Disproportionate Pelvis =(

[first1]

I'm 37+3 with my first baby and went to the GP today to confirm position and engagement. Well she's cephalic (posterior grr) but still really high and there's never been any attempt for her to engage previously. My GP suspects I have CPD or cephalo-disproportionate pelvis, i.e. I'm too small causing obstruction for baby's head to engage. Going to see the consultant tomorrow morning about it, will find out if an ELCS is the plan, which to be honest I now kinda want, because apparently VB with an obstruction can lead to cord prolapse. Do any of you know much about it?. I need all the info I can get. Thanks

[morethemerrier]

Bump x

[first1]

Thanks MtM for your post on May thread. Just cried all over my jacket potato! I'm just glad that by tomorrow I'll know, just wish someone had spotted this before.

[mummytosquidgies]

I had this with DS, though we didn't know it until they took him out in the EMCS after 21 hours of labour.

All they have said to me about it, is there is no way he would have come down on his own, he never engaged, and was still so high after all that time. I got to 9cm and stopped, they gave me the drip to make contractions better as my body was tired, but nothing happened. Now we know why!

I'm having an ELCS for this one as they're worried it will happen again, and my mental health after DS's birth was not good (PTSD, suspected but undiagnosed PND, feelings of failure and guilt etc).

I was told though that true Cephalo-pelvic disproportion is rare (my consultant told me I'm the only one she's seen in 20 years), so if you're keen to have a VB perhaps ask if there are ways they can diagnose it before you go in to labour?

Hope someone else more knowledgeable than me can come and give you some help

[morethemerrier]

Ah bless x

I just hope someone can offer you more info/exp!

Glad they are seeing you tommorow and not dragging it out over the weekend, nothing worse!

Keep your chin up, it'll all work out fine, and you will be cuddling your little girl sooner than you can say, cephalo-disproportionate pelvis!

x

[Lulumaam]

what does your MW say?

or obstetrician?

with th best will in the world , a GP might not be best placed to make such a diagnosis, esp. as true CPD is rare

if you do really have CPD, then yes, a planned section is probably the best way forward

you wold expect some degree of engagement at this stage, but babies can pop in and out of the pelvis, and if the baby is partially engaged, then that is a good sign

i had a MRI scan after my first delivery, as i had an em c.s , i was induced, and thikn in hindsight , my body was just not ready. my pelvis was normal

secnd baby was delivered vaginally with no intervention at term

i would set more store by your consultant's opinion..

[first1]

Lulumaam - My GP's speciality is obs&gynae. He worked in obs before switching to general practice so I do trust his judgement somewhat. Plus he's known me for years, knows my stature etc. My MW is shite to say the least, you can never get hold of her (she's currently sunning herself in Portugal) so the majority of my appointments have been with GP. Baby's head is totally free, there's never been any attempt for it to engage. I'm just glad I'll be seen this morning so my mind's not on overdrive over the bank holiday weekend. Think of me at 11.20 ladies. I'll holla back. x

[CarmenSanDiego]

CPD is very rare and difficult to diagnose because it's impossible to tell how much the pelvis will open during labour.

It's very often misdiagnosed and is just guesswork. Scans are massively inaccurate at predicting a baby's birthweight and size, and even more inaccurate at predicting the ratio between the baby's head and your pelvis.

Bear in mind that a squatting position can open the pelvic outlet significantly and allow a large baby to come out.

If you are unsure about a caesarean, I would honestly be very, very dubious about this diagnosis just because it's not possible to tell.

I had almost the same as mummytosquidgies with my first baby. I eventually had an emcs for failure to progress/cpd. My third baby was a VBAC and the same size but that time I kept really active and upright.

Remember, CPD wouldn't be an emergency so if you wanted, you could always have a trial of labour and if it really isn't working, go to a caesarean.

[mummytosquidgies]

Agree with CarmenSanDiego about having a trial of labour. If it wasn't for other reasons, I would love to try a vaginal birth again this time around.

Perhaps have the suspected problem mentioned in your notes, so during the birth they won't leave you for a long time if things aren't happening? The CPD itself won't stress the baby- I was left for an awfully long time, and the decision to operate was made as I wasn't progressing at all,and DS was getting extremely distressed (as was I!), the CPD was only found in the operating theatre once they opened me up.

Hope your appointment this morning goes well.

[first1]

Well been this morning. Been told my pelvic size will and can only be determined in the midst of labour. So I've been given two options, try labour and possibly end up with an emergency situation or have an elective. I've got until next week to decide. Great . I really don't like the idea of going through labour hell for it all to not work, but then also would hate to have surgery if not 100% necessary. I've asked my GP to arrange a pelvic scan for me hopefully before next Friday and I think whatever the outcome of that is will determine which way I choose.

[first1]

Can I also just ask a different q...I've got a horrendous cough, really we're talking hurts my chest when I do. Had my chest listened to though and that's ok so know it's just viral. But can serious hacking effect baby in any way? Feels like I need to hold the base of my bump when I'm coughing

[fabhead]

hi there i just wanted to second using a squatting position if you do go for vag birth. With my first I had a shoulder dystocia where the bab4's head comes out but shoulders get stuck behind the pelvis - often associated with small women etc (I am 4ft 11). All sorts of drama etc but eventually came out (he did engage a bit beforehand though). With my second baby they were trying to get me to have a CS but I read up and stood then squatted throughout. The baby literally just popped out, even though he was a bigger baby. I think squatting massively opens up the pelvis - I wonder if it is even worth trying this now if you are full term to see if the baby will slip down?

[Owlingate]

I thought sometimes babies didn't engage until labour? My first baby was not engaged in any way whatsoever until my waters broke and then I was induced with a drip and out he came really easily. My third baby had head on 98th percentile and he was fully engaged from 35 weeks. Can't they scan you just to check the size of the baby's head? Have you got a v small pelvis do you think?

