Aug 232011
 

“You seem to have a very small pelvis.” – OB during a vaginal exam at a prenatal visit.

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 August 23, 2011  Cervical exam, OB, pelvis, prenatal  Add comments

  42 Responses to “"You Seem To Have A Very Small Pelvis."”

  1. And your point is…?

  2. You seem to have a very small brain.

  3. “So let’s just go ahead and schedule that c-section right now!”

  4. I wonder if it’s got anything to do with her being on her back… hmm…

  5. “You seem to have a very small penis.” (turnabout is fair play–actually this is how I misread it in my feed. lol)

  6. It’s a good thing the labor process spreads everything out so it can accomodate a baby, huh? Oh, you didn’t know that? Are you sure you should be attending birthing mothers?

  7. And, if this were true, it would be a problem if every single woman grew a baby exactly the same size as every other.

    But since babies come in different sizes, that’s the first reason what you’re saying has no bearing on anything. Shall I go on?

  8. And………. your point us????

  9. they are so jealous of women’s ability to birth!!! just *have* to knock it down at every opportunity! you are too immature, you are too old, you have a small pelvis, your uterus is scarred, your placenta is faulty, you can’t take the pain, your body will infect your baby with diseases, omfg!!!!!

  10. Wow, what else can you see in your crystal ball?! Seeing as it is IMPOSSIBLE to tell pelvis size from a vaginal exam.

  11. This is just the first step in setting a woman up to accept that her body is defective. (Whether or not she has physical issues, this sets her up to believe she does.)

  12. I was told by my OB that I have “narrow hips” which I took as a compliment, and yet I was able to birth without drugs, an episiotomy, or even a tear an 11 pound boy, a couple over-10-pound girls, and for my grand finale, a TWELVE pound boy!

  13. My OB actually said this to me too my first time being pregnant. He then proceeded to tell me that I was going to have to have a c-section. UM, yeah, NO, I won’t! I went on to have four babies, all vaginally, no epidurals. Glad I knew better before and not after. :)

  14. How the hell does the OB know how roomy a woman’s pelvis is from shoving a hand in her vagina?

  15. soo what!? they said that same thing to me seven months before I had a natural birth with an almost ten pound boy. I mean really, are they trying to scare her into a c-section in her first trimester? That is what I think he or she was trying to do with this statement.

  16. The OB I fired at 6 months (for her rude, demeaning, “Why do you ask questions, just do as I say” attitude) sat at my bedside after 36 hours of labor, ready to get me into the OR and asked if i had any more questions.
    Me: “I want to have a VBAC with the next one. What’s the likelihood?”
    Dr Evil: “Oh…you’ll NEVER (her emphasis) be able to deliver vaginally. Your pelvis is too small for that!”
    Me: “hmm, seems you could have told me that nine months ago if you are that good at the crystal ball predictions.”

  17. Well, as all the old obstetrics books used to say, “The best pelvimeter is the baby’s head.”

  18. Dang, I just went in for my first appointment last week (I’m 11 weeks now) and the midwife told me I have a pelvis made for pushing big babies out. Well, I guess it’s good to know that she believes in my ability to give birth.

    • But why is this okay? Why is okay to say, “you have a pelvis made for pushing big babies out” and not okay to say, “your pelvis is small.” Either you can tell or you can’t.

      Everyone seems to argue you can’t tell when the doc says the pelvis is small, but yippee!! the doc is great when she says it’s large.

      Pick one.

      • Because in your first scenario, you’re not telling the mother her body is defective and setting her up for failure.

      • Fact: They really can’t tell by a standard vaginal exam. The exam for pelvic size involves the doctor pressing his/her knuckels into you butt cheecks to feel where your pelvic bones are. (I had this done before they started the pit.)
        Therefore: either saying You have a roomy pelvis or saying You have a tight pelvis is a psych. One is a good kind motivating psych and one is an evil psych. They are both lies! But your pelvis was made for birthing babies is true.

      • That’s not what I meant–since people here are saying that a VE is not the most accurate way to judge, I’m thinking I better not get too excited about it.

