so looking forward to birth and anxious as well. At her appointment last week her doctor told her that baby was not engaged into her pelvis and that there may be a possibility of a c-section. This weeks appointment led him to say this again giving her until monday, She will be 40 weeks 1 day to get the baby to engage of he wants to schedule a section for Tuesday. She says babie is kindof sideways it feels like and that his head is grinding on her hip bone like he is trying to get down but in the wrong spot, her doc says maybe he is too big. She asked doctor if she could be induced and at least try and he states to her that there is no reason to add stress to her of baby. Being a mother of 4 and having my first c-section due to breech presentation I know how much one misses when laboring and natural birth is taken from you..Please can you give me advice on maybe ways to get baby to engage or advice to pass on to her factuals on this…..I told her I was going to do some online research and am not having much luck, I just don’t want her to give in to this doctors request if it isn’t for the health of the babie….Thank you

Dear Laurie, I think your friend needs to get a different doctor or just be more assertive with him. He has no business telling her that she needs a c-section. She can wait for the baby to engage. She needs to tell him no to induction and/or surgery. this is totally ridiculous!!
To encourage the baby to come down and engage, she should be doing lots of walking. This moves the pelvis back and forth, the bones move and the baby can wriggle into position and negotiate the bones of the pelvis. Unless she has scurvy (highly doubtful), her pelvis should be fine! She can do belly dancing type movements. She will show this doctor that she can give birth vaginally! Tell her to have confidence. Go to the ICAN website for information on preventing cesarean. ~blessings, Guinever

7. 2Ndtimearound - November 22, 2007

I would like to add my story. I am currently 13 weeks pregnant with my second baby. With my first child I was induced because of fluctuating high blood pressure, and I found out later my Dr was going on vacation. When two days of cervadil didn’t work I was sent home, my water broke so I was then induced with Pitocin, told I would have to lie down flat, as my sons head was not engaged. After being told I “had to have an epidural” and being in labour for only four hours, I was told my pubic arch is too small and I must have a C-section. This is not where the story ends. My son was born and everything seemed fine, until he turned blue and had to be intubated. He was in ICU for 6 days with a feeding tube, and I was not allowed to see him or hold him for 23 hrs. He was on oxygen and his blood oxygen level could not stabilize because he DID NOT COME THROUGH THE BIRTH CANAL. From the way it was explained to me by a very understanding pediatrician, there is a hormone (or something similar) that the baby receives when being born vaginally that prepares the lungs to breath for the first time. Also by being born vaginally, a baby is squeezed so that all the extra flood is pushed out of the stomach and lungs, so that they can breath properly. My son recovered but continues to have stomach issues due to all the trauma he went through so early in life. I had a spinal headache and ended up with and infection in my scar. I thank myself lucky that I came off with only this, as a friend of mine with a C-section for her first child had extensive bleeding and had to have a hysterectomy.
I have since changed caregivers and my midwife will be delivering this baby vaginally in the same hospital my son was born in. My midwife believes that this will not be a problem.

dear second time around, blessings to you and your baby! Thank you for sharing your story and I sincerely hope that you have a beautiful pregnancy and birth this time with none of the complications you experienced before. ~Guinever

8. Kimberly - November 20, 2007

I am 39 weeks pregnant with my second child. I have had no complications during this pregnancy at all. I have recently begun to swell really bad and my blood pressure has elevated, but my midwife does not seemed worried about that. I do know that she is head down, but I have not dialated any. The past few days I have had a lot of pain in my pelvic area and hips. The pressure gets so bad sometimes that I can not stand up straight. Is it normal for the engagement/lightening process to be so painful. I did not experience any of this with my first child, he weighed 7 lbs 7 oz according to my midwife and ultrasounds they are saying that this baby will be 8.5 lbs or better. Could this be the reason that it is so painful?

I don’t think your baby’s size has anything to do with your increased pain. I would make sure you’re getting enough to eat and drink, with plenty of protein. To minimize and help with the pain, get on all fours or put pillows on the floor and get on your knees and lean down on them with your upper body. Try to get comfy! This position really works. ~Guinever

9. Martha - October 23, 2007

Guinever, Thank you so much for providing such great, accurate information. It’s great to see evidence based knowledge in the midst of our medicalized birth culture!

I just want to add my story briefly–I was diagnosed as CPD with my first 2 children. My first was induced and she never descended into my pelvis. I was also labeled Failure to progress. She was delivered by c-section and weighed 9 lb. 3 oz.

My second I went into labor on my own but it stalled at the hospital (looking back I think it was just prodromal labor) They augmented me because they don’t “allow” VBAC moms to leave the hospital. My 7 lb 3 oz daughter was also born by c-section, though she did make it to +3 station. Again CPD diagnosis.

