Posted by My OB said WHAT?!?.
Jun
2
Posted by My OB said WHAT?!?.
“…You’re Too Narrow…”
“It’s a good thing you had a cesarean section. You’re too narrow. You’ll never have a baby vaginally.” – New Gyn doing a routine exam 6 months after an unnecessary primary c-section by another doctor.
There are 46 comments to this post.
“She looks kind of sad when I ask about her birth. Let’s see: it says in the text books that some women blame themselves for their cesarean sections, or even blame their doctors! That’s horrible. I don’t want her to blame herself. I’ll just tell her that her hips are too narrow to deliver a baby and then she’ll feel better about the whole thing.”
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CCindy Reply:
June 2nd, 2010 at 7:32 am (Quote)
Jane you always have such an interesting spin on things. Now teach us what to say to that type of doctor to remind him about the hormones that permit the ligments to streach. How do we remind him?
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Jane Reply:
June 2nd, 2010 at 7:37 am (Quote)
“Well, yes, NOW I’m too narrow because my body hasn’t had thirty-eight weeks of pregnancy hormones to get those ligaments to stretch out and loosen up. But I believe that both relaxin and prostaglandins do amazing things for a woman at term, if they’ve been allowed to build up naturally. Plus, don’t forget that a woman who delivers in a squatting position scissors open her hips by an additional fifteen percent. Next time, I’ll birth just fine as long as I’m not induced or put flat on my back.”
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Sarah Dorrance-Minch Reply:
June 2nd, 2010 at 11:38 am (Quote)
Don’t think the young doctor was there for the lecture the day the professor covered this little phenomenon called “vaginismus,” either. Given that it’s not uncommon for women to clench up at the sight and touch of a strange fellow they’ve never even seen before, white coat notwithstanding, it would be a good idea to look it up.
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Jane Reply:
June 2nd, 2010 at 6:11 pm (Quote)
Vaginismus is far more than that. In many cases, the vagina closes so tightly that a doctor wouldn’t be able to get a finger in there at all, nor a speculum. In most cases of vaginismus, even the woman’s partner can’t get in there.
I don’t think real vaginismus happens only in a clinical setting.
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I am soooooo afraid that the next OB I see will say something like this. After my unnecessary c/s, the OB said I had a “tight pelvic girdle.” I made the mistake telling my husband this, and so now he thinks that I will NEVER be able to birth a baby vaginally, that the only sensible options is to just go for a ERCS next time around. Of course, we will be getting a “second opinion.” And lordie, I do not know what I will do if the next OB says some BS like this.
(I personally want an HBAC, but there is no way DH will even consider that an option until I find an OB who agrees to do a hospital VBAC and confirms that my pelvis is perfectly fine.)
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Mama Mirage Reply:
June 2nd, 2010 at 9:16 am (Quote)
I hope you get to have a wonderful VBAC followed by an amazing HBAC then! 
It’s amazing what natural labor and a good pushing position will do for “too narrow.”
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Sheva Reply:
June 2nd, 2010 at 10:15 am (Quote)
Can you share where you live so we can maybe share our knowledge and resources for your area?
And a suggestion – hire a doula. Maybe one who has experience with VBACs, and one who knows the OBs or midwives in your area who are most receptive to, um, evidence based practices.
Maybe the ICAN website has some resources for you? Or for your husband.
There are some great books you can ask him to read, too.
I wish you the very best of luck and health with your VBAC!
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Cristy Reply:
June 3rd, 2010 at 5:20 am (Quote)
Thanks to everyone for the kind words and support. I live in middle Georgia, 2 hours south of Atlanta, 1 hour from Macon, 2 hours from Savannah. I would love any suggestions for helpful resources in my area.
I have been on the ICAN website and forums. They have been a great help in healing from my first c/s.
Thanks again to all.
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brige Reply:
June 2nd, 2010 at 10:16 am (Quote)
Your best bet is not with a OB but with a midwife, and don’t stop shopping until you’ve found someone who will support you, and at least give you a Trial of Labor… No one, and I mean NO ONE can predict what will happen during a birth, Ask lots of questions about their rates, anything over 20% c/s is a no go as their protocol obviously does not support the natural physiological process of labor. They can not deny you a TOL. Good luck and many blessings
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Sarah Dorrance-Minch Reply:
June 2nd, 2010 at 11:49 am (Quote)
Who’s birthing the baby – your husband, or you?
Your wishes should be paramount.
His lack of confidence can, unfortunately, undermine yours, especially when you enter hard labour and are suggestible as hell due to hormones and to your concentration being focused more on labour than on the need to come up with logical defenses and rebuttals.
