Posts Tagged ‘CPD’

Eleven Ways to Avoid the CPD Diagnoses

Cephalopelvic disproportion is commonly diagnosed, but women who have had the label slapped on have later birthed subsequent babies (sometimes larger!) vaginally without a problem. CPD has been noted as one of the most common and most controversial reasons for a c-section, and the general consensus (among birth professionals and crunchy birth bloggers alike) is that in most cases the diagnoses is incorrect. (It could just as easily be called “failure to progress”-or as I prefer to call it, “failure to be patient.”-an equally unsatisfying reason for a C-section in many cases…) If you missed it and would like to read more, check out The Problem with the CPD Diagnoses.

So, how can you avoid getting stuck with the CPD label? Try going through this checklist before determining that your pelvis is too small or that your baby is too big. Remember that some of these suggestions are pointed at the fact that the CPD diagnoses is often given to women who don’t birth quickly enough by your caregiver’s standards. (e.g., Your baby isn’t coming? He must just not be fitting through.)

1) Allow the mother as much freedom of movement as possible.

The more the mother can move about, the more room she creates for her baby to wiggle and move downward through her pelvis. Think of it like fitting a key into a tight lock- sometimes it gets jammed, but if you wiggle it this way and that, then it will fit in just fine. Many times getting up and walking around, moving your hips, or simply shifting positions can allow baby the extra room he needs to fit through.

2) Allow pain management drugs to wear off a bit.

Sometimes mothers who are on an epidural cannot feel enough to push their babies out. If they allow the medication to wear off just enough that they begin to get some sensation again, they may be able to connect to their pushing muscles to feel enough to continue on to a vaginal birth. The mother is not to blame if she cannot feel to push; rather, she should be aware of this possibility and consider asking for more time to birth vaginally, provided that she and the baby are doing fine.

3) Try alternate pushing positions.

This goes back to #1. Getting off your back and getting in the position you feel most comfortable in can help your baby to find a little more room to fit through. For example, squatting opens the pelvis up to 30% more than in other positions.  (Check out this video for a discussion on walking and squatting for labor and pushing, and this video to hear suggestions for alternate pushing positions.) Upright pushing positions can also give you the advantage of gravity, and more pushing force. Both of these can aid in getting your baby out more easily.

4) Encourage your baby to be in optimal fetal positioning.

What position is your baby in? Do you know that it can make a big difference in how easily he makes his way out? For example, a baby that is in the occiput posterior position (crown of his head facing your tailbone) has a much more difficult time fitting through the pelvis (though most will turn if given a chance). The baby’s rotation to fit through your pelvis is just as normal a part of labor as your dilation is. Check out Spinning Babies for more information on how to decipher your baby’s position and to encourage a great one for labor and birth. This can be done during pregnancy or even during labor. (Here’s a great article specifically on CPD.)

5) Consider chiropractic care in pregnancy.

“Some women report that chiropractic care throughout and between pregnancies is helpful in avoiding CPD. Look for a chiropractor who has experience working with childbearing women and utilizes in-utero constraint techniques.” –ICAN on CPD.

6) Keep your energy up during labor.

Rest. Eat. Drink. Try not to wear yourself out. The uterus is a muscle- and just like any other muscle, it can get tired and give out if worked too hard. Keeping your energy up can help your uterus (and you!) to have the strength to birth vaginally.

7) Avoid an induction if possible.

If you and the baby are both healthy, try to avoid early or routine inductions. (Remember, even ACOG states that a pregnancy isn’t considered postterm until 42 weeks.) Your risk of cesarean is significantly increased in an induced labor. What might contribute to a “CPD” cesarean caused by induction? One factor is that you are less likely to dilate as quickly or effectively in an induced labor.  Another is that you are more likely to need pain medication when induced, which in turn creates less mobility for the mother (remember #1-3?) and also tends to slow labor. (That’s not even mentioning the emergency C-sections due to increased risks to babies from inductions, but that’s off topic…)

8) Keep a calm birth environment.

If women are allowed a calm, peaceful environment where they feel comfortable and at ease, it is quite possible that they will dilate more quickly. Adrenaline suppresses oxytocin, so being nervous can quite literally slow your labor progress (& sometimes stall it out!).

9) Hire a doula.

Doulas can help suggest ways to encourage your baby to move into a better position for birth, to make pushing more effective, and to generally help speed and ease your labor. The various techniques a doula brings to your birth are invaluable for many reasons, but can also help you to avoid a “case” of CPD.

10) Listen to your body.

This might sound strange to some, but you should pay attention to how your body is feeling throughout labor. Extreme discomfort is often a signal that something needs to change. If you feel like you can hardly bear a certain position, try a different one that works for you! In the process, you may help your progress and facilitate baby’s descent.

11) Be patient.

If you and the baby are both healthy, a slow labor or long pushing phase doesn’t necessarily mean anything is wrong. It took 3.5 hours of pushing for my son to decide to turn from his posterior to anterior positioning and make his exit. Yes, it was difficult. Yes, it was exhausting. And I do admit to thinking to myself, “So what’s wrong with a c-section?” There was a period where I myself didn’t believe that he would actually come.