[PacificDogwood]

first, easy question first: no, coughing, no matter how hard/sore, will not affect your baby.

There really is no way to reliably predict CPD prior to labour, sorry.
You may be small/slight in stature but that does not say much about the size/diameter of your pelvic outlet. Also, size and moldability of baby's head also comes into it. Most women 'cook' babies that they can deliver. TBH, no matter how experienced in obs your GP is, I think to remark you may have CPD on examining you only is a bit ...
Also, lots of baby's heads only engage in labour. It not having engaged yet really does not mean an awful lot.

Go into labour with confidence and let your body guide you. I found labour pains required concentration and breathing and making an effort to relax really helped. I hope your confidence in your body's ability to do this has not been dented too much.

And if you do need a CS or decide you'd rather have one, then that is the way it was ment to be . Just do not think that CS is the 'easy' option - having delivered both ways I'd choose a VB any time.

V best of luck. Hope your scan goes well and cough settles down.

[twolittlemonkeys]

I believe I had this, as DS1 stayed high and never engaged, even in labour. At 39 weeks they said it was unlikely I'd have baby naturally so they'd give me a chance to go into labour but book a section for 41 weeks. Went into labour at 40+1, laboured for 20 hours and DS1 was born by emergency section at 40+2.

[first1]

Of course I don't want surgery. I had my appendix out and even that turned me into the devil woman afterwards! I want what is best for baby ultimately. I've read CPD in labour can cause cord prolapse and that's my biggest fear. I just really hope I can get a scan before Friday otherwise I'll have no real evidence to make my decision, and let's face it, it's not a light one. Just scoffed a big bar of galaxy, it's made me feel a tad better

[Poppet45]

I actually think that because the thought of a c-section is on the horizon you won't be so shocked if the trial of labour ends in an em-c section so it won't be so psychologically damaging as it might be. I'm trying to find out if I had CPD, as DS (9lb 6oz and not fat just very, very big and tall, with shoulders like a scrum forward) never engaged and then turned transverse during the second stage of labour, but actually I was really glad to have 19 hours in labour then a section as I knew I'd given it everything I had - keeping active, spending lots of time in the pool etc, LOTS of squatting - and knew that I had to have a section and it wasn't just an easy option. Of course had I known I was going to end up with a spinal I might have gone for something more than just gas and air for the rest of the time. But hey ho. Anyway good luck.

[fiveisanawfullybignumber]

Strange question first1, but any chance of an emergency referal to an orthapeadic surgeon, just for an exam & consult?
Reason I ask is that my DD1 (15) is under the care of orthapeadic surgeon for femoral anteversion (her thigh bones are turned into her pelvis too much.)
He said if we opererate she'll need differnt clothes as her hips will widen significantly, and pelvis will open up. If not (and we don't want to unless we really have to, involves 2 ops on each leg, having bones broken & realigned etc,) she will probably have difficulty giving birth naturally when she's older as her pelvis is too compacted in & narrow.
Strangely enough DH's cousins wife has the same femoral anteversion & had an Em CS for DC1, then an elctive one with DC2 for same reason.
You may have a similar reasoning behind what GP says???

[PacificDogwood]

Oh, gosh, I hope my post did not sound like I was implying you wanted a CS . If it did, I am sorry.
Just ment to say, with the benefit of having had (successful) VB and a CS if it was me and as there is no reliable way to be certain of CPD before labour, I'd go for a trial of labour.
If it works, great, if not be proud of having delivered your DC safely by CS.
IIRC they used to x-ray mother's pelvis and child's head to try and assess size and even that is not acurate and AFAIK no longer done routinely.

[first1]

Interesting thought fiveisanawfullybignumber - But with the bank holiday weekend I doubt I'll get referred so quickly before my obstetric appt on Friday. I've rung around a few private scanning clinics and they say they don't offer any sort of pelvic scans for pregnant women anymore. What was a usual practice has now diminished. I tried to call my MW but she's still in bloody Portugal. My GP has offered to see me twice next week, Tuesday and Thursday to give his second and third opinion on baby's engagement, then I'll go to the hospital on Friday and see what they say. My mind is virtually made up for a trial of labour first. But I'm going to make it clear (if patient opinion counts for anything?) that if baby's head is not descending after say 6hours to go ahead, not leave me going on indefinitely struggling. Is that reasonable do you think?

[LittleSilver]

Of course your opinion counts! Have no experience or qualifications in anything you have posted on, but have you considered writing down that suggestion and incorporating it into your birthplan and discussing it with the consultant? You could do a sort of: If X happens then this is what I would like to happen, if Y occurs then I would prefer Z. Would that be helpful? It sounds eminently reasonable to me, but you do know that you are in control here, don't you? They can't just "do" things to you without your express consent. I hope that doesn't sound really patronising and my apologies if it does!

[first1]

Thanks littlesilver. I'm definitely going to put it into my birthplan. It's getting longer by the day what with all my "strategies" if I have an asthma attack and now this, I'm going to be the labouring woman from hell!

[fiveisanawfullybignumber]

First1, get your DP/H to watch you walk towards him with legs bare. Normally your knees should point directly forward, if they turn inwards you may have undiagnosed femoral anteversion. It doesn't always give any pain, but will definitely affect your pelvic width. Hope this helps.
Good idea about the trial of labour, but definitely push for intervention if you feel nothing is happening.
Have you joined the May Ante-natal thread yet? I'm due 14th but hopefully going in for induction on Monday. Come join our chatty little gang.
www.mumsnet.com/Talk/antenatal_clubs/954985-Due-May-2010-the-final-thread-unless-the-thread-bursts