Posts Tagged ‘unnecessary cesarean’

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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Tempering Passion with Humility

As a birth enthusiast, I love hearing birth stories. I love hearing positive changes in maternity care. I am eager to help women who want more information. I want to encourage women rather than scare them. I’m thrilled and honored whenever I get to attend a birth. I want to help women to get the birth they want. I even love trying to figure out exactly what happened at births.

But there’s an ugly side that sometimes can accompany my passion for birth. It’s a skeptical train of thought that slyly sneaks in… For me, it’s hardly ever voiced aloud. It could go in any number of directions…

Baby born by cesarean? Unnecessary, I’m sure.

Maybe she just took the epidural too soon.

Emergency c-section? Probably a shift change, is more like it!

If only she had read [insert favorite birth book title] beforehand. Then she would have known that [insert most despised intervention] wasn’t really needed.

The doctor probably only did that because it [sped things up/got him more money/got him home to his golf game sooner/etc.].

If only she had hired a doula! Her birth would have been so much smoother.

It’s a poisonous cynicism that is catalyzed by both a broken maternity system and my own pride. I see it all over birth blogs and forums, and quite often I see it in myself too.

What do I think? That I somehow was stronger than another woman for remaining calm throughout my labor? Did I clearly follow the Most Knowledgeable and Highest Path by having a home birth? Did I earn a complication-free birth by doing prenatal yoga and practicing deep relaxation?

What about you? Do you ever find yourself wandering these paths?

Do we really think that we know everything about a woman’s situation before we start talking or thinking through it? We absolutely do not. We don’t know her preparation, her preconceived notions, her level of being informed, her doctor’s viewpoint, her fears, her hopes… We do not know what was told to her or untold. What was performed with full consent, what was proposed as necessary, what was done without permission. What was encouraged, what was discouraged. We do not know the pain of her contractions. The position of her baby. The reason labor stalled or went too fast or whatever else may have happened.

And most of all, none of us can truly control it, and none of us can go back and change it.

We can prepare, we can practice, we can hope, and we can plan for contingencies. And lest you think I’m a willy-nilly, I DO advocate for these actions. I think that in many cases, they can help a birth to stay on track in the first place. They can also help a mother to process better if it goes awry anyhow. But ultimately, none of us can choose exactly how our births will play out. Birth is, by nature, unpredictable (though I do agree that it is usually safe when attended by a qualified caretaker and left well enough alone).

When you add to the unpredictable nature of birth the many layers of convoluted maternity care, mixed messages from friends and family, and the great birth debates across the world, it’s a wonder if any woman makes it through a birth without at least some uncertainty!

When I take a step back from my thoughts, I need to remember to be humble. I don’t need to judge doctors, second-guess decisions, and inject doubt into birth stories I don’t understand fully. My job is not to be the birthy know-it all. When it comes to hindsight, my job is to listen to the mother. Support her. Help her with her and her baby. Be understanding of how she feels. Pray for her and with her. Help her to heal. To be the one who doesn’t tell her what she should or shouldn’t have done.

When pride comes, then comes disgrace, but with humility comes wisdom.

Proverbs 11:2

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