Expert: Catherine Beier MS CBE - 11/10/2008

Question
I had my first baby nearly 2 years ago by emergency c-section due to failure
to progress. I was 42 weeks had my waters broken and was induced on a drip
for 15 hours but didn't dilate past 3-4 cm. He never engaged at all before the
induction and nothing at all seemed to happen during.
I am now 35 weeks pregnant with my second child and desperate to have a
VBAC. I just got the all clear from placenta previa last week (placenta is now
7cm away from the uterus and the babies head is low and beneath the
placenta so the lady performing the scan didn't see any reason why it should
pose a problem as presumably it will just continue to be pulled further away.)
I have an appointment with my Dr tomorrow to discuss the scan results and
have a feeling I will still have a battle on my hands to go for a VBAC. I am so
worried that my pelvis is too small to deliver naturally - why did my 1st baby
not engage even by 42 weeks?????? I am tall and broad and see much smaller
women who have given birth (this probably sounds ridiculous). My previous
Dr said there was a ratio between feet size and pelvis and I have big feet!!!
Why did my baby not engage????? I'm so worried this one wont either, I know
the babies health and mine is most important but to give birth would mean so
much to me. Any info would be greatly appreciated. Thanks for your time.

Answer
Vicky,


There are many reasons why your baby might not have engaged that have nothing to do with its size.  These include the positions you were laboring in - if you were laying on your back in bed, your pelvis is up to 30% smaller in this position than if you are upright and moving freely.

Also, having your waters broken too early before the baby is well engaged can lead to a malpositioned baby, or one that is tilted or turned facing your abdomen, which doesn't allow them to freely descend.  This can prevent even a small baby from moving through the pelvis freely.


Also, you didn't indicate whether you had an epidural, which can cause complications by removing all sensation so you can't move freely and it can make your labor more likely to stall and require more interventions that can all contribute to an eventual c-section.  


Induction itself carries a 4 times higher risk of ending in a c-section, so it's possible that the induction itself was to blame.


There is simply no way to accurately assess whether a baby is too big to fit without a trial of labor.  Your doctor is not citing evidence when she's talking about a correlation between pelvic size and feet - the research is clear that there is no reliable way to determine whether a baby will fit without laboring first.


In addition, labor itself is beneficial for babies.  Babies born by c-section are twice as likely to have respiratory difficulties, poor feeding, cry more often, and be harder to calm than those born vaginally.  They are also more likely to have allergies than those born vaginally.


So, choosing a repeat c-section does not guarantee a better outcome for your baby or for you.  There are risks involved in either choice, but in both cases, the risks are small.


You should talk to your doctor about your desire for a VBAC, which the research clearly supports as a safe option.  You can tell her you first want a trial of labor and a repeat c-section only if it becomes truly medically necessary.


To learn more about VBAC and locate supportive people in your area, visit ican-online.org


Best,
Catherine