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Is Baby Too Big?

4/15/2021

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During pregnancy, a big concern can be that baby may be too big to be born vaginally.  Approximately 1/3 of births nationwide are cesearean sections, of these it is estimated that 1/3 are performed for the reason of CPD or cephalopelvic disproportion, meaning the head of the baby is too large to pass through the pelvis during birth.  

Is this really a thing?  What is the likliehood you will grow a baby that is too big to fit through your pelvis?  CPD used to be an issue when nutritional defiencies lead to issues like rickets which could affect bone growth. Polio could also cause pelvic issues.  Those things are pretty rare in developed countries now.  There can still be pelvic issues due to accidents that may cause damage to the pelvis or pelvic anomolies.  Babies of mothers with unmanaged gestational diabetes can also be big, and some congenital anomolies can also cause larger than normal head size.

I believe that with a mobile mother, a flexible pelvis, a newborn head that can mold to fit, and a provider who is willing to be patient, CPD should be extremely rare.  The effects of the hormone relaxin let the pelvis open up as baby descends.  A mother who is mobile can move her body in different ways to help keep the pelvis open, and help baby move down.  For example, a deep squat opens the pelvic outlet by up to 30%.  Having a provider who does not expect a certain amount of cervical dilation within a given time, who is willing to wait if labor slows will eliminate "failure to progress", the most common reason for a diagnosis of CPD.

During labor, I encourage mothers to listen to how thier body is telling them to move.  If my intuition makes me think a particular position or combination of positions may help baby with descent, I will share that with the mother.  Somtimes Mom just needs to rest, and wait for her baby and her body to adjust to be ready for the next phase of work needing to be done.  So long as Mom and baby are doing well, there is no reason to rush the process.  I trust the birth process and I trust women's bodies and thier babies to navigate birth well.  While I can't say that CPD does not exist, I do feel that it is rare in women who are able to move how thier body and baby tell them to move. 

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Ultrasounds

4/1/2021

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For as long as women have been pregnant, curiosity has abounded about what the baby is doing in utero and how it develops and grows.  X-rays were used starting in the 1920's to look at the baby in the uterus.  As concerns about safety arose and evidence accumulated, X-rays finally stopped in the 70's in the US.  Ultrasound was used in pregnancy starting in the 1950's in Scottland.  As the technology improved in the 70's, viewing baby in utero shifted from X-rays to ultrasound.

Ultrasound can be very helpful during pregnancy. Ultrasound can tell where the placenta is located, if it is on scar tissue for someone wanting a VBAC, or how close the placenta is to the cervical opening in suspected cases of placenta previa.  It can tell if baby is breech or head down, or outside the uterus in the case of an eptopic pregnancy. It can also detect some fetal anomolies such as a 2 vessel cord instead of a 3 vessel umbilical cord, kidney issues, heart defects and many other anomolies that may be concerning or require additional medical attention.  And of course, it can show baby's gender, or what baby is doing at the time of the ultrasound.  It can be amazing to see your baby doing things like sucking their thumb or having hiccups.

Ultrasound studies completed before 1992 showed no adverse affects.  These studies were completed using lower intensity ultrasound.  Since 1992, ultrasound intensity has increased by seven times without any in-depth studies to track if there are any effects from this higher intensity.  We do know ultrasounds can heat up water and tissue.  The longer the ultrasound is applied, the higher the risk of overheating the tissues and amniotic fluid.  

I may ask my clients to get an ultrasound if there is information I feel we need to provide optimal care.  For instance I may ask a client who is planning a VBAC to get an ultrasound to verify where the placenta is located in relation to the cesearan incision site, or to confirm baby is head down if we are wondering about a breech presentation.  I do not require my clients to have an ultrasound as a routine part of my prenatal care.  If my client wants to get an ultrasound, or decides not to is their choice.  I support my client's decision regardless of what they choose.

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    Author

    Gail Webster, CPM

    Gail is a Certified Professional Midwife serving Manhattan, Junction City, Fort Riley and other areas in Kansas.  


    When Gail is not occupied with birth work, she enjoys reading, quilting, baking, riding her motorcycle and spending time with family.
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