        Plus, it was really late when I wrote that…

  19. For those asking ‘how could you even tell’…well, if doc tries to do a VE and (s)he can’t place a speculum or more than 2 fingers because they run into bone, it’s safe to say a woman has a small pelvis. But even that doesn’t have anything to do with ability to birth vaginally since those bones relax, stretch, and adjust dramatically during late pregnancy/labor. it’s not *always* a bad thing to say a woman has a small pelvis, it can be very accurate and good to know (for instance mom might adjust how she plans on pushing to maximize space) but, as this doc did, it’s never ok to imply that in and of itself will keep a woman from birthing!

    • And you know of at least one woman in the world who can’t use a speculum because it runs into BONE! Really? Because the bones that you sit on are at the top of your legs. And the pubic symphosis is nowhere near you vagina. There is a heck of a lot of muscle wall before you ever hit bone. Yes, the ligaments do strech during pregnancy and the three joints that make up the pelvis do open. But I don’t think you know where those are in relation to the vagina and the cervix. And I think if you can’t place a spectulum or two fingers then that is a muscle thing. So that brings us back to a vaginal exam is not the right exam to determine pelvic size.

  20. Thanks. I work out.

  21. I can’t directly reply on my cell, this is to Details who responded to my 1st post.
    Yes, you’re talking to her. My pelvic girddle was tipped in and down, with bone not only easily felt on 3 sides of my vaginal wall, but forming about the same U as you’d form with your fingers if you held a quarter between your thumb and forefinger. They had to use a child’s speculum on me until after the birth of my 1st child. And while my 1st babe did suffer from a shoulder dystocia, my 2nd babe was bore in just 3 pushes with no problems fitting. Because the *bones* shifted during pregnancy and birth. My whole walk has changed, and I actually experience much less daily pain due to the placement of my pelvis. It’s rare, I’ll give you that, but it’s also important to know if you’re one of those rare people. And, like I said, *not* excusing the doctor here, just trying to toss out there to other woman that it’s not impossible for a pelvis to be ‘small’ on internal exam. Maybe someone reading this will be able to prepare their daughter/granddaught/etc for such a possibility. Because knowing it before I tried to consumate my marriage would have saved me a serious tear.

    • A CHILDREN’S SPECULUM…. WHY DO THEY HAVE THOSE!?!?!

      I mean, I’m sure that in some rare cases they are needed but it still really creeps me out that they have child-size speculums laying around.

      • They should just call it a size zero. Like the jeans that nobody over 14 should be able to fit into, but a few models do.

      • Because some young teenagers still have mostly juvenile physiology but may still need gynecological exams (though sadly rarely for the same reasons as adult women…)

        I’m one of those women too, they always have to use the “child size” because the regular adult size small are still too big. They go flying right back out whenever I’ve had one used on me. (And FTR, I’m also a size zero in jeans, so maybe that is “fitting” ;)

      • I was going to a gynocologist at age 12 for debilitating periods, and I know two or three other people who had to go to the gynecologist for problems with their periods when they were in middle school as well, so I don’t think it’s THAT rare.

  22. Btw, Details, my tailbone and last 2 vertebra of my spine are also able to be felt on a VE, my midwife asked if her 2 students could do a VE on me too because she’s never been able to feel the tailbone/spine on a VE before.

    • I’m glad you found a midwife who knew what she was dealing with and didn’t panic. I think we agree that 90% of the OB’s who say this stuff have no idea what they are even talking about. Sorry you have this condition. Thanks for sharing! Hopefully somebody will benefit.

  23. It must have been the tone of voice that was infuriating, since we can get an idea of a small or large pelvis. That’s the whole point of pelvimetry. A lot of OBs don’t study it, but I’m a student CPM and we had a whole unit on it. You can use your hand to determine the length of the diagonal conjugation, the placement of the coccyx, and the width between the ischial spines. The reason this is important is because there are four different general shapes of pelvices: gynecoid, android, anthropoid, and platypelloid. It’s less about how large the pelvis is – this isn’t really relevant, since the pelvic changes so significantly in the last weeks of pregnancy and of course during the labor and delivery even more so – it’s about the shape of the pelvis. Differently shaped pelvices (all of which are normal, I should add) can lead to different deliveries. For example, if a baby reaches zero station and the labor seems to stop, instead of just declaring a failure to progress and starting the meds, the midwife can step back and say, “Well, when I measured her during the pregnancy this woman had a platypelloid pelvis, so it’s likely that the baby is progressing right now as each contraction helps rotate the head to the right angle to fit through the pelvis.” At that time, you (the midwife) suggest different positions to the mother that can help with that particular difficulty, and onward we go!

