Obstetric Lie # 84- CPD (or, Your Baby Doesn't Fit)

CPD- Cephalopelvic disproportion.

In layman's terms, the babies head is too big to fit through the pelvis, or your pelvis is to small to allow a head through it. 

As with many of these subjects, this one is close to my heart.

I was blessed with a long labor with my first child.  I labored for three nights and two days.  One of those nights was spent mostly pushing.  To be exact, I pushed for a total of four hours.

It was quite possibly the hardest work I have ever done in my life.  I was blessed to be rewarded, at the end of it, with a triumphant natural birth.

How easily could I have been cut in my abdomen after two hours of pushing?  Quite easily.  Many a woman is sent to surgery after a very short time of pushing- the diagnosis often given, CPD (or of course, failure to progress, another favorite).  

"Mama, you just were not big enough to have that baby come out of your vagina."

I once heard a woman say that she thought sometimes we secretly liked this reason for the c-section.  Why?  It is nobody's fault....well, except maybe God's.  You didn't do anything wrong, the doctor didn't do anything wrong, you just had a too cute and too tiny a pelvis for baby pushing.

I admit, the thought of somebody telling me THAT part of my body is small is appealing (though ridiculous) so I can see the reason why care providers like to give the CPD excuse for surgery, even when in actuality and by all accounts it is really quite rare.

(I can't find good numbers on this.  I see quoted all over that ACNM considers CPD to happen in about 1 of every 250 births, but despite this common claim, I can't find proof of it.  I have also heard quoted the number 1 in 2000 births.  So, I just won't make a numerical claim on this that I simply can't back up.)

Without any further ado, lets get real about CPD and why it happens and what we can do about it.  

Why would CPD really occur?  What makes a baby and a mama incompatible for vaginal birth?
Well, there are some REAL reasons for this.  

Malformed pelvis- this does sometimes happen.  Sometimes disease, and even injury, or maybe just our different bodies can cause a pelvis to be shaped in such a way that babies do have a hard time (or find it impossible) to pass through.  (Yes, all obstetric lies are sometimes TRUE!)

Poor positioning- Sometimes a baby could pass through the pelvis if positioned normally, but because it is not, it can't seem to fit.  Now often while laboring I believe that babies move and CAN find a way.  They move, you move, and eventually, like a key in a lock, they make their descent.  Chiropractic care, lifestyle, and even positioning tricks can help with this also. 

Huge baby- There are probably also times where a baby for some reason grows abnormally large and cannot fit.  Gestational diabetes is said to cause this, as are a million other things.  Some claim dairy makes babies too big.  Others say sugar.  I think it is probably safe to say that we should eat well and avoid junk food (anything in a package and anything that is "white" while pregnant if we want to grow the healthiest baby possible.)

I also think it is pretty safe to say that most women don't normally grow a baby that is too big for them to birth.  And let us NEVER forget that there is virtually NO WAY to know if you can or can't birth your baby without a generous time laboring with each baby.  Ultrasound, pelvemetry, and x-ray are not "proof" that your baby is too big or your pelvis is too small. Nor is a past diagnosis of CPD.

Now lets talk about avoiding a FALSE claim of CPD and subsequent c-section.  

~ Epidurals- Pretend You Hate Them~

Yeah, I know, people love 'em.  In fact, on occasion when I say dumb a#$ stuff about how I hate epidurals, people go totally nutso on me.  Apparently there is some special connection women share with a drug in their spine.  (For the record, making fun of epidurals in my mind is VERY different than making fun of people who GET epidurals).

But let's be real ladies.  An epidural pretty much stops you from walking.  In fact the entire POINT of this nifty invention is that you can't feel anything from where it is placed on down.  

I have heard that I can't "prove" that an epidural can lead to a c-section.  (Says the NIH and ACOG).

I am just going to have to disagree with my boys over at ACOG and the National Institute of Health.  Yes, I am a strong enough woman to disagree with two huge and respected organizations.  I only do it because they are wrong.

How on earth is an immobile woman who can't feel her own vagina supposed to birth a baby out of it?  How is a bipedal mammal supposed to birth normally while on her back?  How does the law of gravity become magically suspended when a women decides to give birth lying down?  Is there some time/space continuum where the laws of nature are suspended during what should be a natural process?!  

If this is the case then this SHOULD BE ON THE NEWS!  Somebody call the CNN and patch me through to Ted Turner himself.  

So, relating to epidurals.  If you don't want your baby to be too big to fit through your pelvis, you can take my totally unprofessional and unprovable advice and stay away from epidurals.

(My secret thoughts on these studies is that they were comparing supine women without epidurals to supine women with epidurals.  No surprise that both had equally good chances of having surgical births.  Just my two cents though.)

Does one really have to have a medical degree to see that numbness, supine positions, and immobility are going to clearly work against a woman when she is laboring and birthing?  This seems self evident to me. 

