VBAC with a small pelvis?

Mrs. K in TX · January 2011

I'm 6 weeks postpartum from my first baby, so I'm not going to be having another one anytime soon. But I had my 6 week appt today, and my doctor said that he thought my vaginal birth was unsuccessful because I have a small pelvis. My cervix was favorable, the baby was a good size, and my contractions were more than adequate. I just wouldn't dilate past 5 cm. He mentioned at the beginning of my pregnancy that I had a small pelvis, but he wasn't sure if it would hinder my ability to have a vaginal birth. After my pelvic exam today, he said he's pretty sure I didn't dilate fully because of my small pelvis. He said he'll let me try a VBAC with my next pregnancy, but he is pretty sure it will result in a repeat c-section.

Has anyone here had a successful vaginal delivery with a small pelvis?

iris427 · January 2011

I will let you know in May My OB also told me that my pelvis was too small (aka cephalopelvic disproportion or CPD) and basically that I shouldn't even bother with a VBAC attempt. But I've done a lot of research since then and I've discovered that when CPD is the reason for the primary cesarean 60+% of women are able to have successful VBACs. So I would say those odds are pretty good, especially when you consider that the overall vaginal birth rate in the US is only around 68% anyway.

Do you know if your baby was malpositioned, like sunny side up? That can interfere with labor progress. Did you have an induction or an epidural?

There are things you can do to try and help labor with a smaller pelvis. Laboring and pushing in different positions can ber eally helpful to get the baby into as n optimal position and to open up your pelvis as much as possible. The lying on your back position that they use in most hospital births actually can make your pelvic diameter smaller. Positions like hands and knees or squatting will open up your pelvis more.

GL!

sbl630 · January 2011

I'm hoping you get a lot of replies... I have a scheduled c-s with DS b/c the dr. thought my pelvis was too small. I've since changed drs.and hospitals and my current dr. thinks I should trya VBAC. He said it's impossible tell how much your pelvis can "spread" before going into labor. I had DS 3 days before my due date...I hadn't dilated at all at the point...(Don't really know if that means anything....)

sbl630 · January 2011

I'm hoping you get a lot of replies... I have a scheduled c-s with DS b/c the dr. thought my pelvis was too small. I've since changed drs.and hospitals and my current dr. thinks I should trya VBAC. He said it's impossible tell how much your pelvis can "spread" before going into labor. I had DS 3 days before my due date...I hadn't dilated at all at the point...(Don't really know if that means anything....) I'm wondering the same thing as you...

Mrs. K in TX · January 2011

iris427:

I will let you know in May My OB also told me that my pelvis was too small (aka cephalopelvic disproportion or CPD) and basically that I shouldn't even bother with a VBAC attempt. But I've done a lot of research since then and I've discovered that when CPD is the reason for the primary cesarean 60+% of women are able to have successful VBACs. So I would say those odds are pretty good, especially when you consider that the overall vaginal birth rate in the US is only around 68% anyway.

Do you know if your baby was malpositioned, like sunny side up? That can interfere with labor progress. Did you have an induction or an epidural?

There are things you can do to try and help labor with a smaller pelvis. Laboring and pushing in different positions can ber eally helpful to get the baby into as n optimal position and to open up your pelvis as much as possible. The lying on your back position that they use in most hospital births actually can make your pelvic diameter smaller. Positions like hands and knees or squatting will open up your pelvis more.

GL!

Thanks for the information.

LO was positioned correctly. Everything looked great, except I just wouldn't dilate. My doctor was really surprised that I didn't dilate. I had to be induced because I developed high bp at 36.5 weeks. My doctor induced at 37w 1d. I was 3cm dilated and 70% effaced when the induction began. I quickly progressed to 5, and I spent 12+ hours at 5.

I unfortunately wasn't able to do much in the way of positional changes. I started my labor in a rocking chair, and after about an hour, I had to get in bed and stay there because my blood pressure kept getting higher and higher. They let me sit up in bed in the "princess" position for a couple of hours, but it didn't do much for my dilation.

It won't be the end of the world if I have to have another c-section, but I really would like to try for a vbac. The good thing about a c-section? Short term disability paid me 2 weeks extra!

