Sunday, August 9, 2009

Size isn't everything - and even when it is, it still might not be.

Weekend Movie: "Too Big". Oh yeah?

It's one of the most common scare tactics used to pressure women into either early induction or into outright c-section, for supposed macrosomia, leading to cephalopelvic disproportion, a.k.a. CPD. I wish all women in America knew two things. First, ultrasound estimates of weight are notoriously, laughably inaccurate, by up to TWO POUNDS. I cannot tell you the number of birth stories I have read where the big baby card got played and they got pressured into a c-section, because it looked like this baby was going to be 9 or even - gasp - 10 pounds (more on that in a sec) . . . and the little slip of a thing turns out to be 7 pounds plus change after all. Whoops!

Second: True CPD is very rare, and our perception of what is "too big" is skewed by mainstream birthing practices. Case in point: when I was pregnant and attending regular home birth support group, 4 women had their babies within the same month, all at home, none with any complications. Three of those four babies were over ten pounds. And only one of those three had any tearing at all (and I'm told it was very minor, requiring maybe two stitches). What made this possible? Well, I very much doubt any of these women were immobilized flat on their backs during any of their labors, much less during second stage (pushing). A ten pound baby with a numbed woman in lithotomy position, well, sure, you might encounter some difficulty. The risk of true shoulder dystocia (which is what practitioners are worried about when they play the big baby card) is, again, rare, and minimized when one is able to move and assume normal, efficient positions for labor, especially pushing.

But don't take my word for it! Read up. For starters, here's some thorough info on CPD from ICAN. It includes suggestions for things you can do to improve your odds if CPD ever becomes a concern, such as chiropractic care and fetal positioning. Oh, and hiring a doula. *bats eyelashes* And here's a great post by Enjoy Birth on the topic with lots of great linkage throughout. Both include the very video I'm sharing with you here. Watch and be inspired, especially if VBAC is part of your journey.

4 comments:

  1. So true!

    My first babe: 20-hour labour, scared into c-section b/c "we could try forceps or vacuum, but if baby is so big that head isn't descending, might get shoulders stuck." Weight: 7 lb, 15 oz. Official reason for c-section: CPD.

    My second babe: 3-hour VBAC at home with m/w. 20 minutes of pushing, nuchal hand. Weight: 7 lb, 15 oz.

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  2. On the other hand that is anecdotal and there are probably just as many stories on the othe sideof things. Stretched skin is more painful than skin with a tiny cut that has to be stitched. I had one birth without any epesiotomy and it was my most painful and hardest to recover from. And my doc says that some women who say no to epesiotomies becaue they have averse reactions to being cut 'down there' look like a grenade went off 'down there.' I just wish that those women didn't get those notions because of open hostility toward the medical profession that baffles me because they are the ones that have made childbirth virtually painless. With the twins the most painful part was the IV. I received my epidurl before I was induced and had nery a painful contraction. I could feel them, they just didn't hurt.

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  3. Again, your mileage may vary. I personally know many many women for whom, when comparing multiple births, much preferred to be left uncut, and found their recoveries easier without stitches. But anecdote can always be traded for anecdote, yes. I prefer to go with what's evidence-based: http://www.ahrq.gov/Clinic/tp/epistp.htm

    Even ACOG, with whom I disagree on a number of positions ( . . . as you, er, may have noticed, heh), has recommended against routine episiotomy and its accompanying risks: http://www.acog.org/from_home/publications/press_releases/nr03-31-06-2.cfm

    The thing is, though, it's just not as simple as to cut or not to cut. The context makes all the difference. If a woman is pushing flat on her back, or worse, at a slight but still reclined angle, of course the pressure is going to be damaging to her perineum; and if she is anesthetized, the musculature of the pelvic floor is going to be slack, so the positioning of the emerging head is going to cause much more damage than it would otherwise. And if both are true, if she is numb and flat, she may have to be coached in directed/ "purple" pushing, which can result in the head emerging much faster than it would have if the mother were pacing herself, and the tissues been gradually fanned.

    Pushing the head through under all factors listed - flat, numb, and externally directed? Yep, without an episiotomy, it probably WILL look like a grenade went off. I agree with the doctor on the end result - just not on the route that leads to it.

    As with any intervention, there are unquestionably times where its use IS appropriate. Not to sound like a broken record/skipping mp3 file, but I am not in opposition to any one particular intervention (perhaps with the exception of Cytotec); what I am opposed to is routine intervention that flies in the face of what is evidence-based.

    Thanks for sharing your thoughts!

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  4. Oh yes, the Big Baby Bull. This is one of my buttons, that really can get me mad!
    Thanks for spreading the truth!

    I have a whole post about it.
    http://enjoybirth.wordpress.com/2009/06/29/big-baby-bull/

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