can my baby be too big for my pelvis? August 7, 2007
Posted by guinever in birth, health, labor, pregnancy.trackback
I frequently get questions in the comment section of my article, cervical dilation 101, frequently asked questions. Every once in awhile, a question comes up that doesn’t have a simple, short answer so I’ll write a new article. The following comes from a pregnant reader:
Just an update,
I went to the doctor today, I am 38 weeks and 3 days. I am 3 cm dilated and 70% effaced. My cervix is still posterior, but the baby is head down and -2. My blood pressure has been slightly elevated the last 2 weeks and the doctor thinks the baby weighs around 7 pounds. He is also concerned that I could need a c-section because I have a small pelvis. All this in account we are inducing labor Thurs morning. Do you think it could be a long labor? Or could it be pretty quick given I am already 3 cm and this is my second child?Thanks for all of your help, Christina
Dear Christina, Your pelvis is not too small. You do not need a c-section. A doctor has absolutely NO business telling a woman her pelvis is too small before she is even in labor and tries to push the baby out. (did you have a c-section for your first baby?) Your pelvis is not fixed in place. Hormones right now are working on softening the ligaments, loosening your pelvis so that it may move and widen and change shape to accommodate your baby. And your baby’s head is not hard and fixed in place either. Your baby’s skull has plates that move and mold to fit through your pelvis. These are the baby’s soft spots. This is why some babies are born with pointy heads; their heads have merely changed shape so they can be born and will quickly regain a more normal shape within hours. Please just be confident in your ability to birth your baby! Put the word c-section out of your head. There is a huge mind and body connection when it comes to labor. If you believe that you can’t birth your baby, or if your doctor’s words are in the back of your mind, then it might come true.
Also, why are you being induced in a couple days? High blood pressure, out-of-control blood pressure is definitely a valid reason for induction, but in your words, yours is “slightly elevated.” Although many doctors are quick to induce, most wait until the due date unless there is a medical reason and you still have a week to go. I hate to say this, but is your doc going on vacation? Sometimes, a doctor will induce his patients so they’ll give birth while he’s still in town and so that he will get paid for the births (rather than whoever is on call for him while he’s gone). He is getting you used to the idea of having surgery just in case you don’t have your baby before he wants to leave in the morning. He has already told you that you might need a c-section. He’ll have the induction started in the wee hours of the A.M. and be checking in periodically throughout the day with the nursing staff. He’ll go home for dinner and then come back and say you’re not progressing or your baby is just too big for your body so it looks like you need surgery after all.
Now having said this, this may not be the reality in your case, but you should consider it. Ask your doctor, why are you inducing me? What happens if we don’t induce this Thursday as planned?
To answer your question as to how long the induction may take, like I tell everyone, I have no idea! There is no magic formula that says a woman dilates 1 cm an hour even though some OBs like to tell us that’s the way it should happen. Read my article, what does being 2 centimeters dilated mean?
You are 3cm dilated and 70% effaced. With these numbers, a pitocin induction will most likely be successful and lead to a vaginal birth if given enough time. If your body and baby are ready for labor, you could have your baby in only a few hours or it could take all day. You also said the baby is at -2 station so your baby is still floating and very high.
Zero station is “engaged” or “dropped” where your baby’s head is fixed in your pelvis and not going anywhere. But at -2 station, your baby is still “floating.” It is common to break your water during an induction. Please know that if they break your water , called artificial rupture of membranes (AROM) before the baby is at 0 station or lower, then there is the danger of cord prolapse. This is a dangerous situation because the head will compress the cord, cutting off the baby’s oxygen supply. You do not want that to happen. So if you do get induced and if they talk about breaking your water, be sure that your baby has come down to at least 0 station.
To sum up, just trust in your ability to give birth! You can do it. To answer the question posed in the title of this article,
“Can my baby be too big for my pelvis?” Watch this inspiring video for the answer.
The answer is probably not! Be inspired by the pygmy women in Africa who are only 4 feet tall. Gloria Lemay writes for Midwifery Today that the average weight of their infants is eight pounds. In relative terms, this is like a woman five feet six giving birth to a fourteen-pound baby.
Birthing Blessings, Guinever
To read other pregnancy related articles, please refer to my welcome page .