This past August 7th I had a 100% natural VBAC after my 2 c-sections with my 8 lb 14 oz daughter who was shorter and had a bigger head than my first 2. Labor started and she was born in under an hour! CPD hah!

Thanks for sharing your wonderful VBAC experience. ~Guinever

10. Hannah - September 29, 2007

My first had a large head and we went for a completely natural delivery in spite of it. I labored for 9 hrs, then pushed for 3. All seemed smooth until the pushing stage, really. After 3 hrs, the mid-wife — there was no doctor involved at all — proposed that we do an episiotomy, and she was born 10 minutes after that. HOWEVER, the severely mishaped, coneshaped head she was born with had her pediatrician worried for several months. It took 5 or 6 months for the back of her head to round out and the doc was worried that some bones may fuse.

I am having my second in 8 to 10 weeks and I am determined to once again go all natural. At the same time, I have already told my midwife that I will want her to perform an episiotomy earlier than last time, way earlier, that is, so that we can perhaps avoid the head trauma for baby #2.

How long was your baby on the perineum? An episiotomy won’t help you have your baby any quicker unless you’re crowning. Was the majority of your 3 hours of second stage spent with the baby crowning? ~G

I know episiotomies are frowned upon in natural birth circles. However, I’d rather deal with the aftereffects of the elective cutting than with another head that is so squished it will not mold back naturally within a few days.

I can’t speak for all natural birth circles, but personally, I have a problem with anything done on most women just because it’s routine. I think there is a time and place for every intervention during childbirth. I think each laboring woman should be evaluated separately. I think that most women do not need episiotomies. Clearly in your case, an episiotomy was beneficial. ~Guinever

11. msovoice - September 22, 2007

Kathryn – a chiropractor who is certified in the Webster Technique would be extremely helpful for any alignment problems as a result of natural (and especially c/s) childbirth. Don’t assume that a c/s will produce better outcomes for you or your future baby. Have you researched the potential health problems associated with c/s – it is a major abdominal surgical procedure? Best wishes for your future delivery!

Wendy – you said: “Also, for women having their first baby, many care providers measure the dimensions of the pelvic outlet at the first visit (or at least they should). An abnormally small pubic arch, such as what ‘dxunknown’ was told, is very simple to diagnose (although very rare, so perhaps some providers just don’t do it). If this or any other pelvic abnormality were properly diagnosed in early pregnancy, the mother’s and baby’s health would not have to be risked by putting them through labor before resorting to emergency cesarean.”
I’m wondering what measuring a pelvis in early pregnancy tells you?

Maria – wow, big bony structure, eh?! Size 4 at 160#! Cool!

I am 5’10” and am fairly curvy. My CNM commented at some point during my pregnancy that I had a good pelvis for birthing. I essentially went into preterm labor (even though I was at my due “date”) because of the flu, and ended up with a c/s and CPD diagnosis. Such crap since the baby never engaged into my pelvis. Well, if anyone wants to read my DD’s birth story, you can go to my blog.

Guinever, do you ever recommend women to work with the Pink Kit?

Thanks, Labortrials

Although I have heard of the pink kit, I’m not real familiar with it and there isn’t enough information on their website for me to make a determination about it either way. ~Guinever

12. Kathryn Watt - September 16, 2007

Hi. I have been reading your posts with great interest, and would like to add my own story. My first child was born naturally, on his due date, weighing 11lb 9 1/2 oz. His shoulders were partially dislocated, and his neck was ‘out’, both problems were not detected until he was around 7 weeks old. Needless to say we had a very unhappy bub in the beginning, who could only manage sleep in 20 min patches, and it took months to rectify this. We are extremely lucky he shows no signs of any long term effects. I too had a lot of problems following the birth, secondary infections, blood transfusion etc, and found it very difficult to bond with my bub. I am now 37 weeks pregnant with bub # 2, and seeing a different Ob. Estimates are this bub is slightly bigger than # 1. Ultrasound at 36 weeks estimated 4 – 4 1/2kg, and I have been measuring 5 weeks ahead of what I should be. You only have to look at me to know this is another huge baby. Now don’t get me wrong, I am very proud of the fact that I was able to birth such a big baby the first time round, and would love to be able to have a natural birth again, but I must consider the potential health problems for both me & my child. As such, I am booked in for a caeserean next week. My Ob examined me today, but refused to induce, as although my cervix is softening, bub is still floating way above the pelvis. However she did say I may even go into labour before the caeserean. Anyhow, my point is, that some babies are so big that there is most certainly a considerable risk with a natural birth. Sometimes a caesearean is indeed justified.


