Successful VBAC after CPD?

[monkeytoes]

My first labor was very long (37hrs) and ended in an emergency c/s. I got to 9cm and it did not progress. My medical records show it as "Failure to progress - reason is CPD". (For those of you who don't know CPD is when the babies head is supposedly too big to fit through the womens pelvis.

Now - I am NOT a petite person, and in my personal opinion my labor was so long that I just got too tired to continue. I don't believe that CPD was the real reason for my c/s. Anyway - I am really wanting to have a VBAC for this birth.

So - I am wondering how many of you were told that your first c/s was due to head/pelvis disproportion and then went on to have a successful VBAC?

Please give me some hope...........

[~Emmylou~]

I haven't had a VBAC after a CPD "diagnosis" but I would say you are definitely right to be suspicious of it.

True CPD only occurs in something like 2 percent of women - and many of those have had pelvic injuries (for example in car accidents) or nutritional deficiencies that are hardly heard of any more such as rickets.

CPD is a convenient, cover everything excuse for many a c/section and it's scandalous how many women are told this and believe it to be true - at least you're questioning it so you're on the path to a successful VBAC already

[nats]

I'm with Emmylou (and most other women around here)

CPD "diagnosis" is a crock! Listen to your instincts, you know it's a crock.

It's just a convenient excuse for scare providers, that's all it is

Reclaim your body! Birth your baby your way.

[Luvem]

I forget the correct English for the 'head dropping into the pelvis' but yeah that! I had a CT scan with 1st pg and it apparently showed that ds head was 'not going to fit,' and thats why his head was not coming down into the pelvis. Ended up with c/s due to feotal distress, no labour. I was overdue.
Attempted VBAC with DD and it was unsuccesful. Her head also didnt enter the pelvis and we had our hopes up that the contractions would push it down (der! thats what labour is for. lol) But she didnt budge!
I was extremely dissapointed. Im still not really over it.
But everyone is different and Im sure you will have success! It just wasnt meant to be for me.

[stellarella]

Good luck with it.

I am an example of what can happen if you have great care providers.

My labour was 48 hours and my baby was posterior. I was 3cms dilated before labour actually started, just to give you an idea of how slow I was to progress.

My pelvis is not inherently defunct (only women with rickets or serious malformation of the pelvis actually have CPD) but I have problems with my hips and pelvis which caused it to be quite narrow and unable to open up the way it should have. My body really had to work hard to rotate my sons big (38cm) head through my tight pelvis but after 2 1/4 hours we did it.

Just want you to know that with the right knowledge and given the opportunity the vast majority of babies can fit.

I am sure you will have a VBAC!!!

ETA: With the foetal distress, the best way to avoid that is to stay away from drugs, refuse induction and ARM and be active and listen to your body about which position to be in.

[doulacara]

I know this has been posted before, but darned if I can be bothered searching for it at this time of night .....it rates as one of my all time favourite articles about women birthing:

Pelvises I Have Known and Loved by Gloria Lemay

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.

[flib]

I got to 10cm dilated with my DS and had a c/s after 36 hours. It was termed an 'obstructed labour' and 'failure to progress'. I got my notes from the hospital and found out he was posterior with his head deflexed. In that position unless baby turns there's no chance.

I've since had 2 VBACs. My first DD had a BIGGER head than my son. She came out easily after a 16 hour labour. DD2 was the same after 4.5 hours of labour,. I didn't even need stitches for either of them. I couldn't believe how different these experiences were!

It sounds like it's worth a try. VBAC doesn't work out for everyone but it's so good when it does. Get your notes and get someone outside of the hospital to look over them with you. The fact that you got to 9cm is great. You'll dilate faster next time especially if your bub is in a good position.

Good luck!

[MamaSage]

Another poor CPD sufferer here, although strangely enough I have not had rickets or had sex with a ten foot man and yes, a baby came out of my vagina last year. CPD is thrown around too easily. You know you don't have it.

[PunkyDiva]

Having a experienced midwife/doula on board before labour and birth is your best bet as from what I've read it is more about positioning of babies head and this is acheivable if you know what to do.
A lot of doula's will even just chat to you over the phone about what you can do and most middies should at least know the theory of how to do it.
My GP told me today that due to us becoming such a litigious (apt to sue at drop of a hat) society that OBs really are covering their own and hospitals butts at the slightest hiccup. But if you have enough passion & determination you can get them to at least allow you to try for VB/VBAC. Sometimes it's just a case of finding the right person as they are not all "protocol" orientated and some do actually still beleive birth as a natural thing rather then a tedious illness to be fitted into schedules. Best of luck.

[monkeytoes]

Thanks for your inspiring comments. I am definately going to VBAC. I am just concerned that the hospital/doctor/middies are going to put so many restrictions on me that I will get 'stage fright'. I have been told that I:
*can't be induced
*can't have drugs
*will have constant fetal monitor
*must come to hospital at begining of labor
*time restrictions may apply if I stall for a significant amount of time.

Where do I stand with these things? Can I refuse to come to hospital until I am in active labor? Can I refuse fetal monitoring? Can I ask for more time in labor if I am feeling OK and the baby is not in distress?