A good compromise would be to birth in a free-standing birth centre, if your area has one, but depending on the comfort levels of the midwives and the laws in your state, you may or may not be allowed in due to your “risk.” (Stupid insurance red tape… We all know VBAC is far less risky than repeat C, unless you’ve had a vertical incision, been aggressively induced, etc.)
I agree with the others – you NEED a midwife. And you need a real midwife, one with plenty of experience in natural childbirth, and one who has assisted at VBACs before. No hospital-oriented medwives. You should also get a doula. Not only would a doula help by being an extra pair of hands in labour, but often, a doula can be a voice of calmness in the onslaught of a husband’s jitters/terrors. Or at least a person willing to believe in your body’s ability to birth, if your husband steadfastly refuses to see the possibility. You need someone in your cheering section.
A good midwife might also be able to help your husband consider the possibility of an HBAC. Maybe. At the very least, maybe her authoritative advice to the effect of your body being perfectly capable of birthing a baby would plant a seed of hope… if he’s willing to see a midwife as a real authority, and isn’t brainwashed into the common American notion that doctors are better because they have a fancier degree, surgical training, and cost more.
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cheeks023 Reply:
June 2nd, 2010 at 4:20 pm (Quote)
Christy…some hope for you. My Girlfriend is 105lbs soaking wet, narrow as a rail. Had a CS for her first birth…baby was breech. This time around, she is going for a VBAC (very likely in CANADA!!) She had a car accident years ago, which slightly altered the natural physiology of her pelvis, her doctor has looked at her x-rays and said that with the bodies natural ability to stretch, her accident and extra bone shouldn’t interfere with giving birth vaginally…so long as she does it in a squat position. I will be attending her VBAC sometime at the end of this month and will let you know how it goes. But if she can do it, with an unnatural extra bone in her already narrow pelvis, I would think you have nothing to worry about!
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Sarah Dorrance-Minch Reply:
June 2nd, 2010 at 5:08 pm (Quote)
One of the women on my ICAN e-list a few years ago VBACed… from a bicornate uterus. I can’t recall if she had a septum all the way down her vaginal canal, or if that was another VBACer that I read about somewhere else, but I’ve read about women birthing vaginally (including VBAC, even HBA2C) with all sorts of interesting anatomical variations, including android pelvises.
Relaxin is an amazing hormone.
You can do it.
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Kit Reply:
June 2nd, 2010 at 7:23 pm (Quote)
Android? What is an android pelvis?
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Sarah Dorrance-Minch Reply:
June 3rd, 2010 at 1:02 pm (Quote)
In a couple of my midwifery books, there are diagrams of four different types of pelvis. The most common is gynecoid (I think; I could get up and reference the book, but that involves running across the house to another room, and I’m feeling lazy, alas). The pelvic opening is large and well rounded and thus, apparently, somewhat easier for a baby to pass through than through other shapes. An “android” pelvis is more oval than round, and has bone spurs that make passage a little trickier.
Some midwives say that this is no barrier to giving birth naturally – it’s all a matter of getting the mother to find a position that widens her pelvic outlet as much as possible, and having a skilled midwife who is good at helping to gently wiggle and manouvre babies through (gee, it makes birth sound almost like playing a game of Tetris). Others, not so much confidence. One of my online friends was told by a MIDWIFE that she would always be a c-section mother due to her android pelvis. A DIRECT ENTRY midwife, no less.
It probably depends on the individual midwife’s experiences. A mother with an android pelvis, if told “you’ll never birth naturally,” would be wise to shop around a little and see if there are any care providers in her area who have more experience with android or otherwise unusually shaped pelvises.
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Charity had this to say,
Jun 2, 2010 @ 6:43 am (Quote)
I firmly believe that a healthy woman cannot grow a baby she cannot push out. If I can push out my son’s 17 inch melon without tearing, anyone can!
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Heather P Reply:
June 2nd, 2010 at 7:49 am (Quote)
So we’ve got “My OB Said What?!?”, Somebody suggested “myplacentawashuge.com” I think we should also get “mykidhadabigheadandipushedthemoutanyway.com”
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Sarah Dorrance-Minch Reply:
June 2nd, 2010 at 5:11 pm (Quote)
Kassandra (my home-born child who rocketed out of me after one hour and ten minutes of active labour) had huge shoulders. Can’t remember if they were 6 1/2″ or 7 1/2″, but they were big, anyway.
Seventeen inch head, though – oof. What were his other measurements, just out of curiosity? (I think you get a Superhero Point, all things considered. 
)
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I had an GP make such a comment about my pelvis before I ever tried to get pregnant.
I pushed out my daughter with her 15inch head with her hand up near her face in just over an hour. I felt like calling my old doctor and bragging to her.