13. Maria - August 16, 2007

Okay, I just had to add another example. 🙂 With my first child (almost 9yrs ago) I was induced at 39wks due to progressively worsening hypertension. Prostaglandin gels the night before and Pitocin drip started at 4am with contractions starting immediately. At 8am my membranes were ruptured with not quite 2cm dilation. When I attempted to walk my son went into distress (dropping heart rate), so I was confined to the bed with an internal fetal monitor. Despite more than adequate contractions throughout the day, I never progressed past 2cm. As a pharmacy student at the time, NO drugs (with the exception of antibiotics due to GBS+) were administered until the 6:30pm c-section epidural. Since that time I have had at least 4 gynies tell me I couldn’t fit a 5lb baby through my pelvis. (My son was 6lbs 15oz) I am also 5’8″ tall and weigh (non-pregnant) about 160lbs wearing a size 4. Despite the antibiotic drip, my son was treated for sepsis (infection) in the NICU for a week due to the long labor with GBS. I was SO confident that I would have a natural childbirth, I skipped the class on c-sections! I wish someone had told me that a c-section was a possibility so that I could have been better prepared. Watched a video, completed some research, something, anything…rather than the feeling of failure that hits a lot of women with unplanned c-sections. (As DXunknown hinted at). There are SO many complications women can have, that their gynie may be aware of that we are not, oligohydramnios, gestational diabetes or placental sufficiency concerns or who knows? It is tempting to judge the hearts/minds of physicians who sometime speak without explaining. But the benefit of the doubt never hurts either…I think for all the women who are concerned, take some of the info you have here and go start a conversation with your physician. If he/she doesn’t want to listen, then he/she is probably not the MD you want with you during childbirth anyway! BTW, I am 35weeks along with my 2nd pregnancy and due to new complications, we expect this will be a c-section too. Try to remember that even if you have this lovely natural childbirth vision in your head, (which is undoubtedly the best thing to try for!!)…the most important end result is that you and your child are safe and healthy!!

Dear Maria, thanks for sharing your story. When you say no drugs were administered until you had surgery, I’m assuming you mean that you had no pain meds because the gels you had and the pitocin are most certainly drugs. I totally agree with you that women need to dialogue with their doctors and if they’re not getting the answers they need, they should find another doctor. ~blessings, Guinever

14. Kellie - August 10, 2007

Guinever, thanks for the reply! Yes, I have read many books on all-natural labor and I’ve read many different articles over the internet as well. My favorite book is “The Birth Book” by Dr. Sears and his wife Martha. But I have spent the last 7-8 months reading up on epidurals, other drugs, and all-natural. So I felt completely prepared to tackle the challenge. I also have 2 friends who have accomplished birth w/out drugs. They have helped out a ton w/ different moves, exercises, and pressure points that will help w/ the pain. I have also attended childbirth classes. I have not hired a doula b/c I have an acupuncturist that will be there for me during labor. I had complete faith in my body, until the dr. told me that his head was too big and my pelvis was “normal”. The size of his head was determined from my 38 week ultrasound. He’s been an OBGYN for 34 years and I feel that he knows what he’s doing. So, that’s why I now have doubts! I’ve never gone through this before, and he’s birthed thousands of babies. He wants to induce b/c he would like me to try a vaginal delivery, and he thinks that if I go through term then the head will be way too big to fit and I’ll end up having a section anyways. So he’d rather me schedule a section at 40 weeks – just so I don’t have to go through hours and hours of labor, only to have an ER-section.

Dear Kellie, it sounds like you are well-prepared for birth. Don’t forget all those things that you have read. Keep filling your mind with positive thinking surrounding your birth. It’s great that your acupuncturist will be there. She can encourage you during your labor. You said that your doc has birthed thousands of babies. As a man, he has not birthed any babies. He has caught them and cut them out, but he has never birthed even a one!! Why don’t you prove him wrong. Your baby’s head is not too big for you to birth vaginally. Go for it! Remember walking helps to bring your baby down. As your hips sway, the baby can negotiate the bones in your pelvis. Walking up and down stairs is also good. When it comes to pushing, squatting whether in a traditional squat or doing it on your knees can open the outlet of the pelvis by 10% or more! As for being induced, be careful. Make sure your body is really ready for induction or you will most likely have a cesarean unless you’re given lots and lots of time (over 24 hours, even over 36 hours). This is highly unlikely that a hospital will “allow” you to labor this long. read this article from birthsource on induction. Kellie, you can do it! ok? ~birthing blessings, Guinever

15. Kellie - August 10, 2007

I’m currently at 38.5 weeks, not dilated at all. My dr. just informed me that my baby’s head is too big and he is going to induce on Tuesday if I’m dilated. He’s afraid that his head will get stuck in my pelvis, so he wants to induce early. He believes that if we wait until 40 weeks or more, then his head will be way too big and I’ll end up w/ a C-section anyways. My baby’s weight is fine, but the head is just big. I really wanted an all-natural, no drug, birth – but he just said that w/ a head that size, I’ll definitely want the drugs. I’m afraid that if they induce then I’ll have a higher chance of a section. I was all pumped up with “let your body do what it was designed to do” and now I’m super nervous that I can’t so this! Should I get a second opinion?