Most of the time labor doesn’t bring immediate results. It is long, sweaty, hard work, and all you can do is ride it out and wait for each contraction and each challenge to pass. Patience doesn’t guarantee a perfect birth, but oftentimes patience can save you from jumping the gun and trying to “fix” something that wasn’t broken in the first place. Sometimes what seems like a baby not fitting through the pelvis is actually a case of the baby simply taking longer to make his way down through the pelvis and birth canal.

Let me be perfectly clear. True CPD, though rare, does exist. If you are one of those women who actually does have it, do not blame yourself. You are not at fault. We live in a broken world, and not everything always works as it should. These suggestions are meant to be tools for you to try to help avoid the CPD diagnoses. You are doing everything you can to do the best for your baby and yourself, and in the case of a truly necessary cesarean, you are absolutely doing the best thing for your family by going through with it.

So now you have some tools to take with you to labor. Suspected big baby? Previous CPD diagnoses? Don’t be afraid. Give it a shot. You can try to birth this baby vaginally, and many of you will go on to do so.

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The Problem with the CPD Diagnoses

There’s no way that head was fitting through vaginally!

No wonder you needed a c-section, your baby was so big!

Don’t worry honey, it’s not your fault. Your pelvis is just way too small.

The diagnoses for the cesarean?

Cephalopelvic Disproportion (CPD)
1. a condition in which the fetal head is too large to traverse the maternal pelvis. (MediLexicon)

Either the baby is too big, or the woman’s pelvis is too small, or a combination of both, they say. However, CPD seems to be one  of the most common and the most controversial reasons for a c-section. I personally have known many women who were told that their babies couldn’t fit through their pelvis. Many choose to have an elective cesarean afterwards; others go on to birth subsequent (and sometimes larger) babies vaginally.

So, outside of the labor room, what are people (birth advocates and medical journals alike) really saying about CPD?

“Cephalopelvic disproportion (CPD) occurs when a baby’s head or body is too large to fit through the mother’s pelvis. It is believed that true CPD is rare, but many cases of “failure to progress” during labor are given a diagnosis of CPD. When an accurate diagnosis of CPD has been made, the safest type of delivery for mother and baby is a cesarean.” – American Pregnancy Association (APA).

“Cephalopelvic disproportion is rare. According to the American College of Nurse Midwives(ACNM), CPD occurs in 1 out of 250 pregnancies. If you have been diagnosed with CPD, it does not mean that you will have this problem in future deliveries. According to a study published by the American Journal of Public Health, more than 65 % of women who had been diagnosed with CPD in earlier pregnancies, were able to deliver vaginally in subsequent pregnancies.” APA

“When a diagnosis of CPD has been made, many people still believe that this constitutes a reason for elective repeat caesarean section in future pregnancies, despite the wealth of evidence to the contrary. Indeed, there have been many documented cases where women have been diagnosed as having CPD and then gone on to deliver vaginally a larger infant than the one that was delivered surgically.” –Belly Belly

“In one study, 68% of women diagnosed after labor with “absolute CPD” still went on to have a vaginal birth. However, in extremely rare cases, true absolute CPD does exist, usually in the context of severe malnutrition or a permanent injury.” International Cesarean Awareness Network (ICAN) (1).

“A trial of labor is reasonable in women whose previous cesarean was for dystocia in the second stage of labor. In this series, patients who underwent a trial of labor after a previous cesarean for dystocia in the second stage had 75.2% (95% confidence interval 69.5, 81.0) chance of achieving vaginal delivery.Obstetrics & Gynecology (2) (Note that dystocia is associated with a long labor, and is often associated with the CPD diagnoses.)

A woman’s pelvis is flexible and is made to open during birth. When there is interference with the birth process (induction before baby is ready, mother’s movement is restricted, etc.), the pelvis is not able to open to its maximum. The baby’s head molds (changes shape) during labor and delivery in order to fit through the pelvis. Neither the pelvis nor the baby’s head are fixed in one position; both expand and shift as labor progresses. A birthing woman’s pelvis is most likely to expand freely and accommodate the baby when the following conditions are present:

The birth takes place when the baby is ready and when natural birth hormones are present.The laboring woman moves freely to her comfort level.Adequate time is allowed for the molding of the baby’s head.” –ICAN

(All bold print mine.)

All of this is not to say that true CPD doesn’t exist, nor that all cesareans for CPD are bad. But there is sufficient evidence available that should make one rightly question the commonness of the CPD diagnoses. Could it really be that so many women’s bodies are not able to function properly in stretching and opening for a baby? Or that babies are that much bigger today than they were many years ago (say, back in 1970 when we only had a 5% c-section rate?) Or that a women’s pelvises could actually get that much smaller in the past 40 years?

It’s something to think about… and maybe even something worth questioning.

Have you ever been faced with the CPD diagnoses? Do you think it was given rightly? Why or why not?

Check back in next time for a post on how to try to prevent the CPD diagnoses during your birth.

(1) Impey L, O’Herlihy C. First delivery after cesarean delivery for strictly defined cephalopelvic disproportion. Obstet Gynecol 1998 Nov;92(5):799-803.

(2) Bujold, Emmanuel MD; Gauthier, Robert J. MD. Should we allow a Trial of Labor After a Previous Cesarean for Dystocia in the Second Stage of Labor? Obstetrics & Gynecology 2001 Oct; 98(4):652-655.