~Your Back- Stay Off Of It

So, relating to epidurals, my next piece of advice would be to stay upright and mobile for as much of your labor as you can.  This is WHY I would say to avoid the epidural.  You can't be upright when you are numb from the waist down.

I think we tend to think of birth in very mechanical terms.  This makes sense if you are a guy and you like cars.  Sadly, it doesn't make a lot of sense if you are a woman birthing a baby.  

Here is the thing, you CAN measure dilation, station, hours of labor, and length of contractions.  You cannot however measure what exactly goes into getting a baby out of a woman.  

I am of the belief that both mom and baby are involved in the process.  This isn't just about dilation, it is about two people working together towards the same goal.  That goal, is vaginal birth.  

When we are on our backs, we make it harder for the baby to move down.  Because of course, it isn't moving down when we are supine, it is moving... kind of up hill.  

The uterus is meant to help expel the baby, but it is NOT meant to do this on its own.  We are beautifully and magnificently designed as whole and entire women.  Our bodies along with the laws of nature and gravity work together with the baby (he is moving too) to crescendo at the birth of said baby.  

When we take away all these other factors (gravity, movement, walking, and feeling) we make it much harder for this process to occur.  The truth is, I am amazed that anybody births vaginally when lying on their back with numb legs and a needle in their spine.  Kudos to them because I can GUARANTEE that I simply could not have done that.  The fact that women deliver their babies like this is, if anything, is a testament to the resilient nature and power of the female form.  Our bodies can actually overcome the laws of gravity and potent medications to get babies out.  

I will be honest with  you- I think the first baby is kind of a tight fit.  Mine sure was.  That doesn't mean it can't be done!  It just means you need to be surrounded by people who understand and respect your ability to birth. 

So, my second piece of advice, stay off your back.  Rise UP!

Some other helpful tips- 
~Push intuitively and use gravity.

~Check your hospitals policies on birthing positions.  You would be surprised how restrictive many of them are.

~Remember that continuous monitoring will also keep you strapped to a bed even if you avoid an epidural.  Think seriously about how you feel about being constantly monitored. You may want to consider intermittent monitoring.

~Affirmations- Remind yourself of your ability to birth and the beauty and wonder of your birthing body.   

~Remember that just because somebody pushes for a few hours, that is mostly REST time.  Pushing contractions (when natural) often have about ten minutes of rest between them.  Nature is kind when left alone.  

I have to admit, these posts used to make me really kind of angry.  How have we become so lost?  How can anybody so seriously doubt the ability of human women to safely deliver their own babies?

Now, they just kind of make me feel... sad.

We are capable of birthing your babies.  I am a real mother.  I really pushed my baby out.  He weighed 8 pounds and 6 ounces.  It took me four hours.  But I did it.  My last baby weighed 9 pounds and 9 ounces and she was posterior.  I pushed her out in one contraction.  I am not a big woman, but I did it.  I have talked to far too many women who were told that they couldn't do it.  I fear that many of them were lied to.  

Chances are, you to can do this.  Prepare yourself.  Prepare your birth place.  Respect the pelvis.  Work with your baby and your body, and miracles (like birth) happen.


MosMum said…
When you kind of 'go off on one', as we say in the UK, and say what you really think, you are all types of awesome. I love to read these posts the most, they make me feel truly empowered and excited about my VBAC and like a fierce, amazing goddess who CAN give birth naturally. So, thank you!
It's being told to women who have already had a baby vaginally (raising my hand)... by a MW no less. It is a highly abused excuse to cut.
t said…
cycliseGreat Article! I know a few women who feel helpless with this diagnosis hanging over their head. It's so sad, when they succumb to c-section after c-section in the name of "safety". Yuck! I also wanted to say that some laboring on your back can actually be helpful. In birth, it is good to keep an open mind. In my experience, I have a tilted uterus, and in both of my births, I have not dilated unless I am lying on my back with a few pillows. It's the only position baby's head can engage with my cervix. It's not knowing this info that led to my c-section.
Mama Birth said…
True T- It is just pretty rare. But thanks for bringing it up because it DOES happen.
Crunchymommy73 said…
Very, very well said. Thank you for speaking your mind!
May I just add this little gem of a video from ICAN: http://www.youtube.com/watch?v=roFVkDV45MM
AmandaRuth said…
Thank you for this post!