Dear Kellie, You say that you want an “all-natural, no drug, birth.” Have you prepared for this kind of birth by reading books, taking an independent childbirth class, possibly hiring a doula? I think that you should take the weekend and do lots of reading and preparing your mind for birth. See my list of recommended books. Going natural is really a mindset. Have confidence in your ability to birth your baby! How did your doctor determine that your baby’s head was too big? Unless there is a genetic problem or disorder which you didn’t say anything about, I would think that you can birth your baby. Please remember that the baby’s head can mold to fit your pelvis. You wanting drugs really has nothing to do with head size. You’re right that you’ll have a higher chance of a c-section if you get induced. You’re more like to have surgery now with baby’s head being smaller than you would in one, two, three weeks when your body is ready for labor and it will open up and allow you to birth your baby. You asked if you should get a second opinion. Yes! Find a midwife or a doctor who trusts in birth. If you don’t know where to look, see if there’s a Bradley teacher, other natural childbirth instructor, or doula in your area and ask her for recommendations for a good care provider. You could also ask her opinion of your current doctor. Also, go to this web page titled “big baby bull” for some helpful information.

Let me know how it goes, Guinever

16. Hilary - August 8, 2007

Here is the study I was referring to:

CONCLUSION: Based on data from observational studies, labor induction for suspected fetal macrosomia results in an increased cesarean delivery rate without improving perinatal outcomes


17. dxunknown - August 8, 2007

I am not going to spend a lot of time answering specific questions about my labor as I feel you are trying to find some reasoning to make my failure to deliver naturally my fault… i.e.
“Did you walk during labor”… questioning what positions I tried. You ladies need to appreciate that some women just simply cannot deliver a child naturally without putting the baby at greater risk than would be posed during a planned c-section. You shouldn’t make them feel like a failure or that if they just do something different they will succeed.

Dear dxunknown, I am definitely not “blaming” you for your cesarean birth. BUT, I am putting all the blame on your doctor if you labored in your bed the whole time and/or you never had an opportunity to push. I am suggesting that your doctor was ignorant or wrong or lied to you. Did you seek a second or third opinion?

When it comes to obstetrics and saying a woman’s body isn’t capable of birth, I think getting another opinion is important because obstetrics is one of the branches of medicine where a lot of docs do not follow evidenced-based-care. You still haven’t told us any of the details of your birth. If you tell me that you reached the pushing stage and were even crowning (this is the point that the baby would be at your pubic bone) and that you tried several positions that would get you off your tailbone (including lying on your side, standing, squatting, on your knees), then I will think that the diagnoses you received of cephalopelvic disproportion is correct. Like I said in our earlier exchange, the only reason I doubt CPD (not just in your case) is that many women after having this diagnosis go onto have vaginal births.

18. Wendy CPM - August 8, 2007

Remember that the original question was from a woman having her second baby. We already know that it’s possible for a baby to come through her pelvis.

Also, for women having their first baby, many care providers measure the dimensions of the pelvic outlet at the first visit (or at least they should). An abnormally small pubic arch, such as what ‘dxunknown’ was told, is very simple to diagnose (although very rare, so perhaps some providers just don’t do it). If this or any other pelvic abnormality were properly diagnosed in early pregnancy, the mother’s and baby’s health would not have to be risked by putting them through labor before resorting to emergency cesarean.

19. Rachel - August 8, 2007

I’m going to try to do some searching and analysis of studies on this in the next few days and will post something to your blog.
dxunknown – Guinever asks some good questions, as many docs will make these kinds of claims when they’re not really backed up by the evidence. My understanding is that induction can cause fetal distress on its own, so I wonder if that was a factor.

Dear Rachel, I really appreciate your input on this. Thanks so much, Guinever

20. Hilary - August 7, 2007

I think a meta-analysis in ACOG (yes, Rachel, I know….) showed that cesarean for babies that were predicted to be large did not show any improved outcomes for mom or baby.

