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Natural Birth
Is it possible to be TOO SMALL for a natural birth?
My friend just had her baby this morning. We are both small girls (in our early 20s and around 100lbs pre-pregnancy weight) and of Asian decent. She did not have an epidural and was trying really hard to push un-medicated. After awhile the doctor decided the baby just wasn't going to come out naturally and he decided to do a C-section. He said she was 'too small' down there for the baby to fit out. Her baby was only 7 1/2 lbs at birth, which to me seems like a pretty average weight for a newborn baby.
I really want to have a natural birth, but not if that means the doctor will resort to a C-section if I can't push the baby out on my own. Should women who are young with a smaller build like me not even attempt a natural birth and just get the epidural? (TMI note: I already know I'm small down there. Sex is often painful, and using a tampon can sometimes even be too much. I had to get my OB-GYN to help me use a tampon at first because it hurt so bad to put it in. How am I supposed to push out a baby if I can't even handle sex or using tampons??)
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Re: Is it possible to be TOO SMALL for a natural birth?
I think being too small to birth the baby that your body created is rare unless there is something else going on (ex. malformed pelvis, uncontrolled gestational diabetes).
That being said, if there are issues I do not really see how an epidural would help the situation.
How long was your friend pushing? Was she free to move around or was she in bed on her back the entire time?
If the baby is not in the correct position it will be much harder to push the baby out. Being free to move around into different positions will often help the baby get into the proper position.
Just because things did not work out for your friend does not mean you need to go straight for an epi.
Okay first off, having discomfort during sex or tampon insertion does not mean you are small. I have something called vaginismus where my vaginal muscles involuntarily contract making both of those activities uncomfortable. It did not affect my ability to push my baby out. Something going in is very different from something coming out.
I agree with PP. I think it is very rare to create a baby that is too large for the woman without any other factors or red flags. And just because things didn't work out for your friend does not mean it won't work for you. Every woman and baby are different.
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Thanks for the responses.
My friend was allowed to move around. She tried several positions, in bed and standing up.
I REALLY want to do natural, but after both of their C-sections, I freaked myself out that I wouldn't be able to do it. Everyone thinks I'm crazy for not wanting an epidural, but I think I'm being brave and doing what's best for my baby. Why can't people just be supportive of that?!
I think in general our bodies are pretty good at making babies that will "fit" for birth. And for sure going without an epi which will allow you more freedom of movement will help a ton as flat on your back is the last place you want to be if baby isn't descending. Sadly, many OBs do like to use the "too small" argument to push for a c-section if labor isn't going as they'd like.
I'd also second that pain related to tampons and sex are not indicators of how you will give birth - it's your pelvis size that matters. And was pointed out - something coming out is different than going in ;-)
If it makes you feel better a friend of mine who is your size and also Asian home birthed her first baby with no problems and is due with her second soon (who will also be a home birth).
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Keep in mind that receiving an epidural actually increases your risk for a C-section. So what you're talking about would actually be motivation for you to attempt a non-medicated delivery. Very frequently, mommies who have babies delivered by C-section were actually just fine size wise... their babies just were coming out in an unusual position which makes it a lot more difficult to deliver.
I have a good friend who had a C-section with her first because she was "too small". Her second child was delivered vaginally because they couldn't pull a surgical team together fast enough. If she truly had been "too small" the second delivery would have stalled as well.
You should ask your OB about your pelvimetry. Inlet, mid pelvis and outlet as well as pubic arch and sacrum. Although they aren't the end all be all, they will give you some insight into your pelvis.
There are 4 different shapes for the human's pelvis. These shapes can affect how the head descends. Gynecoid is the most common and best shape for vaginal delivery. Anthropoid had dimensions which makes it more likely for the baby to come down OP or sunnyside up. Platypelloid is an elongated pelvis from side to side but thin front to back and those have a higher rate of failure of descent. Those babies also tend to look sideways or OT. Android is more of a triangle shape.
