Ignoring the pelvis?

[lucysnowe]

Hi all

I was reading an old Miriam Stoppard childbirth book (from 1993!)and it details a fairly simply looking test the midwife can do in late pg to work out whether the baby will fit through the pelvis or not.

Other books I've read seem to suggest that in 'olden days' doctors focused quite a lot on the pelvis, measuring it, etc.

So is there a reason why it seems to be 'ignored' these days? I ask because my obstructed labour and c-section seem in all evidence to have been due to my small/?deformed pelvis (rather than DD being disproportionately big, presenting wrong etc) but when I mentioned it to the consultant when preparing for birth no 2, she didn't seem that interested and it certainly didn't come up the first time around either.

Any thoughts? :)

In Belgium they pay more attention to the pelvis. My friend had a CS, and during her second pregnancy, was given a pelvic scan which deteremined that she would not be able to give birth vaginally.

In the UK, these scans are not considered to be accurate because the pelvis changes during pregnancy and during labour itself. Therefore the scan is not considered to be financially viable.

My interpretation was not so much that the scans weren't financially viable, but more with the former point - the measurements may be accurate now but the pelvis can change so much during labour (especially if you don't labour on your back so the coccyx can lift) that the measurements can change by a significant percentage. Why expose the baby to radiation of whatever form and spend money to gather data that you know will be inaccurate at the point of use?

apparently it is an uncomfortable scan, considering you are heavily pregnant, you are moved into all sorts of positions to get all the readings.

That said, I think there's a lot more justification for it if there are reasons to believe that a woman's pelvis is deformed - either congenitally, developmentally or through injury. Unless there is specific reason to expect that problems may be present that will prevent the pelvis spreading during labour, then I think the opinion in the UK is that pelvic scans in pregnancy are a waste of time and money for the reasons given above.

(Hi again belgo :o)

Interesting, thanks!

The test in my MS book consisted of the mother lying on her back, then sitting up a bit so that the baby's head slipped back through the pelvis. It looked v. simple in the drawing :)

Do they never do the scan in the UK these days? I suppose they don't want to freak out mothers unnecessarily if the pelvis will change during labour, but if there is the likelihood of a big disproportion, or if small pelvises run in the family (like they do in mine)... or there is the possibility of deformity, is it still not worth it?

Also is it a scan or an x-ray? Can you even do x-rays on pg women??

Oh, x-post Tangle!

You can do X-rays on pregnant women, but there needs to be a significant clinical reason for doing so. The closer the X-ray to the uterus, the bigger the reason to justify the risks. X-ray exposure of the baby is known to increase the risk of childhood cancer, so they'd need to have quite a pressing need before they'd want to do an X-ray. That's possibly another factor in why pelvic scanning has gone out of favour - US isn't so good at penetrating solid bone (IIRC) and X-ray and MRI aren't recommended without strong need.

There's another aspect as well - the baby's head is designed such that it can squeeze through a small gap. I don't know that there have been any studies done on just how much the head circumference can reduce.

I think there's a lot more knowledge now about how the baby and pelvis interact during labour - enough knowledge to know that predicting where there will be a problem is very hard! The only sure fire way to know that the baby ain't coming out that way is by trying it and seeing what happens.

That said, if you have a strong family history of obstructed labour and small pelvises, and/or you believe your pelvis to be deformed then you can push for a scan - your consultant should at least be prepared to explain why they don't consider it will be beneficial or why they consider the risks don't justify the benefit. If you don't get a satisfactory answer you can request (demand - politely ) a 2nd opinion.

x-post again :o

The pelvis is not fixed, its also about the ligaments and muscles and how telaxed they are.
I do think certain pelvic shapes can increase the chance of malpositioning and require more support to have a normal birth (preperation in pregnancy, body work etc and also movements etc in labour)
But not sure a simple test could tell you anything for definete (as it will be based on baby size, baby position, work in preperation in pregnancy and mobility in labour).
In the past they have (esp in the US) tried to schedule CS based on pelvic examination, but it doesn't always hold true (see
See Spinning babies website for loads of info!
www.spinningbabies.com/

LOL at x-post :)

In my case, I felt there were several clues to my having pelvic problems. Besides what my mum was told, there was the fact that DD was breech until 37 weeks, didn't engage, was distressed during labour (induced at 42 weeks) and, according to the consultant, there was a lot of fluid trapped (?I think that's what she said) behind DD which is not common. And as I say, she apparently presented fine, so it was my fault, not hers :) OTOH I had an epidural, was flat on my back, got to 9 cm, so who knows, I may have had a successful VB if things had been a bit different.

This time round I'm almost certainly going to have a c-section anyway but in some ways would like a scan, as you suggest - just to be sure. BUT all this is creating trauma in some ways which I didn't really experience at the time. I don't like the idea of poor old DD being stuck because of me.

Thanks Selina, v. interesting!

Are your shoulders wider than your hips, I posted lots of info on here in the past which I will search out when I get home! I've been seeing a chiropractor in this pregnancy (my DD was persistant OP) and so far this baby seems to be in a better position.

So if my shoulders are wider than my hips, there's no way a baby's coming out the way it went in?!?!

Please don't think what happened with your DD was your fault.

All we can ever do is to make the best decision we can, based on our current situation and the information available to us at the time. Its only with the benefit of hindsight we can look back and say "maybe if...", but that shouldn't devalue the decisions that we made at the time.

Fingers crossed things go more smoothly for you this time, however they happen :)

My shoulders are wider than my hips & the babies squeezed out fine.
Have very broad shoulders, though :).

hmm I think my shoulders are a bit bigger - what does that mean?!

Tangle I don't really blame myself, insofar as I would probably make the same decisions again, given the circumstances...

It can indicate an android shaped pelvis which can make it more likely babies will be malpositioned and harder to get out. But like I said before, it depends on lots of things!

After my birth of ds1, he was well and truly struck and wouldnt come out and got distressed so ended up with emcs, my nct teacher recommended an xray of my pelvis to see if that was the reason. It made sense as I have small hips so I asked for one at first the consultant said no but then arranged one. Xray came back my pelvis was fine. So next time I planned a vbac but ds2 got struck again. Not sure how accurate the xrays are

I've had 2 babies, both of whom turned back to back a couple of hours before I gave birth. My first baby got stuck in my pelvis for 3 hrs and I thought she'd never come out, she did but caused me major tearing. I brought up the size/shape of my pelvis when I saw the consultant for my subsequent birth, like you OP, but he also was dis-interested.

I've recently had a pelvis x-ray which clearly showed my pelvis is mis-aligned. I don't know if this is the result of trauma after giving birth vaginally twice or whether my pelvis has always been like that....

tqs, that is really interesting. Sorry to hear you had problems with your DD's birth. Orangehead, that's interesting too. It sounds like it is not an exact science - I think some guidance, or perhaps some explanation of why and why not pelvic issues can occur, would be useful...

Selina, the idea of an android shaped pelvis brings up v. bizarre images :)

1944, that's really interesting! I guess that's why they gave up doing that test. Sorry to hear how it impacted on your births. I suppose these days they consider it's just as good to check on birth as it is progressing and react accordingly.

It also depends on the baby's size as well I suppose. Did they think your babies would be small as well?

Interesting too to read about the different sorts of pelvises. Do m/ws still learn about this today?

Yay I have an ape's pelvis! :)

I shall tell DH, he will be pleased