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Narrow pelvis - c-section or natural?


15 replies to this topic

#1 miss-petal

Posted 01 August 2013 - 09:41 AM

I'm currently 38+4 and had my weekly OB appointment yesterday. The last couple of weeks he's been a bit worried that bub hasn't shown any signs of dropping down or engaging. He thinks it is either because bub is just a bit 'lazy' or it might be because my pelvis is too narrow.

My mum had c-sects with both of her babies for this exact reason, and dr thinks that maybe this might be the right thing for me to do as well. He wants to wait till my appointment next week to do an internal exam and then go from there.

I really don't want a c-section, but am also wary of going into labour and bub getting stuck and other issues. I was thinking of asking him at the appointment if early induction (at 39+3 or 4) might be another option as bub might be small enough to not cause any drama?

Any advice is really appreciated!!

#2 crankybee

Posted 01 August 2013 - 09:56 AM

I didn't have a narrow pelvis but I was advised to have a C section as my baby was big. I said no. I think they never know how it's going to go on the day and you should always try for a natural birth if that's what you want. I went into labour naturally at 41+4 and ended up having a C section because my baby's head didn't drop enough. And you know, I wouldn't have it any other way. I gave it a go, I don't always have to wonder "what if"

#3 boatiebabe

Posted 01 August 2013 - 10:03 AM

My babies did not drop down or engage until I went into labor and they were both past their due dates.

Your OB sound a bit quackish - "lazy" baby?

It's a pity he is scaring you at this late stage. Can you see anyone else?

#4 Soontobegran

Posted 01 August 2013 - 10:08 AM

The 'lazy' comment is very weird. It is way too early to be talking about early inductions and C/S yet.


Eta.. A true pelvic contracture is pretty rare, the baby is designed with a skull that usually moulds to adjust to the variance in the pelvis.
Good luck

Edited by soontobegran, 01 August 2013 - 10:10 AM.


#5 Bluenomi

Posted 01 August 2013 - 10:29 AM

My DD never engaged, not even in labour. My OB never suggested a c section, he was happy to see what happend. In the end he did need to get her out with forceps since she refused to come out but he did that instead of a c section so I was happy.

If your pelvis is too narrow (which is rare) the baby's head is probably already too big so inducing to reduce the size won't help. I'd just wait and see what happens, the baby could engage tomorrow!

#6 Bess Marvin

Posted 01 August 2013 - 10:37 AM

DS never engaged - he had his hand up behind his head and got stuck. Although we needed a CS, there was never any discussion about early induction or a CS until the pushing was obviously not working and forceps were not going to reach him.

It is hard to know what to do... good luck :)

#7 noonehere

Posted 01 August 2013 - 10:38 AM

DD didnt fit and from what I understand cause a lot of swelling so ended in csection, she was posterior face presentation.

If it was we I would try natural so you can at least say you tried

#8 gasgirl

Posted 01 August 2013 - 10:45 AM

i think you should listen to medical advice.
Unlikely to be much difference in size btwn 39 and 40 weeks, babe is already full term at 37+/40 so "early" induction not really helpful.
These things best decided based on ultrasound measurements of babe's head and your pelvis, and internal examination.

#9 Puggle

Posted 01 August 2013 - 01:04 PM

My OB said a similar thing with regard to DD1 - "a narrow pelvic inlet" was how he described it.

In my case I went on to have a VBAC with DD2 who was 25% heavier than the first baby. DD2 was 5.76kg, so in my case I feel the 'narrow pelvic inlet' was a bit of a line.

This is your decision to make, however. Good luck.

#10 Boombox

Posted 01 August 2013 - 01:21 PM

View Postgasgirl, on 01 August 2013 - 10:45 AM, said:

i think you should listen to medical advice.
Unlikely to be much difference in size btwn 39 and 40 weeks, babe is already full term at 37+/40 so "early" induction not really helpful.
These things best decided based on ultrasound measurements of babe's head and your pelvis, and internal examination.

This isn't true, both the baby's head, and the mother's pelvis  have the capacity to change shape in the birthing process, and no ultrasound or examination will show this.

The only true test of whether the baby will fit is labour. It would be a pity to have a cold C/S if it wasn't really needed. The article linked above is very good, I'd have a good read, and have lot's of questions at your next appt.

Every woman has the risk of needing a C/S in any labour- it doesn't mean every woman should have a C/S just because there is a possibility she'd need one.

#11 StopTheGoats

Posted 01 August 2013 - 01:26 PM

My mother does have a pelvis that is too narrow for her to birth naturally, but she discovered this during birth. Having a shot at a natural birth when everyone in the room knows that there is the possibility for complications and is prepared for them isn't a very large risk, is it?

As for 'lazy' baby... bizzare. :lol:

#12 Velociraptor

Posted 02 August 2013 - 07:05 AM

Quote

I think you should listen to medical advice.
Personally I think you should listen to medical *evidence*.

