CPD???? Could I be one of the unlucky ones?

[~mamaspice~]

Okay,
after reading many articles, and watching inspirational videos on YouTube about supposed CPD caesarean mums having blissful VBAC's, I have come to the conclusion that CPD is an absolute load of crapola in the majority of cases. This was fabulous news to me as I had been lead to believe that I could have CPD because my bub did not engage.

However

I've recently been to a Chiro and had a series of x-rays done to try and find out the reason as to why the anaesthetist could not get the epidural in my back for my cs.
Of course the x-rays revealed that indeed I do have a dodgy back (hyperlordosis), but the x-rays also showed that my hips & pelvis are uneven and my left side is noticeably smaller than the right.

Could this mean that I might be one of the teeny tiny %age of people who DO have CPD???? I hope not . . .

Are there any midwives or CPD mums out there who can give me some advice? Has anyone else had a first baby not be engaged at 38 weeks but who've gone on to have successful VBAC's with any subsequent pregnancies?

[BellyBelly]

Have you had rickets before?

Have you broken your pelvis?

If not, I strongly doubt it... you are the result of natural selection... the evolution of human beings has ensured its survival and you can't do that with a pelvis too small to have babies!!!

Know LOTS of women whose baby doesn't engage til labour - and yet they go on to have fantastic births, even homebirths.... trust your body hon....

[Amie]

You are quite correct in that the majority of "diagnosed" cases of CPD are crapola! I'm not saying it doesn't exist but rather, as Kelly says, unless you have had serious trauma to your pelvis then it's highly unlikely that your body has grown a baby that you "can't" birth.

Oh, and as a health professional in my line of work I see up to 15 pelvises (pelvii?! ) every day and nearly every single one of them is "uneven" to some degree. Even people without back pain/issues have an uneven pelvis.

Yay for you and your perfectly-able body!

[~mamaspice~]

hey Kelly, No, no rickets or broken pelvis. Was it a first pregnancy for some of those women who's bubs didn't engage til the last minute? Please say yes . . . I know that second babies sometimes don't engage til the last minute but I was under the impression that first bubs were mean't to engage by 36 weeks?

Thanks for your positive thoughts. Can you tell I'm a bit paranoid of failure

[~mamaspice~]

Thanks SJH, I just read your post. That's great to hear that most pelvis's are uneven, so fingers crossed mine is not incapable after all . . .

[Jesstibb]

With Miss 3, my first pregnancy, I had an appointment on the Friday afternoon and she wasn't engaged and went into labour the next day and only had a four hour labour. I've just got back from the Dr today and this baby hasn't engaged yet at nearly 38 weeks. But I haven't got any pelvis problems so I don't know if that helps you at all

[BellyBelly]

Yup thats what I meant, lots of first time mums whose babes didn't engage til labour. They are just comfy floating about!!! I also know some first time bubs who engaged, unengaged, engaged again.... these babies do what they want!! But at the end of the day, they ALL COME OUT!!! Your body will labour eventually and your baby will engage eventually too.

[~mamaspice~]

Thanks for your post Jesstibb. That's really re-assuring to know! How many weeks were you when you went into labour? Best of luck for the birth of bubba #2. How exciting

Thanks for your reply again Kelly. BTW I know I'm going slightly off track but if I'm going to start my bachelor of midwifery in the next couple of years DH and I were just discussing that we might have to tighten the spending and ditch a few luxuries, one of which is our private health insurance. So it looks like I might be going public with my next bub. I'm a teeny bit apprehensive because it'll be a different care model than what I'm used to, but I know it's probably a good thing because the Gold Coast hospital is very pro VBAC.
Oh also, can you recommend any good doula's on the Gold Coast?

[Jesstibb]

Miss 3 was four days early.

[kyliealysha]

Thanks for posting this. I have been thinking the same thing. I was delighted to read that it may be possible for me to have a natural birth, but I am really thinking my case was real.... Reasons for this thinking are:-

My baby's head was in the 97th percentile at birth.

I experienced many hours of labour and was fully dilated for hours (including a few hours of syntocin to try and move things along) and she still never engaged. The furthest she ever got was "-1"

After the emergency c section I noted that her head was a perfect shape. She had no bruising or shaping suggesting she was even almost there.

My OB after the surgery told me we made the right decision and that she would never have come through.

Any thoughts?? I think I will still aim for a VBAC next time, but am not confident it will be successful. I was SO exhausted after my first labour which went for DAYS (another reason I thought I may have a true case, as I have heard it can make labour prolonged)

[Trillian]

Kylie, there could have been other reasons why your labour was so long - malposition of the baby for a start. If a woman is left alone to let her body do what it is supposed to do then even a baby with a large head can be birthed vaginally - that is why babies have skulls that mould to the vagina - mother nature knew what she was doing. Often Obs don't like to let a woman go past a certain stage of pushing either, which is ridiculous because if they could just wait, stop telling her to push and just let her be, then it will happen. There is a post that Hoobley made recently that said often women can go past the magical 10cms if they let their body take all the time it needs to stretch slowly to accomodate the baby and this makes a lot of sense.