JimsBride08 · January 2011

Were you lying flat on your back the whole time? How long were you at 5cm? What position was baby in? There are SO many things that can affect your labor. Chances are so small that you actually have a pelvis that's too small to deliver a baby. You have plenty of time to research and decide whether you'd like to try a VBAC or not with your next baby. GL to you whatever you decide-if you do want a VBAC, make sure you have a truly supportive provider.

Sazhrah · January 2011

I don't have a small pelvis but I was induced at 39 weeks. I was not effaced or dialated. They tried pit and cervadil for 24 hrs on me and when they stopped it, nothing happened on it's own. Sometimes our bodies just aren't ready i guess. There are a lot of things to research before your next baby. I would research and research. Our bodies don't generally make a baby we can't birth.

iris427 · January 2011

Mrs. K in TX:

Thanks for the information.
LO was positioned correctly. Everything looked great, except I just wouldn't dilate. My doctor was really surprised that I didn't dilate. I had to be induced because I developed high bp at 36.5 weeks. My doctor induced at 37w 1d. I was 3cm dilated and 70% effaced when the induction began. I quickly progressed to 5, and I spent 12+ hours at 5.
I unfortunately wasn't able to do much in the way of positional changes. I started my labor in a rocking chair, and after about an hour, I had to get in bed and stay there because my blood pressure kept getting higher and higher. They let me sit up in bed in the "princess" position for a couple of hours, but it didn't do much for my dilation.
It won't be the end of the world if I have to have another c-section, but I really would like to try for a vbac. The good thing about a c-section? Short term disability paid me 2 weeks extra!

Failed inductions like that happen all the time on first time mothers. The c-section rate for first timers who are induced is high, especially if your cervix wasn't ready. 37 weeks is barely term and your body probably just wasn't ready. It's completely possible and even likely that you would have labored just fine if you could have waited until labor started on its own. I'm not a doctor and I wasn't there for your labor but I don't think there is any reason to suggest you had CPD because of that--especially since you couldn't get out of bed to do anything to help labor progress, like walking. It sounds like you simply had a failed induction, which isn't surprising under the circumstances.

Here's an article talking about how the c-section rate *doubles* in first time mothers who have an induction:

https://findarticles.com/p/articles/mi_m0CYD/is_1_38/ai_96891958/

When you say your baby was positioned properly, do you mean head down? Or do you specifically mean head down and occiput anterior? Just being head down isn't necessarily proper positioning for birth.

papagena · January 2011

iris427:
Failed inductions like that happen all the time on first time mothers. The c-section rate for first timers who are induced is high, especially if your cervix wasn't ready. 37 weeks is barely term and your body probably just wasn't ready. It's completely possible and even likely that you would have labored just fine if you could have waited until labor started on its own. I'm not a doctor and I wasn't there for your labor but I don't think there is any reason to suggest you had CPD because of that--especially since you couldn't get out of bed to do anything to help labor progress, like walking. It sounds like you simply had a failed induction, which isn't surprising under the circumstances.

Ditto - I'd say there are many factors that could have possibly played into your c/s, and many of them have nothing to do with the size of your pelvis. I'd actually try and get a second opinion, and possibly even switch doctors for a 2nd pg, just so you don't have a doctor that already is thinking small pelvis. To be honest, it is very hard to really truly diagnose if a pelvis is too small/won't expand enough for baby.

I will be perfectly honest, I wouldn't think that a small pelvis would have a lot to do with your dilation - but I'm not a med professional at all. I would have assumed that pushing would have been the issue - but again, I don't know.

Did you mention if your water was broken during labor?

sarahsteve · January 2011

JimsBride08:
Were you lying flat on your back the whole time? How long were you at 5cm? What position was baby in? There are SO many things that can affect your labor. Chances are so small that you actually have a pelvis that's too small to deliver a baby. You have plenty of time to research and decide whether you'd like to try a VBAC or not with your next baby. GL to you whatever you decide-if you do want a VBAC, make sure you have a truly supportive provider.

This. Do some reading when you're ready, the book Pushed is excellent.

Mrs. K in TX · January 2011

Thanks for the responses, ladies. I do have a lot to think about. But I've got plenty of time to think about it.

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