Although the girls above do point out that most women do have pelvis bones that are adequate, I actually have to say in my career that there are MANY who do not. If I can't even fit 2 fingers in without touching bone, there is no way a baby can fit.
Even if some pateints become fully dilated, they may push for 5-6 hours and the baby will never descend.
I hate that people jump to think OBs are not being honest. That's just unfair and really inaccurate for most. Maybe old school male OBs were more likley to be that way.
In the end, the only way to "prove" a pelvis is to attempt labor.
Good luck!!
I'm 5ft tall and between 100-105lbs generally. I had a 7lbs 3oz baby with no issues, in fact my labour was very quick. I had a 2nd degree tear, but that was because baby's heart rate was declining, so I had to work hard to get him out ASAP. My midwife had originally said she would coach me to slow down at times and she would apply pressure, etc. to hopefully minimize tearing.
Keep in mind everything loosens up before birth. I saw a chiro, and did lots of exercises to ensure that baby was in the best position possible. I'm sure that helped. You can find many exercises on spinning babies.
I find that a funny statement. How would you even know this? We all practice it whether or not the patient realizes it.
I am also of asian decent and ~100 lbs pre-PG.
With DD, I ended up with a CS but it had nothing to do with cephalo-pelvic disproportion or malpositioning. The only thing that matters is head circumference and once she was out, it was clear that she could have been born vaginally. BTW she was 8 lbs 5.5 oz.
With DS I am switching hospitals. I am shooting for a VBAC and my new OB has no qualms whatsoever about me being able to go natural. He is also expected to be over 8 lbs.
Oof. Is that why the c/s rate is 30+% in the US? We've all been taken over by inadequate pelvises?
I pushed for 4+ hours with my first son, and ended up having a c/s. Planned a VBAC with my second, and had a successful one with a baby who was 2+ lbs and 2+ inches larger than my first (my VBAC baby was 10.5 lbs, 24 inches). I'm really really really glad I had a MW who didn't subscribe to the "you pushed too long, your pelvis SUX" theory when I was pregnant the second time.
I would have to argue that most cases of CPD/baby is too big is more likely that the baby was in a bad position, and/or the providers themselves were inpatient about how quickly the mom was laboring.
OP - how big is your DH? How supportive of active labor is your provider (i.e., they will encourage you to stay upright during labor, to push in different positions, they've dealt with women who are small and short, etc. etc.).
DS2 - Oct 2010 (my VBAC baby!)
Being small "down there" and having a pelvis that's too small for baby are two different things. I have the same issues you describe, but my midwife has had no concerns about my pelvis accommodating the baby, though she did recommend perineal massage given the problems I shared with her.
Keep in mind too that you're small, so your baby is getting at least one set of "small person" genes from you. No gaurantee, but it's unusual for a woman to gestate a baby that's too big for her. If you're worried, ask your ob specifically about your pelvis shape and size (as pp explained) in terms of delivery.
Finally, my history nerd wins out and I have to share--I compiled death records from the 18th century (yes I have too much spare time and access to some odd data) and the maternal mortality rate was about 1% (with comparable stillbirth rates). Way higher than today, but clearly every woman with a small frame or a big baby was NOT dying because she couldn't have a C-section.
This theory by Ina May Gaskin makes sense, and to me, might be the reason your friend had trouble . . .
https://www.inamay.com/article/understanding-birth-and-sphincter-law
I think that you should be able to have a vaginal birth, and I don't see how getting an epidural would help, unless you are simply unable to relax and let your body to the work. Epidurals have their purpose, but they are way overused. The same goes for c-section.
I'm 5 feet tall, and gave birth un-medicated to a 6lb 14 oz baby. I really don't think that size has that much to do with your pelvis. You're growing a baby with your genes, and I agree with PP, it would be rare that your baby would be too big to birth.