Tamara, I really doubt that you have it - bubs not being engaged at 38wks is no indicator at all considering that a pg can be up to 42wks long. Out of my 4pgs I have only had one baby engaged before labour started and that was my second. As for public hospital birth and VBAC, you will be better off in a public hospital than a private one and better off again if you have a homebirth with an independant midwife. Private hospitals seems to be the natural enemy of VBAC from what I have read of other women's experiences.

[BellyBelly]

Was your bub posterior? Were you induced? Were you flat on your back/in the bed?

[kyliealysha]

Was your bub posterior? Were you induced? Were you flat on your back/in the bed?

I don't think she was poterior but not sure. I was not induced although I did have syntocin at the end (after I was already fully dilated) in the hopes it would push her down a bit. I was sitting up, not laying down.

Trillian, thanks for that info. I didn't get to push at all as she was too high up

[shorty]

My first baby, Logan never engaged till birth.

[paradise lost]

Hi,

Ok, let's be clear that CPD is a REAL condition, it is just very very rare. I know that seems like an obvious statement but it does mean that for SOME women, the diagnosis of CPD will have been correct.

Kyliealysha it's hard to know if you had true CPD. The head %ile, believe it or not, isn't hugely relevant - in general c-section babies with 41cm heads would have been vaginal birth babies with 38cm heads - the skull moulds to such an extent, you can never REALLY know how it would have gone down if the birth had been vaginal (or a section, if it WAS vaginal). I know my vaginally birthed DD had a 35cm head the day she was born and a 37cm head on day 6...

What WOULD be an indicator is a baby that remains high for all the attempted 2nd stage with no descent. -1 is in fact descended to some extent, but since her head was entirely unmoulded it is possible she simply didn't fit into the pelvic inlet. There is a homebirth midwife's account here of a true CPD labour. Her lady was fully dilated for many hours too and they tried all kinds before they decided to section - the baby never came down past -3 and the head was unmoulded at birth.

The good news is that CPD is not a permanent diagnosis - it ONLY applies to that baby and that labour. Studies show that around 65% of women with section due to CPD do NOT have it in the next pregnancy and go on to birth vaginally.

I would urge you to surround yourself with positive people, use positioning techniques to gets bubs in the best position, learn good birthing positions for bigger babies (supported squats, deep squats, hands and knees) and THINK POSITIVE for your future VBAC.

CPD is very rare and though you're slightly more likely than most to experience it, having had it once, that doesn't mean you will - even having had it once you're still more likely to birth vaginally successfully than have CPD again.

Best of luck.

Bx

[~mamaspice~]

Hoobley, I think that was very well said.
Kyliealysha, I am going to take my second pregnancy and birth as a whole different experience. I am hoping for a VBAC and I will be doing everything in my power to try and achieve this. At the end of the day though none of us can be certain that our birth WILL go as we want it to. I wish you all the very best for your next birth

[suse]

I was given a diagnosis of CPD; after a long labour, full dilation and three hours of pushing (posterior bub), heartrate was starting to drop and he was showing signs of distress. The ob suggested that it would not be safe to try an instrumental birth at that stage, as bubs had not descended enough and was already starting to distress. He had not engaged prior to labour, which was started naturally 11 days postdates.

The ob said that she would check my pelvis during the surgery and see if there was any reason due to pelvis shape / width that would prevent me having a VBAC. She said that true CPD is very rare and that hopefully it was just a case in this instance of bubs getting stuck in an unfavourable position, but later debriefed me that I do have a pelvis that is unusually narrow and that even a smaller, anterior baby could not be birthed through my pelvis. In my case I am apparently one of the genetically unlucky ones. I too have questioned whether my own diagnosis has been a genuine one, and intend to have it confirmed, even though I trust my ob and know that she is very supportive of VBAC.

Euan had fairly significant moulding though (and a relatively narrow HC of 33.5cm), so it is interesting to hear that other CPD babies have not had any moulding. Does anybody know if lack of moulding is a trait common to all CPD babies?

Kel, I do agree with you that we are the result of natural selection, and that diagnoses of CPD are bandied about quite unnecessarily at times. It is unfortunate that the term is not more accurately used (aside from the implication to the birthing mother), as any studies on the incidence of CPD would undoubtedly be skewed.

Having said that, it is quite feasible that the occurrence of CPD as a genetic trait (which may be either due to mutation or a combination of multiple slightly unfavourable genes that were not sufficient to cause true CPD on their own) will rise in this and future generations due to the incidence of c/s surgery - before this, women with genetic CPD would have died in childbirth. It would be interesting to see some accurate studies done on this.

[kyliealysha]

Thanks everyone!!

I will definitely aim for a VBAC next time and intend to be much better prepared