I had one birth medicated and one naturally - I can tell you in all honesty that the non-medicated one was less painful and more effecient at getting a baby out, at least in my experience.
Birth Servant said…
Truly AWESOME! You are such a wonderful writer. I love your stuff...it rings true!
Ashley said…
I hate the CPD diagnosis too, and was given it with my c-section. Luckily I was enough of a birth junkie by that point that my husband knew the terminology, and understood when the doctor told the nurse "occiput posterior face presentation". It also helps that I reached in myself and felt what I realized the next day was her forehead. Yeah, 10 pound brow presentation on a primip..not gonna happen. But that doesn't mean that my next child (due in 10 weeks) needs to be cut out of me, that there's anythign wrong with my pelvis, etc. etc.
Paala said…
Great post! And by the way, when I read this part of your post, "So, relating to epidurals. If you don't want your baby to be too big to fit through your pelvis, you can take my totally unprofessional and unprovable advice and stay away from epidurals," I thought, has she heard of the study that shows a link between maternal IV fluids and newborn weight? “It appears neonates exposed to increased fluids before birth might be born overhydrated...” - What does that say to me? If a mother gets an IV, then an epidural, then her baby is getting pumped full of extra fluids which logically must make it harder for the mother to push the baby out. http://www.eurekalert.org/pub_releases/2011-08/bc-mif081211.php
I'm sure there will be a study (not soon enough) that proves how wrong birth interventions are. Especially since now the seemingly harmless IV is being questioned. Keep posting!
Valery said…
I just love all your posts and the true, raw honesty of them.You rock!
Jenifer said…
Awesome post, and so completely true! I pushed for 3 hours 45 minutes with my first baby (I'm currently pregnant with my 2nd). Fortunately I changed my birth plan at 39 weeks pregnant from a hospital birth to a home birth, and I had 3 wonderful midwives content to let me labor as long as was necessary to birth my baby. I had previously had a conversation with my OB (before changing to midwife care) in which she had said that as long as something was happening during my labor, she would let me labor w/out intervention. But if things weren't moving forward, then she would intervene. I believe with all my heart that if I had been in the hospital, I would have been fighting off some type of intervention or worst case, a c-section. I'm so grateful I was able to have the peaceful, natural home birth I so desired.
Doula Darlin' said…
no epidural, unlimited moving around following mother's and baby's intuition, privacy, loving touch by partner and TIME will get most all babies born vaginally. Our current way of 'managing' birth is ludicrous and the very reason why it gets so messed up. There is a good reason why (most) midwives have learned to 'sit on their hands'...
Kong Choon Yen said…
I was shocked to hear a doctor who supported natural birth would consider cytotec as safe when it comes to inducing labour given the risk of uterine rupture. What ashame! Hope all parents or parents to be do their own research before agreeing to any kind of medical intervention.
trish said…
When I told my OBGYN that I was considering a home birth she said she "strongly recommended against it" because the baby might not fit through the birth canal. I've since switched doctors, but I'm happy to say I had a 9 pound 1 ounce baby naturally! He wasn't too big and my labor was 9 hours, I pushed for 15 minutes, and he was out. I probably could have birthed an even bigger baby!
rach said…
Thanks for this! I so feel you. Yes, we need to stand up in labor, but I had to ask permission to do so! Trying to have a baby in the normal way in many hospitals is an uphill battle. The doctor and nurses thought I had drunk some kind of kooky punch that convinced me that epidurals were bad. But I wasn't the crazy one!
Jen Currier said…
YES!!! I had "complications" with my firstborn and felt forced to go with many interventions- both Pitocin and an epidural (later they figured out that I just wasn't in full labor yet. Great.) I was lucky to get him out- while on my back,and with little to no feeling in my lower half (I HATED this feeling. I felt like I was going crazy.) So, when I gave birth to my younger son, I insisted on waiting and doing it without intervention and sure enough- everything was EASIER. My friends who have epidurals think I'm crazy to endure pain "for no reason", but it's NOT for no reason. It was WAAAY easier. Plus, right after pushing the baby out (and my body helped naturally, BTW) I walked right into the shower- no nurse assistance necessary. It makes me crazy, because I feel like we women have been brainwashed.
jazzchick said…
I am a real mother. I had a c section and an epidural. My labor was 53 hours long and my daughter and I both would have died without the c section. I struggle with guilt as it is. Please don't add to it by saying I am not a real mother or that I have been brainwashed.
MH said…

I don't think anyone is saying that you aren't a "real" mother for having had a c-section and epidural. No matter how the baby comes out, you are still a mother deserving of respect. This post and the anger in the comments are directed toward professionals who have, wittingly or unwittingly, given women the impression that their bodies can't be trusted. There is definitely a misconception about baby size and pelvic size that leads women to think that the baby their bodies have made can't be birthed by that same body. But sometimes that is the case. Two examples - (I've posted this before, but) my great aunt gave birth unmediated and unassisted at home to a 13 pounder, and the women in my family are lucky to grow past 5' 2, if that gives you a decent picture. On the other hand my doula has never been able to have a vaginal birth, despite her preference for natural childbirth, because she has a fused pelvis (rare). It happens, but, as they are trying to point out, a woman deserves a (fair) trial of labor to determine whether her pelvis requires assistance.