Guinever, thanks for posting this. I’d add that the size estimate is frequently quite wrong. I know someone who was recently told the same thing, and the baby was really a full 2lbs under the estimate.
Yes, I heartily add my agreement that estimates of fetal weight in the third trimester are NOTORIOUSLY inaccurate, especially when done by ultrasound. Studies have shown that the mother’s own estimate of her baby’s weight (and an experienced midwife’s hands) is far more accurate than a third trimester ultrasound.
There is also great concern over the rising rate of preterm birth in the U.S., and much of this has to do with inducing labor or scheduling cesareans. Estimating a due date is an art, not a science, and when the baby is induced to come out before it’s ready, we are finding far too often that the baby was not as old as they thought it was. Because of the inaccuracy of ultrasound in determining fetal age or weight in the third trimester, we don’t know until it’s too late that the baby really isn’t 39 weeks after all. Oops!
My advice: just say no. If your baby is doing fine and your blood pressure is not over 140/90, let nature take its course and wait for labor to start on its own. True cases of “the baby was too big for her pelvis” are exceedingly rare. Don’t let your doctor induce you or perform major abdominal surgery on you to cover his @ss “just in case”. Your body and your baby are more important than his malpractice insurance.
Well I certainly wish someone would have measured something with me! In my 42nd week, I had not gone into labor on my own and was given pitocin. After 12 hours of agonizing pain and continuous adjustments to the pitocin, my baby went into fetal distress and my blood pressure bottomed out. We were rushed off for an emergency c-section and those aren’t as pretty as the “scheduled c-sections” we see on TV. It was later concluded that my pelvis was in fact smaller than usual due to the shape of my pubic bone. As someone who nearly lost a baby because of this, I can’t agree with your dismissive attitude about it. I feel you are also missing the essence of the question. I don’t see it as a matter of the baby being too large (which 7lbs is hardly “large”), but rather the pelvis being too small. If a smaller than normal pelvis is a rare thing, then Christina may be the one in a million that has this problem (with myself being the other one, I guess). By the by, my baby only weighed 6 lbs. 3 oz. so her weight had very little to do with my anatomical problem. I am THRILLED to hear that her doctor has identified a potential problem and has a Plan B in place!
I think a meta-analysis in ACOG (yes, Rachel, I know….) showed that cesarean for babies that were predicted to be large did not show any improved outcomes for mom or baby.
I’m going to try to do some searching and analysis of studies on this in the next few days and will post something to your blog.
dxunknown - Guinever asks some good questions, as many docs will make these kinds of claims when they’re not really backed up by the evidence. My understanding is that induction can cause fetal distress on its own, so I wonder if that was a factor.
Remember that the original question was from a woman having her second baby. We already know that it’s possible for a baby to come through her pelvis.
Also, for women having their first baby, many care providers measure the dimensions of the pelvic outlet at the first visit (or at least they should). An abnormally small pubic arch, such as what ‘dxunknown’ was told, is very simple to diagnose (although very rare, so perhaps some providers just don’t do it). If this or any other pelvic abnormality were properly diagnosed in early pregnancy, the mother’s and baby’s health would not have to be risked by putting them through labor before resorting to emergency cesarean.
I am not going to spend a lot of time answering specific questions about my labor as I feel you are trying to find some reasoning to make my failure to deliver naturally my fault… i.e.
“Did you walk during labor”… questioning what positions I tried. You ladies need to appreciate that some women just simply cannot deliver a child naturally without putting the baby at greater risk than would be posed during a planned c-section. You shouldn’t make them feel like a failure or that if they just do something different they will succeed.
When it comes to obstetrics and saying a woman’s body isn’t capable of birth, I think getting another opinion is important because obstetrics is one of the branches of medicine where a lot of docs do not follow evidenced-based-care. You still haven’t told us any of the details of your birth. If you tell me that you reached the pushing stage and were even crowning (this is the point that the baby would be at your pubic bone) and that you tried several positions that would get you off your tailbone (including lying on your side, standing, squatting, on your knees), then I will think that the diagnoses you received of cephalopelvic disproportion is correct. Like I said in our earlier exchange, the only reason I doubt CPD (not just in your case) is that many women after having this diagnosis go onto have vaginal births.
