Pelvis Assessment - any experiences?

[pinkelephants]

Just wondering if anyone has any experiences of pelvic assessment (of shape and size.) I have a 7 month old DS, born by ELCS. I was born with a dislocated hip ad have had surgery to my hip and pelvis as a child to correct this. I was initally told during my pregnancy tha my previous history should have no impact on delivery, however on my due date I saw a different consultant and was advised to have an ELCS because of my history and because she felt the baby was very large (he was.)

For various reasons the CS didn't go quite as planned, there were some complications and wasn't a good experience. We would like to have another baby at some point and I would be very very keen to avoid a CS if possible. However I have been told by various people (midwife, GP etc) that I will be strongly advised to have a ceasarean should I get pregnant again.

I haven't had any treatment to my hip in years so there has been no recent x-rays etc of my pelvis. I am concerned that possible problems with my pelvis will be used to justify another caesarean when this really isn't what I want. I discussed this with my GP and he has agreed to refer my for pelvic assessment. However he made it very clear he thought it was a waste of time. His closing comment was "so you're one of these women who want a natural birth whatever the risk are you?"

For me its not about having "a natural birth wahtever the risk." Its about being sure that a ceasarean is really necessary before I agree to it and not undergoing major surgery unless it is absolutly neessary.

So my question is, does anyone have any experience of pelvis assessment - would x-rays etc provide any useful information, and would the imformation be taken into account anyway. Sorry this is so long. Any advice would be appreciated. Thanks

Tricky. My background is that I'm "just a mum" - but I went against medical advice and planned a home birth of my breech baby (which happened and she was fine). Choosing to ignore the advice/instructions of people that society tells us have near god-like status was not an easy decision but, like you, we felt that we needed to understand the actual risks to me/DD of a planned vaginal breech birth VS CS and, once we did, felt that the risk profile of the HB was better for us. Still not easy following through, though...

From what I've read, pelvic assessments have fallen out of favour as, whilst they can give information about your pelvis today they can't give information about how your pelvis will respond to labour. The hormones that your body releases in late pregnancy/labour should act to loosen your pelvis (taken to extreme it gives you SPD) such that when you try to push a baby through it there's a bit more room than an X-Ray taken out of pregnancy would suggest. Allowing the coccyx to move while pushing by not lying your back can also dramatically increase the amount of space. All in all, the size of your pelvic outlet as seen in an X-Ray is no indicator as to how big that same pelvic outlet will be during labour nor how big a baby will pass through it (especially by the time you factor in the amount of molding a baby's skull goes through and how inaccurate pre-birth estimates of a baby's weight and size are).

How much information do you have on exactly what has been done to your pelvis over the years? I would imagine that whilst, in general, a pelvic X-Ray wouldn't be of much use, in your instance it might give insight as to whether the join between the L and R halves of your pelvis has been effected and therefore may give a clue as to whether your pelvis is likely to loosen with labour hormones. You might also get information as to whether the shape of the inside of your pelvis has changed such that a baby would find it hard to engage).

That said, I couldn't tell you whether its even possible to get that level of detail from a pelvic X-Ray or whether that's the concern that the consultant had when she recommended a CS.

How much of an explanation did the consultant you saw on your due date give as to why she felt your history made a CS advisable? As previous consultants had felt it unnecessary, was this consultant more experienced in this field or just more conservative? Did she see something that the others had missed? Are you being advised to have a CS in future pregnancies because you've now had a CS, because of factors identified by this consultant, or because of something identified during the CS you had for DS?

sorry - that's more questions than answers, but I hope it gives you some ideas and helps you find a way forward so you can make an informed decision.

Thanks for the reply. Its all so complicated isn't it? It has been made so clear to me that a cs will be recommended in the future and I know I will have to go against medical advice to even try a natural birth. I just want to get as much info as possible now so that if/when I get pregnant again I will be more prepared.

The Dr I saw initially (who wasn't concerned) was a registrar, so more junior. They had lost my referral for that appointment so didn't know why I was there and he clearly didn't know much about my condition. He also said my pelvis is symmetrical which it isn't (this was one of the consultants concerns.) The hospital have apologised for the info we were given in that appointment. Apparently it wasn't possible to say I would definitely need a cs at that time but we should have been warned it was a possibility depending on how my pelvis coped with pregnancy (this appointment was quite early on) and depending on the baby's size and position.

The surgery I have had was to the left outer area of my pelvis, so shouldn't have affected the size or the joints in theory. However the shape is affected and my understanding is that this could affect the baby's position and ability to engage.

The consultant did give us some explanation but I had been fitted into a very busy clinic and there wasn't much time. Also, to be honest, I was so upset at being told I needed a cs that I didn't really take in the rest of what she said. I have since seen my notes. What she wrote was cs advised due to asymmetrical pelvis, left illiac crest (outer bone of the pelvis) missing and large baby. However what I don't fully understand is what effect the pelvic abnormalities would have had. The appointment for pelvic assessment is with the same consultant so if nothing else I will be able to ask her to clarify that for me.

The advice to have repeat c-sections is because of my the position ds was in when he was delivered. He was very big (10lb 11) and very very long, but he was still very high - they used forceps first then ventuse to deliver him as they couldn't reach him. I saw a midwife for a debrief and to go over my notes a while ago. Although she said she didn't know anything about my previous surgery and she couldn't be sure what effect the pelvic problem may have had she felt the the position he was in was not a natural one - a baby that big would have been very uncomfortable that high and if it had been possible he would have engaged or at least dropped a bit lower. She felt that it is likely that there is something about the shape of my pelvis that prevented him from getting into a better position (from what I understand this is what the dr who performed the cs felt as well although this midwife is the only one who has explained it to me in any detail.)

Sorry, this has turned out even longer than my first post! Hopefully this appointment will be useful and give me more information. I think I will need to write a list so I can remember all these questions!

I'm glad you've had a chance to go through your notes with a MW and that she was able to provide some insight into why things happened the way they did. Frustrating, though, that the consultant didn't bother to explain it before hand.

When in your pregnancy did the consultant book you in for a CS? Was it pre/post 40 weeks? I'm wondering whether they felt your DS would be unable to engage (in which case a CS would be inevitable, but no medical need to try and preempt labour as labour unlikely to be spontaneous) or if they felt DS would get into trouble during labour.

I wish consultants would just explain a bit more up front as it would save us so much time - but then maybe those consultants have established that if they act with enough confidence most patients just don't ask questions so they save time overall (and they don't have the hassle). Bah!

Not as obviously useful for you as in some other circumstances, but I found these phrases by Mary Cronk very useful to keep in mind when talking to medical professionals - as much to remind myself that anything that happened was my choice as to use them. They might be useful for you - either now or in the future.

(Oh - and list of questions is a VERY good idea :))