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

[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

[paradise lost]

Suse,

the baby's head moulds in the pelvis, so no, in general a CPD baby would not have a very moulded head, as CPD is when the baby's head is unable to fit into the pelvis. Unless you have had a disease like polio, rickets or an injury to the pelvis where the bones were broken or some other thing to cause a deformity of the bones, it is very very unlikely that your baby would fit into the pelvis but not out of it.

What positions did you push in for those 3 hours? In general, because the sacral and pubic bone joints are loosened by relaxin during pregnancy, a baby that fitted IN will fit OUT - the looser joints make the whole pelvis like a hinge, if you press on the two highest pelvic arches (top of your hips) it opens the bottom of the pelvis - this is called a "pelvic press" and is a way of unsticking babies who are taking a long long time to mould and seem to have problems fitting through. Did your care providers try this?

Another sign of a CPD baby is that they remain high - women generally do not have a pushing urge or never have it consistently (every contraction) because the head is not low enough to press on those nerves which drive expulsive pushing. Did you have an urge to push or were you coached to push? I read your birth story and think i remember you had an epidural which they turned down? When you pushed then did you feel you wanted to or did they tell you push when you felt the contraction?

With posterior babies all bets are off - it is HARD for a posterior bubs of average size to get out - the normal pushing time for a first posterior bubs is 2 or more hours, from that POV although you pushed a long time, it was not abnormally long for that sort of labour (i know a woman who had a brow baby, pushed for SIX hours!). The pelvis/baby combo is the perfect shape for an anterior baby to fit through, and the head of a posterior bub is back to front, the neck has to flex more than it would normally, various little geographic features inside get in the way and make the process longer and harder.

In addition the kind of pelvic measuring the ob did (either with fingers or scans) is very unreliable - it's about as accurate as sizing the baby with ultrasound - it can be ok but is often WAY off. There is really no way to tell if a baby will fit through except by trying it (have a look at Kel's tiny women birthing big babies to see what i mean) and i suspect until someone is actually able to give birth inside an mri machine the mysteries of the mechanics of the female form will remain mysterious.

I'm not sure about genetically linked CPD - how would a trait like that have survived the 80,000 years of humanity before c-sections? Were you a c-section baby? Was your mother? Was her mother? These are the sorts of things that would have killed humanity off many many thousands of years ago. The only thing i think is reliably being passed down due to the high diagnosis of conditions like this and c-sections in response is fear. I know several women who had c-sections because their mums had them and they did not BELIEVE the women in their family could birth!

It sounds from the size/shape of your baby's head that he had definitely begun the arduous task of fitting back to front through the pelvis. Posterior labours can be so hard and painful, the back pain was terible for me until she turned (my bubs was possie for the first part of my first stage, spent ALOT of contractions backwards on chairs, rocking on my knees, crawling about etc. and luckily she turned).

ETA- ok, i've had a read of your birth story again and i would say that....with a posterior labour the first stage is often slow (days and days) as prelabour is what turns the baby. The fact that they tried to induce things when they were slow meant your bubs was pushed hard down into the pelvis while still posterior. It can take a long time (know a woman on another board who had prelabour (i.e. painful ctx but very little dilation) for 8 days before bubs turned anterior while she was scrubbing her kitchen floor) for the prelabour to turn a possie bub, but if you're well-supported and know which positions will help bubs turn they often will, and then labour follows swiftly and smoothly.

Once you were under way and had pethidine and the epidural, this is another factor. I had very brief possie labour and believe me, i KNOW how painful just a tiny taster of it is, so i'm not questioning why you went that route, i just want to point out that the route itself has complications. Pethidine passes to the baby, who needs to be alert in order to turn. I did read a study not long ago (on paper unfortunately) that suggested the rate of positional problems is significantly higher in bubs whose mums had pethidine or morphine during labour - maybe one of the other ladies will have a link - babies usually make vigourous efforts to assist their own births, and babies who have had drugs cannot do this so well. In addition the pelvic floor muscles, the deep ones, actually assist in turning the baby and with an epidural this doesn't happen. With the epi it is usually impossible for mum to get her weight off her sacrum entirely. Sitting up can be some help with an anterior labour but with a possie you really need all your weight off your butt and gravity helping you.

Your baby became distressed, it is very unlikely that by the time that happened there was ANYTHING you could have done to avoid surgery - he was no longer coping with the labour. High forceps delivery is dangerous and usually very damaging to the perineum and vaginal canal, from that POV a c-section would have been the best option for your Ob at that time - possie bubs are hard to extract as well as birth through the vagina!

However i do think that it's INCREDIBLY likely that you would be able to birth an anterior bubs, when even a possie one had moulded to that extent and fit into your pelvis, and that even with another possie, if you avoided certain elements that featured in this labour your body would be able to either turn the baby or get it out facing the wrong way itself.

HTH

Bx