Small Pelvis: It's Non-existant!

Continuing from where I left off in my last post about small pelvis' leading to c-sections. . .(click here for part one, click here for part three)

Unfortunately, learning whether you have a small pelvis doesn't happen until you're in labor. You can't simply look at someone and say, "they have a small pelvis" or "they don't." Otherwise you wouldn't see tiny women popping out five children easily and big-boned women still needing c-sections for this reason. It has nothing to do with your body type or size. I'm five foot-two-and-a-half but never during my check-ups with my doctor did she say I had a small pelvis. It wasn't until I'd pushed for two hours and my baby hadn't moved the smallest of a fraction when I was diagnosed.

Now I must point out that my baby was face up--because I think that actually had more to do with my long pushing phase (one, it's simply harder for the baby to move when it's in the wrong position and two, it's nature's way of protecting the baby's face from suffocating). But my doctor explained that my "small pelvis" was what caused my baby to be posterior.

If I hadn't practiced HypnoBirthing techniques, I'm confident I would have ended up in a c-section. When women have the "small pelvis" AND they're not 100% relaxed it's even less likely that the baby will move. I believe that's why my doctor let me push for the total of four hours--because she knew I was HypnoBirthing and so my chance of delivering vaginally was higher than someone who wasn't. (#1 rule: learn relaxation techniques so that you are in the most relaxed state of your life!) In the end I did indeed deliver vaginally, but it still wasn't the smoothest sailing so I want to do what I can to make the pushing phase easier next time so that 1) I don't need to worry about my baby's journey out and 2) I don't end up in c-section.

So what exactly does it mean to have a small pelvis during childbirth? Cephalopelvic disproportion is when the baby's head is not in proportion to the mother's pelvis (i.e. too big to fit). But my son was average in size (7 lbs) and his head was actually smaller than the average newborn. Therefore, I find it hard to agree with this theory for me.

As I made my way through cyberspace researching this topic, I found that there are millions of other people who completely disagree with the small pelvis theory--and many doctors say that it doesn't even exist!

The truth: it simply varies from woman to woman how the pelvis stretches (just as we all vary with everything). . .but in the end (unless there is a medical reason) they can all make enough room! That's why the exact same woman can have a hard time with one child but not another--in fact I've been reading stories of women who were told there would be no way they'd birth a larger baby than their first. . .but they proved their doctors wrong!

We need to have confidence in our pelvis' ability--the stretching is just another part of pregnancy--we need to remember that our bodies are designed for childbirth! The problem lies because what works for one person may not for another. It's about trying different things and learning what helps YOUR pelvis stretch easier. According to the Australian site bellybelly.com:

1. The pelvic girdle is not a fixed, solid structure

During pregnancy and labour the hormone relaxin softens the ligaments that join the pelvic bones, allowing the pelvis to give and ‘stretch’. The degree of pelvic expansion achieved will vary from woman to woman and from pregnancy to pregnancy.

2. Babies’ heads mould into shape

Babies’ heads are made up of separate bones which move relative to each other, allowing the baby’s head to ‘mould’ and thus reduce its diameter during passage down the birth canal. No one can predict the capacity of an individual baby’s head to mould and, as this is a feature of the normal birth process, should not adversely affect the health and well-being of the baby.

3. The position that a woman adopts during labour and delivery makes a difference to pelvic dimensions

Squatting, for example, can increase pelvic measurements by up to 30%. One of the most common positions in which women give birth, that of being semi-reclined where the mother’s weight is on her coccyx, restricts movement of the coccyx, which can severely compromise a below-average pelvis.

4. Baby’s position

The position of the baby can be crucial, and whether its head is well flexed or tilted can mean the difference between an easy delivery and delivery being impossible.

I wish that I would have tried squatting during my labor. I did learn about that position prior to my labor experience (from my friend's blog that I referenced in my last post), but since I (obviously) didn't know I was going to have this issue, I didn't put it front & center in my mind. . .and so I forgot while I was in the moment.

It's too bad that these things are left up to us to remind ourselves. . .I was in the #1 hospital for births in my city and yet none of the nurses suggested I squat to help move L.J. down the birth canal. I'm curious as to whether it would have gone easier/quicker had I tried that position. That's actually the ONLY way women deliver in many other countries. I read somewhere that the U.S. is one of the few places where women give birth lying on their back (the least effective position). I did try the "all fours" position for a while, since that is best for posterior babies (the hospital staff did remind me of that one) but unfortunately I didn't notice improvement.

There's no denying that my pelvis didn't stretch like some women's--my doctor has delivered a ton of babies and could definitely tell the difference--but the diagnosis of "small pelvis" is misleading. It doesn't mean my pelvis will react that same way next time or that I would have needed a c-section had my son's head or size been larger. It simply means during this pregnancy there were factors that slowed down the stretching process. . .but obviously it still eventually happened, as L.J. did come out!

Aside from his bad positioning, maybe my body didn't release enough relaxin. (Relaxin in pregnancy is secreted by the corpus luteum, the placenta, and part of the decidual lining of the uterus. In certain rodents, it relaxes the symphysis, inhibits uterine contractions, and softens the cervix.)

There are DVDs and books that can teach you about your pelvis and how to find out which unique shape your pelvis has, providing suggestions on positions based on that shape and as a result reduces fear and increases confidence in your body’s ability to birth well. There are also positions you can do in the weeks leading up to the birth to prepare your pelvis. And, if you're like me, where the pelvis may prevent the baby from getting into the best position, you can read about optimal fetal positioning HERE or check out Spinning Babies.com

I will expand on the positioning topic in my next/final "small pelvis" post, as there are even more things you can do to prevent posterior babies. But the message of today: don't just assume because you've be given the diagnosis of a small pelvis that it means you can't birth a normal-sized baby. It just means you have a couple of extra steps to get to where "Jane Doe popping out a ten pounder is." We've all heard of the rare women who have twelve-pound babies. . .we all hope we're not them, but they should actually be a positive reminder to us that we all have the ability to do it. Our pelvis' are all different, yes, but after doing my research I can't use the "small pelvis" excuse anymore. It will not be an issue for me next time because there's no such thing!

I will end with more suggestions from my friend's blog that I referenced yesterday:

--Yoga during pregnancy. The mind and body work closely together. The mind has a large influence over what the body can do. Yoga helps to stretch and strengthen your mind and body. The stretching during pregnancy can help your pelvic ligaments loosen and stretch during labor. The more they “give”, the more room your baby has in the birth canal.

--Sit on a birthing ball during prenancy and labor. Birthing balls are wonderful to sit on because they encourage your pelvis to widen and open. Doing figure eights is a great exercise for mothers.

--During pregnancy try to keep your baby from settling into a posterior position. When a baby is posterior it means that his/her spine is lying against your spine. The ideal position for a baby to be born is with his/her spine against the front of your belly. This is the perfect fit for any baby. To encourage this position, try not to recline too much in late pregnancy. Always sit up straight and never lie directly on your back. Also, the hands and knees position works great to rotate your baby.

--When you come to the pushing stage of labor, don’t lie on your back or sit. This prevents your sacrum from fully flexing and allowing the baby’s head to pass. The best pushing positions for a smaller than average pelvis (or any pelvis for that matter) are the squatting position and the side lying position. This allows your pelvis to stretch and accommodate your baby while he/she travels through the birthing canal.

P.S. I didn't do any of these but you can bet I will next time!