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Dorothy "Hyphen" had this to say,
Jun 2, 2010 @ 8:33 am (Quote)
This one’s mine.
I did wind up with another c-section after this, but that one truly was necessary (during a planned homebirth, my son got stuck).
I started to wonder if this gyn was right, but my daughter (the largest of all of my kids) was born vaginally at home last year.
She was a military doctor, so I’m sure she’s long gone by now (that comment was made 8 years ago), but I would LOVE to go introduce her to my youngest. I’m sure the doctor wouldn’t even remember me, though. I never saw her again after that stupid comment.
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Heather P Reply:
June 2nd, 2010 at 8:36 am (Quote)
Dorothy, that’s great that you had a HBA2C!
At least you didn’t have this doctor at the birth of your child. So sad that doctors are out there that truly believe this.
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Birth Unplugged Reply:
June 2nd, 2010 at 9:15 am (Quote)
Congrats on your HBA2C! I’m glad you proved her wrong!
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Sarah Dorrance-Minch Reply:
June 2nd, 2010 at 11:51 am (Quote)
Woohoo! You definitely earn the right to send a smug birth announcement to the old doctor, should you be able to locate her.
Congratulations.
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When I was pregnant with my first, I was VERY young. It was during my first pelvic that my doctor said, “You have GREAT childbirthing hips”. It’s amazing that that ONE comment made me never question my ability to push out a baby.
I wish more OBs would take the positive road with their patients. It’s incredible how one comment can instill or destroy confidence.
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Sheva Reply:
June 2nd, 2010 at 10:11 am (Quote)
That comment gave me chills. It’s amazing (and not a little bit frightening) how powerful words are and how careful we have to be. Even we (not just docs) can make or break a person with our words.
Our kids, our loved ones…
Our clients – it’s so important.
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Mary Reply:
June 2nd, 2010 at 10:13 am (Quote)
Words are such powerful weapons. They hit harder than a fist and the bruises never really fully fade.
This is what I tell myself every day, especially when my teen and my toddler are pushing me to the end of my rope and I want to snap and explode.
Words can destroy.
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Sarah Dorrance-Minch had this to say,
Jun 2, 2010 @ 11:53 am (Quote)
“You’re too narrow?” And you’re too narrow-minded, Doc.
Such a shame when they get indoctrinated so early in their career. I’ve heard Johns Hopkins and Georgetown med schools are notorious for this, in particular.
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This was said to my MIL. Her doc actually told her b/c she was too narrow (healthy pelvis no issues so WTF) she’d never go into labour. My DH was a scheduled c/s & with my SIL she went into labour (wow! shocker!) which stalled in the scary hospital so another c/s. Her last as SIL had breathing issues. The doc actually told her it was just as well b/c she’d have babies with too big of heads b/c of FIL’s head. This is apparently a common belief that papa dictates the baby size as some quack tried to tell me similar when I was pregnant. I merely stared at him as if he had six heads & he never mentioned it again. We wouldn’t still be here if women grew babies too big for them. Its sad, my MIL & FIL still believe she is physically incapable of vag birth. It affects my SIL’s confidence. She’s not sure she wants to have kids b/c she’s “too narrow” as well. These psychic doctors who have the ability to predict with uncanny accuracy the stretch of mama’s ligaments & baby’s head molding. *head-desk*
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I hate hearing ones like this. It’s ridiculous!
I have had the opposite told to me. Right after my first child was born the doctor told me I was built to birth babies! I took it as a compliment and I have never doubted my ability and there has never been talk of a c-section, not even when I had a partial placental abruption. We were both stable and no one saw the need. I love my family practice doc who will support whatever I need to birth my babies as naturally as possible.
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The first exam on a pregnant woman, the OB will take measurement of the pelvic inlet and outlet with his hand and if the measurement is over a certain measurement; great, there shouldn’t be a problem. But, under a certain measurement can present a problem. However, every woman should be given the opportunity to really try and she doesn’t need a negative attitude. Your first C/S may have been from the baby coming into the pelvis at an odd angle. Congratulations on your vaginal birth. I love happy endings and I for one never mind being wrong when it’s to the patient’s benefit.
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Aron Reply:
June 3rd, 2010 at 5:55 am (Quote)
Thea, I don’t know if you are familiar with the work of Gloria Lemay in Vancouver, BC, but here is a link to one of my favorite of her articles: http://www.midwiferytoday.com/articles/pelvis.asp
Essentially, pelvimetry has never been supported with scientific evidence largely because it fails to account for the stretching a movement of an unhindered woman’s body or of the molding of her child’s head. Unless the mama has a history of catastrophic pelvic injury, rickets or wildly uncontrolled GD there’s no reason to assume her pelvis is inadequate. As Gloria’s own OB mentor states, “the best pelvimeter is a baby’s head.”
