Need some Advice Please!!

[tan1979]

Hi,



I've just had my 40 week check up and my baby has not descended into the pelvis, his head is still floating about. The doc has advised me that my pelvis may not be big enough or that the baby is just lazy or large. I am a large build and have large feet so thought i would have no problems in the pelvis size department! I asked if he had any ideas on encouraging the baby to move down and he said no, not really. I was just wondering if anyone else has been in the same predicament and what eventuated, am starting to panic a little cause I really don't want a ceasarean or to be induced so am trying to find ways to get this little bugger to move! I have another appointment next Tues and if he hasn't moved by then I have to see an ob to discuss my 'options.' Any advice on this matter would be greatly appreciated. Thanks!

[BellyBelly]

Thats not very nice of the doctor! Babies engage when they are ready - many first babies do engage early, but on the other hand, many also engage when you are in labour or just before it starts. I know of many babies born perfectly fine when they hadn't engaged until labour, even at homebirths - no dramas.

A doctor cannot tell you how wide / big your pelvis is without looking at you. It's bollocks. A pelvis scan is just as bad - your pelvis is effected by hormones and opens wide in labour. I wouldn't fall for his scare tactics - unless there is clearly something wrong with the baby (which obviously there is not, only baby isnt ready to engage yet) you don't have to agree to anything - you can just say NO! There is no law about it. CPD or cephalo-pelvic disproportion is VERY rare. Where its usually seen is where there has been prior damage to the pelvis or rickets.

[angelfish]

I'd suggest tincture of time, ie just take it easy and see what happens. Some babies do wait until the last minute to engage, and remember it's quite normal to go anything up to 10 days beyond your date, so there's still time! When you see the ob, be quite firm that you do not want to be induced unless this is medically necessary (as opposed to because you have passed your edd). If you're not feeling very assertive, take a support person along with you.

[Lil_Aussie]

Hi hun,
I had very similar experience with DS#2,,,,,his head would not engage, the doctor did an internal, said I was very small built, and as he did the internal, he tried puching down on my belly a little, to see if bubs head did move down a little,,,,it was firmly in place and didnt move at all.
I was then booked in for a caeser the next day at 37weeks, 5 days, as i was told that bubs head could not even engage at all because I am too short (barely 5 ft 5, and hubby is 6ft 4) and small in size internally.
At the caeser, it was discovered that bubs had his arm over his head into my pelvis, and this is why he would not come down at all. He did however weigh in at 8lb 10oz, and my OBGYN said I would have never birthed him anyway as I am the same size as my mother as well, and she had to have emerency caesars with all three of her children, and we only weighed in at between 5 and 6lb,,,,,,we all got stuck. He also stated, that with his arm over his head like that, if my water had broken, the umbilical cord could have prolapsed, so it was safer to have had the caeser anyway.
So who knows what I may have been capable of if he had given me more time, and more faith????

[grouchfrog]

My midwife has suggested yoga squats to keep my little girl's head lower down in the pelvis (she likes to flip). Maybe these would help you too? I would just be careful with the positions--get a good book, tape, or instructor to show you so you don't injure yourself. Also be very sure she is head down first. They are relatively easy to do and always make my hips and back feel great. At 40 weeks it may be a good idea to do them next to a sturdy chair so that you can hold on for balance.

Good luck.

[**Helen**]

My DD wasnt engaged the day before I had her when I had my OB appointment. I remember when the midwive did an internal she had her hand out. They gave it a bit of a tickle to get her to make it go back and to let her head come down properly. I would give it a bit of thought as to what you decide to do. You could always ask if you can let yourself labour naturally and see what happens. But remember chosing a c/s is not always a cop out. If you feel it is the best decision medically etc for yourself and the baby and have done all your reading, then that's ok. Just remember not to be bullied into making any drastic decisions.

all the best

Love

[BellyBelly]

Lil_Aussie - I can't believe your Ob pressed down on your tummy to try and get baby down amongst other things he said. Sure baby had it's hand up by it's head, but with a little over 2 weeks to your 'estimated' due date and 4 weeks left til the end of what they class as term, I am sure things could have been different. Babies don't stay in the same position for that long and it was probably doing that because it didn't like being pushed on LOL! Babies also slow down with growth towards term and I am sure it wouldn't have been pounds heavier. It's all over weight too, doesn't mean it's all going to mean a bigger head and not fit through. This is where we all need to watch the 'Pink Kit' which you can see in the Birth section of the main site. It explains all about pelvises and what they CAN do.