    To say that measuring the pelvis is impossible or meaningless is to discount years and years of midwifery research that says otherwise. If you want more information, I suggest Varney’s Midwifery, which is the primary text used by British midwives in many prestigious midwifery schools, and is coming to America now as well.

    Now, this doctor, who was probably concentrating on the vaginal exam rather than on her communication with her patient (shame on her), clearly needs to work on bedside manner. A much better way to approach this would be to say, “Do you feel this? This are your ischial spines. Here is what they look like on this model of a pelvis. What I’m doing right now is measuring the depth of your pelvis from here to here [indicating the model] and it suggests to me that you have this type of pelvis. [indicate diagram of different types of pelvices] While we can’t know right now what your body will do in the last weeks of your pregnancy, we know that all types of pelvis are perfectly capable of delivering vaginally, so you don’t need to be worried. We know a lot of positions and techniques that are specifically helpful for women with your pelvic type.”

    Let’s respond reasonably to this comment, everyone. Yes, it was clearly insulting or it wouldn’t be here! But scientifically inaccurate it is not. :)

    • Sorry for the typo. That’s supposed to be diagonal conjugate. :)

    • That’s lovely that you’re learning so much.

      But it’s a pretty big stretch to assume that this OB is studying from your midwifery text!

      • What I mean is, that though this doctor might possibly have been technically correct, and that it is possible to do an exam that gives information about the pelvic outlet, it is highly unlikely that he was actually taking in the data necessary to make such a pronouncement, and much more likely that he was “eyeballing” the patient’s frame and feeling a tight vaginal opening and announcing that that meant the woman had a perilously small pelvis.

        Sort of like Kierkegaard’s example of the village idiot, in possession of a ball which he calls the “world,” recites to himself “the world is round” without actually making any statement regarding the real world and its roundness.

        • Obviously, as a student midwife, my prejudices/biases are abundant and no doubt obvious to all the readers of this blog. ;) However, knowing many doctors as I do (I was pre-med before I switched to midwifery, and my Biology major and Chemistry minor at a prestigious college meant that many of my classmates when on to med school), I find it very difficult to believe that they aren’t taught much of the same material. No, they probably don’t have to take Chinese Medicine I and Chinese Medicine II in order to graduate, but pelvimetry is a standard obstetrical practice. It started in the doctors’ offices and only recently moved into the midwives’ practices. Therefore, it seems more reasonable to me to suggest that midwives are unfamiliar with pelvimetry (as many are) than to say that about the people who first discovered it.

          I find it much more likely that this doctor was communicating badly than that she was practicing bad medicine. The thing is, women with smaller pelvises really are more likely to have problems, and it’s her care provider’s responsibility to consider those ahead of time. There is a head that has to get through there! We can’t predict it ahead of time and it’s ridiculous for doctors to, say, schedule a C-section in advance because of pelvimetry, but it’s a good thing to know going into a labor because it allows us to use our knowledge of anatomy to help facilitate her body’s natural process of giving birth.

          It’s possible that I’m naive, but I think the grand majority of doctors are good at what they do. I find it much easier to believe that this doctor is just bad at expressing herself than to believe that with the incredibly rigorous education and training that she went through that she’s just plain wrong. Don’t misunderstand me – there are SO many statements made by physicians and other practitioners on this website that are flat-out WRONG. But saying to a mother that she has a small pelvis, while it was obviously said rudely and without consideration of the woman’s feelings, is not necessarily a wrong diagnosis. Sort of like when my doctor tells me that I’m overweight; I can be angry at the way she phrased it (and frequently am), but I can’t argue with her medical determination, because I do indeed need to lose weight!

          I’d love to hear from the original poster on this one. If she went in with a proven pelvis and was still fed the line about having a small pelvis, that would be a really different post and I’d happily scoff along with everyone else! The fact that prior knowledge of the statement’s factual inaccuracy is not mentioned leads me to believe that the OP’s objection was less the content than the unfeeling presentation.

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