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Katelyn Reply:
June 3rd, 2010 at 7:58 am (Quote)
I’m currently 32 weeks with my first and have not had my pelvis measured at all. No one has even mentioned it. And I would probably refuse if they wanted too. (And I’m seeing an OB if it matters.)
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CCindy Reply:
June 3rd, 2010 at 8:38 am (Quote)
That may be standard in Thea’s area, but I don’t think it is standard nation/worldwide. No point in doing it. It can only raise a red flag and can’t gaurentee that the baby is decending at an easy angle. Position during birth is so much more indicative.
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Sarah Dorrance-Minch Reply:
June 3rd, 2010 at 1:07 pm (Quote)
I saw OBs for parts of my first and second pregnancies and not ONCE did I get my pelvis measured – not by hand, not by those calipers that used to be used for pelvimetry. Apparently in northeast Ohio, while episiotomy was still not only common but routine by as late as 2004, pelvimetry was not. I think you’re right about regional differences.
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Doesn’t the OB or midwives in your area check you internally on the first visit? The person checking you is not only checking the cervix for length he/she is also checking the uterus for its position and shape. During all of this they are also checking the pelvis to see if it is adequate. A red flag may be prominent ischial spines or a coccyx that is curved more inward. Sometimes it is a women with a male pelvis shape. We are looking for anything different, ie: bicornate uterus, vaginal septum etc. It is certainly not the end all be all test. Having a baby vaginally is. That’s why we say a woman has a proven pelvis up to the largest weight baby they’ve had. Most patients are not aware of what is being checked and why. adly, these ladies are not as educated as some of you. I like how OB medicine is practiced in Canada and Europe. One of the nurses I’ve had the privalege of working with trained in Canada. We practice at the bedside a lot a like. She had asked me to be her nurse when she came in labor unfortunately, I went out on Medical Leave. Baby’s position, mother’s position, length of time allowed to push are all necessary ingrediants to a vaginal delivery. Aron, Keep the articles coming. The more I know, the better able I am to meet all of the patient’s needs. Thea
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Sarah Dorrance-Minch Reply:
June 3rd, 2010 at 1:15 pm (Quote)
Is it common practice to do the procedure without telling the woman it is being done? During my prenatal pelvic exams (so glad I didn’t have to bother with them the third and fourth times around; it’s not that I mind, but I had a pelvic exam a year ago with for the usual Pap smear and so on, and I don’t like being examined routinely more often than is absolutely necessary – I see it as bad hygiene) my practitioner told me what she was doing.
“This is your uterus. It looks like you’re about X weeks pregnant based on its position and size. By the way, did you know it was tilted? Now I’m taking the cultures for your Pap smear.” Etc.
No mention made of my pelvic shape or adequacy/inadequacy, or “red flag” issues.
BTW, I also never liked the concept of the “proven pelvis.” It goes against my philosophy that all mothers can give birth, unless they have ricketts, severe pelvic injury, etc. My CPM’s philosophy, too. (I guess she played a lot of Tetris when she was a teenager. )
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I have actually been told how narrow my pelvis is by my very good midwife. My first was born still because of it, and my son had shoulder dystocia, but my midwife was very skilled, and she helped him out safely.
Still though, I would not wish a c-section on anybody.
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Add Your Comment.
This attitude is disgusting. A healthy woman without pelvic damage can pretty much ALWAYS birth her child if given the chance!! So sad.
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Kayla Reply:
June 2nd, 2010 at 3:26 pm Kayla(Quote)
THIS COMMENT WAS MINE! Ha! They posted it. I immediately got a new Ob-gyn, who I LOVED! Yea, I did have a small pelvis, and yes it did take me 3 hours of pushing, and yes, my son did have bruising, BUT I delivered my healthy son without any intervention or c-section.
A woman’s body is MADE for birth, and shouldn’t be underestimated.
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Kayla Reply:
June 2nd, 2010 at 3:28 pm Kayla(Quote)
…oh and I think my immediate response to that idiotic gyn was “the hell I won’t!!!”
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Lucia Reply:
June 2nd, 2010 at 4:57 pm Lucia(Quote)
YAY! Good for you! Way to tell ‘um off !
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'Bin Reply:
June 4th, 2010 at 10:01 am 'Bin(Quote)
I’m a Big Girl. My Midwife measured me at “more” than 10 cm (pelvic dimension), it still took me 2.5 hours to push my 8lb even son out, with a BIG bruise of the back of his head(probably b/c of his position). So it goes to show you size doesn’t matter!
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