Babies getting 'stuck' is most often than not a positional thing, but Obs do not know what to do to help that positional problem other than to use tools (this is what they learn at Uni which needs to include more alternative methods) - this is why midwives are so invlauable because they can keep things normal - they can show you positions to try in order to get that baby moving around so you can avoid all that stuff - but with so many women having epidurals too, this poses a problem because they can't move. Also a psychological block can stop these babies coming - I have seen it where there is great fear. One woman I supported had been abused and one had an intense fear of intervention.

Cases of CPD were around when our mothers birthed, so they chose to birth at home next time and successfully did that, with even bigger babies. As my above post, it's grossly misdiagnosed unless under slim chances and with the right education and support you can have much better outcomes. Consider getting yourself a private midwife and/or doula. We spend thousands on prams with all the bells and whistles but are so reluctant to spend anywhere near that to help ourselves have the best experience possible - you wont remember the pram all your life, but you will carry your birth experience the rest of your life...

[Fi]

Jenna was in and out of engagement right up until the very end. I could tell the difference in pressure on my pelvis when she was engaged, and then when she popped out again.
I dont think it makes any difference to the actual event as what is more important is you positioning, and all those hormones making all the good stuff happen.
Try not to worry until its time.
As for a private midwife/doula, its a good consideration, but you may find that the midwives at your public hospital are already very competant. I know at Geelong Hospital there are some brilliant ones (especially in the Family Birthing Unit) so they are out there! I suggest that your assigned midwife will have more power to help you with the more credence you put in her skills and opinions.

[BellyBelly]

Studies have shown your own private midwife or Doula (not hospital staff) to have more benefit (however a midwife who you click with and supports you the way you want is always a blessing but not a guarantee!). Plus you have to contend with shift changes which can throw you out sometimes. From the Cochrane Library:

The Cochrane Database of Systematic Reviews 2006 Issue 3
Copyright © 2006 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Plain language summary
Continuous labour support reduces a woman's likelihood of having pain medication, increases her satisfaction and chances for 'spontaneous' birth, and has no known risks
Supportive care during labour may involve emotional support, information, and comfort measures. Such care may enhance normal labour processes and thus reduce the need for obstetric intervention. Women who received continuous labour support were less likely to use pain medications and were more likely to be satisfied and to give birth 'spontaneously' (with neither caesarean nor vacuum nor forceps). In general, labour support was more effective when it was provided by women who were not part of the hospital staff.

Abstract
Background
Historically, women have been attended and supported by other women during labour. However, in recent decades in hospitals worldwide, continuous support during labour has become the exception rather than the routine. Concerns about the consequent dehumanization of women's birth experiences have led to calls for a return to continuous support by women for women during labour.

Objectives
Primary: to assess the effects, on mothers and their babies, of continuous, one-to-one intrapartum support compared with usual care. Secondary: to determine whether the effects of continuous support are influenced by: (1) routine practices and policies in the birth environment that may affect a woman's autonomy, freedom of movement, and ability to cope with labour; (2) whether the caregiver is a member of the staff of the institution; and (3) whether the continuous support begins early or later in labour.

Search strategy
We searched the Cochrane Pregnancy and Childbirth Group Trials Register (April 2006).

Selection criteria
All published and unpublished randomized controlled trials comparing continuous support during labour with usual care.

Data collection and analysis
We used standard methods of the Cochrane Collaboration Pregnancy and Childbirth Group. All authors participated in evaluation of methodological quality. One author and a research assistant independently extracted the data. We sought additional information from the trial authors. We used relative risk for categorical data and weighted mean difference for continuous data to present the results.

Main results
Fifteen trials involving 12,791 women met inclusion criteria and provided usable outcome data. Primary comparison: women who had continuous intrapartum support were more likely to have a spontaneous vaginal birth, and less likely to have intrapartum analgesia or to report dissatisfaction with their childbirth experiences. Subgroup analyses: in general, continuous intrapartum support was associated with greater benefits when the provider was not a member of the hospital staff, when it began early in labour, and in settings in which epidural analgesia was not routinely available.

Authors' conclusions
All women should have support throughout labour and birth.