Doctors can and do give poor advice, and suggesting
your pelvis is too small seems very premature at this early stage, especially if he's been working up to it for weeks.

I'd be asking what, very specifically, is his evidence for believing your pelvis is too small. Do you have an unusually small pelvis in relation to your size? Have you had some past pelvic injury or is there some structural abnormality? (Simply being a small person is irrelevant.) Cephalo-pelvic disproportion is really very uncommon, and baby not being engaged isn't really a good indicator of anything, especially given that it's completely normal for many first babies not to engage until labour is well underway. If it were me, I'd be looking to be presented with a lot of strong evidence, including pelvic measurement (which is also not a great indicator on its own), evidence of the size of baby (are they very large for dates, or even macrocosmic? A truly large baby - and keep in mind ultrasound has a 500g variance - is more likely to become stuck), and so on - and I'd want to know the risks of attempting to deliver naturally. C-sections are risky procedures, and have potential long term effects on both mother and baby, so they should not be performed lightly - and certainly not based on a vague feeling that baby being lazy and not engaged weeks out from your likely delivery date has some bearing on whether labour will be successful.

Also, there is a huge difference in many babies between 37 and 40 weeks - size included. Babies often put on several hundred grams during those weeks, and though the whole window from 37-41 weeks is considered 'term' many babies are by no means ready to be born at 37 weeks in terms of lung function (which is why doctors so frequently refuse to induce or perform an elective c-section prior to 39 weeks unless there is a medical reason).

Edited by Velociraptor, 02 August 2013 - 07:11 AM.


#13 !momo!

Posted 02 August 2013 - 07:30 AM

Unfortunately the only way to know is to try and give birth naturally no amount of sizing scans or internals will tell you how much the babies head will mold or how far your pelvis will flex during delivery.

I have experienced exactly the same thing as you OP. My DD didn't engage and the OB did mention the possibility of a small pelvis being the reason he did mention that c-section was an option but that he was also more than happy for me to try naturally and see. As it turned out she did end up engaging but not until well into established labour all the time a very close eye was kept on my progress and the baby. I did have a vaginal birth but DD did have a mild shoulder dystocia so it was decided for any future births if the baby measured larger than her we would either try and induce early or go for a c-section.

With my second DS was measuring around the same size on the ultrasounds but also didn't engage so the OB didn't want to induce with a mobile head unless we ended up going post dates. In the end my induction was booked for my due date but DS decided to try and come on his own 2 days early still not engaged he never engaged his head was just too big so I did end up having an emergency c-section it turned out he was 0.5kg heavier than DD. My uterus was quite swollen due to the long labour but at no point was DS in distress or their any risk to me otherwise the OB would have recommended a c-section.

Having had both and knowing that my case is not the norm I would still recommend at least trialing labour it should become fairly clear if bubs becomes distressed or if you don't engage. i just found the recovery so much easier with a Vaginal birth. But it is a decision you need to talk about with your caregiver and discuss and weigh up the the possible risks and come to a decision you are comfortable with.

#14 mayahlb

Posted 02 August 2013 - 10:29 AM

My first didn't engage until well into labour. My 2nd was the same, he didn't engage or even decend (was floating high) until about 30 mins before he was born. I am also a small person with narrow hips. The pelvis is designed to flax and bub's head to move so they can be born. Trying labour and being monitored with the information that your mother has small pelvis is probably the best option. But in the end it is up to you. Labour is a scary time the first time, when you are not sure what is best. All the best

#15 Soontobegran

Posted 03 August 2013 - 11:31 AM

View Postgasgirl, on 01 August 2013 - 10:45 AM, said:

i think you should listen to medical advice.
Unlikely to be much difference in size btwn 39 and 40 weeks, babe is already full term at 37+/40 so "early" induction not really helpful.
These things best decided based on ultrasound measurements of babe's head and your pelvis, and internal examination.
Pelvimetries used to be the norm in women whom were thought to be at risk of a pelvic contracture such as previous pelvis injury, extremely short stature or < than a shoe size 5 but these are rare these days because it was felt too many were being assigned a C/S unnecessarily. The 3 P's is what decides how well the baby will deliver vaginally, the Power (uterine contractions) the Passenger (baby and it's size, presentation or position) and the Passages ( pelvis and birth canal) and very often we underestimate the ability of these 3 to work in our favour rather than against us. The babies head has a huge potential to mould and make the best use of the diameter available to it. Of course it doesn't always happen but it can probably happen more often than it is allowed to.        edited to apologise for lack of paragraphs which I am once again unable to utilise. :-/

Edited by soontobegran, 03 August 2013 - 11:33 AM.


#16 TillyTake2

Posted 03 August 2013 - 07:52 PM

My DS didn't engage, even in early labour. It was more to do with his poor position (posterior) than his size or my pelvis. He ended up being born completely posterior & the ob pointed out that I likely had a very roomy pelvis to allow that as easily as it happened (long but "easy"). I don't think not engaging means anything re pelvis size!



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