Here is the study I was referring to:
CONCLUSION: Based on data from observational studies, labor induction for suspected fetal macrosomia results in an increased cesarean delivery rate without improving perinatal outcomes
http://www.greenjournal.org/cgi/content/abstract/100/5/997
I’m currently at 38.5 weeks, not dilated at all. My dr. just informed me that my baby’s head is too big and he is going to induce on Tuesday if I’m dilated. He’s afraid that his head will get stuck in my pelvis, so he wants to induce early. He believes that if we wait until 40 weeks or more, then his head will be way too big and I’ll end up w/ a C-section anyways. My baby’s weight is fine, but the head is just big. I really wanted an all-natural, no drug, birth - but he just said that w/ a head that size, I’ll definitely want the drugs. I’m afraid that if they induce then I’ll have a higher chance of a section. I was all pumped up with “let your body do what it was designed to do” and now I’m super nervous that I can’t so this! Should I get a second opinion?
Guinever, thanks for the reply! Yes, I have read many books on all-natural labor and I’ve read many different articles over the internet as well. My favorite book is “The Birth Book” by Dr. Sears and his wife Martha. But I have spent the last 7-8 months reading up on epidurals, other drugs, and all-natural. So I felt completely prepared to tackle the challenge. I also have 2 friends who have accomplished birth w/out drugs. They have helped out a ton w/ different moves, exercises, and pressure points that will help w/ the pain. I have also attended childbirth classes. I have not hired a doula b/c I have an acupuncturist that will be there for me during labor. I had complete faith in my body, until the dr. told me that his head was too big and my pelvis was “normal”. The size of his head was determined from my 38 week ultrasound. He’s been an OBGYN for 34 years and I feel that he knows what he’s doing. So, that’s why I now have doubts! I’ve never gone through this before, and he’s birthed thousands of babies. He wants to induce b/c he would like me to try a vaginal delivery, and he thinks that if I go through term then the head will be way too big to fit and I’ll end up having a section anyways. So he’d rather me schedule a section at 40 weeks - just so I don’t have to go through hours and hours of labor, only to have an ER-section.
Okay, I just had to add another example.
With my first child (almost 9yrs ago) I was induced at 39wks due to progressively worsening hypertension. Prostaglandin gels the night before and Pitocin drip started at 4am with contractions starting immediately. At 8am my membranes were ruptured with not quite 2cm dilation. When I attempted to walk my son went into distress (dropping heart rate), so I was confined to the bed with an internal fetal monitor. Despite more than adequate contractions throughout the day, I never progressed past 2cm. As a pharmacy student at the time, NO drugs (with the exception of antibiotics due to GBS+) were administered until the 6:30pm c-section epidural. Since that time I have had at least 4 gynies tell me I couldn’t fit a 5lb baby through my pelvis. (My son was 6lbs 15oz) I am also 5′8″ tall and weigh (non-pregnant) about 160lbs wearing a size 4. Despite the antibiotic drip, my son was treated for sepsis (infection) in the NICU for a week due to the long labor with GBS. I was SO confident that I would have a natural childbirth, I skipped the class on c-sections! I wish someone had told me that a c-section was a possibility so that I could have been better prepared. Watched a video, completed some research, something, anything…rather than the feeling of failure that hits a lot of women with unplanned c-sections. (As DXunknown hinted at). There are SO many complications women can have, that their gynie may be aware of that we are not, oligohydramnios, gestational diabetes or placental sufficiency concerns or who knows? It is tempting to judge the hearts/minds of physicians who sometime speak without explaining. But the benefit of the doubt never hurts either…I think for all the women who are concerned, take some of the info you have here and go start a conversation with your physician. If he/she doesn’t want to listen, then he/she is probably not the MD you want with you during childbirth anyway! BTW, I am 35weeks along with my 2nd pregnancy and due to new complications, we expect this will be a c-section too. Try to remember that even if you have this lovely natural childbirth vision in your head, (which is undoubtedly the best thing to try for!!)…the most important end result is that you and your child are safe and healthy!!