21. dxunknown - August 7, 2007

Well I certainly wish someone would have measured something with me! In my 42nd week, I had not gone into labor on my own and was given pitocin. After 12 hours of agonizing pain and continuous adjustments to the pitocin, my baby went into fetal distress and my blood pressure bottomed out. We were rushed off for an emergency c-section and those aren’t as pretty as the “scheduled c-sections” we see on TV. It was later concluded that my pelvis was in fact smaller than usual due to the shape of my pubic bone. As someone who nearly lost a baby because of this, I can’t agree with your dismissive attitude about it. I feel you are also missing the essence of the question. I don’t see it as a matter of the baby being too large (which 7lbs is hardly “large”), but rather the pelvis being too small. If a smaller than normal pelvis is a rare thing, then Christina may be the one in a million that has this problem (with myself being the other one, I guess). By the by, my baby only weighed 6 lbs. 3 oz. so her weight had very little to do with my anatomical problem. I am THRILLED to hear that her doctor has identified a potential problem and has a Plan B in place!

I am so sorry that you nearly lost your baby. And I am very glad that everything turned out ok in the end. I would like to ask you some additional questions. You say you had 12 hours of pitocin. Because you call it agonizing, I assume you did not have an epidural or at least didn’t get it for awhile? At what point in labor did your blood pressure bottom out? Did you reach the pushing stage? I am sorry that you perceive me as being dismissive. I am merely exploring the options. I know many women, either online (see International Cesarean Awareness Network as one example) or in real life who have had a c-section because doctors told them that they just couldn’t give birth vaginally because their pelvis’s were too small or the baby’s were too big. These same women then did some research on their own, switched caregivers and then went on to have a vaginal birth with a bigger baby out the same pelvis that the first doctor said could never birth a baby. It is these thousands of real-life situations that derive my explanations. Yes, you could be the one in million who can’t push a baby past the pubic bone. But this brings me another set of questions. And I’ll repeat one I asked earlier, did you reach second stage and start pushing? How long did you push and what positions did you use? The tailbone is uniquely suited for childbirth. It actually can move back and out of the way, giving more room for baby, but this will not happen if you are in the classic hospital 2nd stage position sitting or lying on your tailbone. If you did reach 2nd stage, did you ever push using upright positions–on your knees, standing up, or squatting? Also, did you ever walk during labor? Like I said in my article, the pelvis is not all fixed bone. By walking, the bones shift and the baby can negotiate the pelvis and work himself down and through the bones. Again, I’m so sorry for your situation. But I will also say that the shape of your pubic bone did not cause your blood pressure to bottom out and the baby to be in distress. The pitocin and whatever else they might have been putting in your IV caused it. Narcotics used during childbirth (stadol, nubain, demerol, etc) have an immediate effect on blood pressure. Some women and babies can tolerate the drop while others can’t and they “bottom out.” A mom in distress means a baby in distress. ~Guinever

22. Wendy CPM - August 7, 2007

Yes, I heartily add my agreement that estimates of fetal weight in the third trimester are NOTORIOUSLY inaccurate, especially when done by ultrasound. Studies have shown that the mother’s own estimate of her baby’s weight (and an experienced midwife’s hands) is far more accurate than a third trimester ultrasound.

There is also great concern over the rising rate of preterm birth in the U.S., and much of this has to do with inducing labor or scheduling cesareans. Estimating a due date is an art, not a science, and when the baby is induced to come out before it’s ready, we are finding far too often that the baby was not as old as they thought it was. Because of the inaccuracy of ultrasound in determining fetal age or weight in the third trimester, we don’t know until it’s too late that the baby really isn’t 39 weeks after all. Oops!

My advice: just say no. If your baby is doing fine and your blood pressure is not over 140/90, let nature take its course and wait for labor to start on its own. True cases of “the baby was too big for her pelvis” are exceedingly rare. Don’t let your doctor induce you or perform major abdominal surgery on you to cover his @ss “just in case”. Your body and your baby are more important than his malpractice insurance.

23. Rachel - August 7, 2007

Guinever, thanks for posting this. I’d add that the size estimate is frequently quite wrong. I know someone who was recently told the same thing, and the baby was really a full 2lbs under the estimate.

Dear Rachel, yes I see this all the time–ultrasound being wrong! I always tell people that ultrasound is not accurate for dating a pregnancy past the first trimester and the weight is always a guess. Could be off a pound or more either way!! I hate it when they induce for a big baby, turns into a c-section after 24-36 hours because her baby and body just weren’t ready…out comes a 6 pound baby and then the docs go on and on about how big the baby is. PLEASE, they’re just trying to save face. I know not all caregivers are like this, but it happens all too often. Thanks for stopping by my website, Guinever

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