Many out of thousands does not equal 30%. Do not misconstrue my words. I am more pro-vaginal delivery than almost anyone. Why else would I even be on this board? I turn patients, flip patients, ambulate patients. I absolutely feel like I fail when I have to section a failed vaginal delivery. I push my own patients too.
But you can't argue CPD does not exist. It does. Is it 30%? Of course not. A huge part of that percentage is a lawsuit happy country and continuous monitoring. I'm not the enemy I assure you. I'm trying to help continue the fight for low intervention.
So the obs YOU know may not. It's still the training standard and I assure you still the standard across the board. It is still on every ACOG form and covered in all of the board exams.
You cannot take your conversations with a handful of physicians and relate that to all ob/gyns. That's like telling a cardiac surgeon that their field isn't performing XYZ because the doctors you know say it doesn't happen.
These statements are what are creating a gap between physicians and patients. And as someone training to be a CNM, you should know better than to bash those who are your future colleagues.
Up until the modern era, women were generally much smaller than they are nowadays. Go to a clothing museum or the like and you'll see how incredibly tiny people used to be in comparison to us. I once went to an exhibit of the castings from Pompeii and it was INCREDIBLE how tiny people were.
And while the rate of childbirth fatalities was much higher, they still had plenty of children through natural childbirth (and it wasn't their size that was the issue, it was lack of hygeine and no medical responses available for things like breech birth or hemorrhaging).
I think it is possible to be too small, but I think it's unlikely and probably pretty rare. I went to school with a girl who was like 4'8 I think, SUPER short, and just a teeny little thing, and she had a natural homebirth, past due, 7 1/2 ish pound baby too.
Some people/babies just need time. My best friend (who is 5'8, so not super tiny) had a 9lb12oz guy a few years ago. She was complete for 6 hours before she got the urge to push. She said she is convinced that he was just misaligned and needed time to sort it out before he could come out. Since she waited, pushing wasn't very long at all. He had a monster head-15". She had a homebirth too, so no threat of c/s or anything for taking too long to deliver.
What makes you think OBs will be her colleagues? My MWs don't work with any OBs.
ETA - I once read that cases throughout history where women's pelvises were too small for labor had more to do with diet (things like rickets) than the way they were actually created. We are created to birth babies and our bodies grow babies to fit our specific pelvises.
But 2 out of 3 of my births have been OP, which leads me to believe that the structure of my pelvis does affect my births. Three out of my mom's four babies were OP, so it must be genetic. Thank goodness I have given birth with wonderful midwives that allowed me to labor without intervention even though my labor patterns with the OP babies were very strange (the last one contractions never got closer than five minutes apart) and let me push for as long as I needed to in order to give birth to my babies. Had I been with an OB I can guarantee you I would have had a c/s with my last OP baby.
Exactly! Like I mentioned--1% mortality rate in the mid 18th century. Not nearly the 30% we ought to expect if every c-section was medically necessary to ensure the survival of mother and baby.
"Many" certainly can mean a lot. And the way you worded it, you make it sound like having an inadequate pelvis is a pretty common problem.
I never said CPD doesn't exist, I said that I think there are other factors that can make providers claim CPD - failure to be patient during labor, baby is malpositioned, etc.
DS2 - Oct 2010 (my VBAC baby!)
This sounds like an issue with tensing up your pelvic floor muscles, which is a completely different issue than having your pelvic bones be too small. It's rare for a woman's pelvis to be too small for vaginal childbirth. Yes, it happens. But women your size have been giving birth vaginally for all of time. There is no way to predict ahead of time whether a woman's pelvis is too small and like I said, it's rare that it actually is too small. I'm 4'10" and 90 lbs and I had a c/s with my first because of her positioning, but had a vaginally delivery with my second with no problems.
Personally I think if you have any concern about your pelvis being too small, you are better off avoiding an epidural. That way you will have more range of movement--changing positions can open up your pelvis more and help the baby descend.
And have you seen someone about the painful sex? If you have vaginismus, there are treatment options for that.