Hi. I have been reading your posts with great interest, and would like to add my own story. My first child was born naturally, on his due date, weighing 11lb 9 1/2 oz. His shoulders were partially dislocated, and his neck was ‘out’, both problems were not detected until he was around 7 weeks old. Needless to say we had a very unhappy bub in the beginning, who could only manage sleep in 20 min patches, and it took months to rectify this. We are extremely lucky he shows no signs of any long term effects. I too had a lot of problems following the birth, secondary infections, blood transfusion etc, and found it very difficult to bond with my bub. I am now 37 weeks pregnant with bub # 2, and seeing a different Ob. Estimates are this bub is slightly bigger than # 1. Ultrasound at 36 weeks estimated 4 - 4 1/2kg, and I have been measuring 5 weeks ahead of what I should be. You only have to look at me to know this is another huge baby. Now don’t get me wrong, I am very proud of the fact that I was able to birth such a big baby the first time round, and would love to be able to have a natural birth again, but I must consider the potential health problems for both me & my child. As such, I am booked in for a caeserean next week. My Ob examined me today, but refused to induce, as although my cervix is softening, bub is still floating way above the pelvis. However she did say I may even go into labour before the caeserean. Anyhow, my point is, that some babies are so big that there is most certainly a considerable risk with a natural birth. Sometimes a caesearean is indeed justified.
Kathryn
Kathryn - a chiropractor who is certified in the Webster Technique would be extremely helpful for any alignment problems as a result of natural (and especially c/s) childbirth. Don’t assume that a c/s will produce better outcomes for you or your future baby. Have you researched the potential health problems associated with c/s - it is a major abdominal surgical procedure? Best wishes for your future delivery!
Wendy - you said: “Also, for women having their first baby, many care providers measure the dimensions of the pelvic outlet at the first visit (or at least they should). An abnormally small pubic arch, such as what ‘dxunknown’ was told, is very simple to diagnose (although very rare, so perhaps some providers just don’t do it). If this or any other pelvic abnormality were properly diagnosed in early pregnancy, the mother’s and baby’s health would not have to be risked by putting them through labor before resorting to emergency cesarean.”
I’m wondering what measuring a pelvis in early pregnancy tells you?
Maria - wow, big bony structure, eh?! Size 4 at 160#! Cool!
I am 5′10″ and am fairly curvy. My CNM commented at some point during my pregnancy that I had a good pelvis for birthing. I essentially went into preterm labor (even though I was at my due “date”
because of the flu, and ended up with a c/s and CPD diagnosis. Such crap since the baby never engaged into my pelvis. Well, if anyone wants to read my DD’s birth story, you can go to my blog.
Guinever, do you ever recommend women to work with the Pink Kit?
Thanks, Labortrials
My first had a large head and we went for a completely natural delivery in spite of it. I labored for 9 hrs, then pushed for 3. All seemed smooth until the pushing stage, really. After 3 hrs, the mid-wife — there was no doctor involved at all — proposed that we do an episiotomy, and she was born 10 minutes after that. HOWEVER, the severely mishaped, coneshaped head she was born with had her pediatrician worried for several months. It took 5 or 6 months for the back of her head to round out and the doc was worried that some bones may fuse.
I am having my second in 8 to 10 weeks and I am determined to once again go all natural. At the same time, I have already told my midwife that I will want her to perform an episiotomy earlier than last time, way earlier, that is, so that we can perhaps avoid the head trauma for baby #2.
I know episiotomies are frowned upon in natural birth circles. However, I’d rather deal with the aftereffects of the elective cutting than with another head that is so squished it will not mold back naturally within a few days.
-Hannah
Guinever, Thank you so much for providing such great, accurate information. It’s great to see evidence based knowledge in the midst of our medicalized birth culture!
I just want to add my story briefly–I was diagnosed as CPD with my first 2 children. My first was induced and she never descended into my pelvis. I was also labeled Failure to progress. She was delivered by c-section and weighed 9 lb. 3 oz.
My second I went into labor on my own but it stalled at the hospital (looking back I think it was just prodromal labor) They augmented me because they don’t “allow” VBAC moms to leave the hospital. My 7 lb 3 oz daughter was also born by c-section, though she did make it to +3 station. Again CPD diagnosis.
This past August 7th I had a 100% natural VBAC after my 2 c-sections with my 8 lb 14 oz daughter who was shorter and had a bigger head than my first 2. Labor started and she was born in under an hour! CPD hah!
I am 39 weeks pregnant with my second child. I have had no complications during this pregnancy at all. I have recently begun to swell really bad and my blood pressure has elevated, but my midwife does not seemed worried about that. I do know that she is head down, but I have not dialated any. The past few days I have had a lot of pain in my pelvic area and hips. The pressure gets so bad sometimes that I can not stand up straight. Is it normal for the engagement/lightening process to be so painful. I did not experience any of this with my first child, he weighed 7 lbs 7 oz according to my midwife and ultrasounds they are saying that this baby will be 8.5 lbs or better. Could this be the reason that it is so painful?
I would like to add my story. I am currently 13 weeks pregnant with my second baby. With my first child I was induced because of fluctuating high blood pressure, and I found out later my Dr was going on vacation. When two days of cervadil didn’t work I was sent home, my water broke so I was then induced with Pitocin, told I would have to lie down flat, as my sons head was not engaged. After being told I “had to have an epidural” and being in labour for only four hours, I was told my pubic arch is too small and I must have a C-section. This is not where the story ends. My son was born and everything seemed fine, until he turned blue and had to be intubated. He was in ICU for 6 days with a feeding tube, and I was not allowed to see him or hold him for 23 hrs. He was on oxygen and his blood oxygen level could not stabilize because he DID NOT COME THROUGH THE BIRTH CANAL. From the way it was explained to me by a very understanding pediatrician, there is a hormone (or something similar) that the baby receives when being born vaginally that prepares the lungs to breath for the first time. Also by being born vaginally, a baby is squeezed so that all the extra flood is pushed out of the stomach and lungs, so that they can breath properly. My son recovered but continues to have stomach issues due to all the trauma he went through so early in life. I had a spinal headache and ended up with and infection in my scar. I thank myself lucky that I came off with only this, as a friend of mine with a C-section for her first child had extensive bleeding and had to have a hysterectomy.
I have since changed caregivers and my midwife will be delivering this baby vaginally in the same hospital my son was born in. My midwife believes that this will not be a problem.
Please help! My best friend is 39 weeks 4 days very excited to be having her first baby for she was told she would never have children and low and behold he is due soon. She has been so looking forward to birth and anxious as well. At her appointment last week her doctor told her that baby was not engaged into her pelvis and that there may be a possibility of a c-section. This weeks appointment led him to say this again giving her until monday, She will be 40 weeks 1 day to get the baby to engage of he wants to schedule a section for Tuesday. She says babie is kindof sideways it feels like and that his head is grinding on her hip bone like he is trying to get down but in the wrong spot, her doc says maybe he is too big. She asked doctor if she could be induced and at least try and he states to her that there is no reason to add stress to her of baby. Being a mother of 4 and having my first c-section due to breech presentation I know how much one misses when laboring and natural birth is taken from you..Please can you give me advice on maybe ways to get baby to engage or advice to pass on to her factuals on this…..I told her I was going to do some online research and am not having much luck, I just don’t want her to give in to this doctors request if it isn’t for the health of the babie….Thank you
Hello. I’m pregnant with my first child. My due date was May 26th, 2008. I don’t have insurance so I go to a clinic where they seem to treat everyone the same. As kind as everyone is there, I feel like an automobile when I’m seen. My last OB appointment was this past Monday, a week after my due date. I was told that I was 1cm dilated, and that the baby had “dropped”. I was also told that if I didn’t go into labor on my own by Saturday, that I was to be induced, with the possibility of a c-section due to the baby’s size. I went for an ultrasound on that same Monday, with another ultrasound scheduled for this Thursday. The ultrasonagrapher told me on Monday that based on her calculations the baby was 8lbs 7oz (she also noted that that weight could be off by 1lb up or 1lb down). This was up from my last u/s performed about three weeks ago when they said the baby was guesstimated at 8lbs 2oz. I spoke to the nurse practitioner briefly and all she said when I voiced my concerns over being induced and a c-section planned — because I’d planned on doing this “naturally”, no drugs for induction or pain, etc. — was “well what if the baby’s shoulders get stuck, then what do you do?” My blood pressure is fine. The baby’s heart rate is fine. The baby is moving around every day, every hour like a wild man. I don’t want to be induced if it leads to a c-section. Now a little update, the nurse practitioner just called me. She said that according to the doctor, the baby’s weight is fine and she doesn’t think a c-section would be needed. They still want to induce though because I’m almost at 42 weeks. She added that I am 50% effaced and my cervix is soft. She seems to think that I just need a little “push” to get things started, but that the doctor thinks I’m “ready”.
I guess that’s it…
Thanks for reading.