Pelvises I Have Known and Loved
-by Gloria
Lemay
What if there were no pelvis? What if it was
as insignificant to how a child is born as how
big is the nose on the mother's face? After over
twenty years of watching birth, that is what I
have come to.
Pelvises open at the three stretch points- the
symphysis pubis and the two sacroiliac joints.
Those points are full of relaxing hormones- the
pelvis literally begins falling apart at about
34 weeks of pregnancy. In addition to this mobile,
loose, stretchy pelvis, Nature has given human
beings the added bonus of having a moldable, pliable,
shrinkable baby head: like a steamer tray for
a cooking pot has folding plates that adjust it
to any size pot, the four overlapping bones that
form the infant's skull will adjust to fit the
mother's body.
Every woman who is alive today is the result
of millions of years of natural selection. Today's
women are the end of evolution- we are the ones
with the bones that made it all the way here.
With the exception of the last thirty years, we
almost all go back through our maternal lineage
generation after generation having smooth, normal
vaginal births. Prior to thirty years ago, major
problems in large groups were always attributable
to maternal malnutrition (starvation) or sepsis
in hospitals.
Twenty years ago, physicians were known to tell
women that the reason they had a cesarean was
that the child's head was just too big for the
size of the pelvis. The trouble began when these
same women would stay at home for their next child's
birth and give birth to a bigger baby through
that same pelvis. This became very embarrassing
for doctors, and it curtailed this reason being
put forward by them as justification for doing
cesareans. What replaced this reason was the post-cesarean
statement "Well, it's a good thing we did
the cesarean because the cord was twice around
the baby's neck". This is what I've heard
a lot of in the past ten years. Doctors have to
have a very good reason for every operation because
the family will have such a dreadful time with
that new baby and mother when they get home that,
without a convincing reason, the fathers would
be on the warpath. Just imagine if the doctor
said honestly, "Well, Joe, this was one of
those times when we jumped the gun- there was
actually not a thing wrong with either your baby
or your wife, in hindsight. I'm sorry she'll have
a six week recovery to go through for nothing."
Aat least 15% of cesareans are unnecessary but
the parents are never told. There is a conspiracy
amongst the hospital staff to keep this information
from families for obvious reasons.
In a similar vein, I find it interesting that
doctors are now advocating discontinuing the use
of the electronic fetal monitor. This is something
that natural birth advocates have campaigned hard
for and have not been able to accomplish in the
past twenty years. The natural-types were concerned
about possible harm to the baby from the Doppler
ultrasound radiation and discomfort for the mother
from the two tight belts around her belly. Now
the doctors have joined the campaign to rid maternity
wards of these expensive pieces of technology.
Why, you ask? Because it has just dawned on the
doctors that the very fetal heart strip of paper
that they thought proved how careful and conscientious
they were AND which they thought was their protection
in court has actually been their worst enemy in
a court of law. A good lawyer can take any piece
of "evidence" and find an expert to
interpret it to his own ends. After a baby dies
or is damaged, the hindsight people come in and
go over these strips and the doctors are left
with huge legal settlements to make. What the
literature indicates now is that when a nurse
with a stethoscope listens to the "real"
heartbeat through a fetoscope (not the bounced
back and recorded beat shown on a monitor readout)
the cesarean rate goes down by 50% with no increase
in fetal mortality rates.
Of course, I am in favor of the abolition of
electronic fetal monitoring altogether- but it
would be far more uplifting if this was being
done for some sort of health improvement and not
just more ways for professionals to cover butt
in court.
Now let's get back to pelvises I have known and
loved. When I was a keen beginner midwife, I took
many workshops in which I measured the pelvises
of my classmates. Bi-spinous diameters, sacral
promontories, narrow arches- all very important
and serious. Gynecoid, android, anthropoid and
the dreaded platypelloid all had to be measured,
assessed and agonized over. I worried that baby's
would get "hung up" on spikes and bone
spurs that could appear out of nowhere, according
to the folklore. Then, one day, I heard the head
of Obstetrics at our local hospital say, "The
best pelvimeter is the baby's head". In other
words, a head passing through the pelvis would
tell you more about the size of it than all the
calipers and X-rays in the world. He did not advocate
taking pelvic measurements at all. Of course,
doing pelvimetry in early pregnancy before the
hormones have started relaxing the pelvis is ridiculous.
One of the midwife "tricks" that we
were taught was to ask the mother's shoe size.
If the mother wore size 5 or more shoes, the theory
went that her pelvis would be ample. Well, 98%
of women take over size 5 shoes so this was a
good theory that gave me confidence in women's
bodies for a number of years.
Then I had a client who came to me at eight months
pregnant seeking a home waterbirth. She had, up
until that time, been under the care of a hospital
nurse-midwifery practice. She was Greek and loved
doing gymnastics. Her eighteen year-old body glowed
with good health and I felt lucky to have her
in my practise until I asked the shoe size question.
She took size 2 shoes. She had to buy her shoes
in Chinatown to get them small enough- oh dear.
It briefly made me think that perhaps this was
someone that I should really refresh my rusting
pelvimetry skills with, but then I reconsidered.
I would not lay this small pelvis trip on her.
I would be vigilant at her birth and act if the
birth seemed obstructed in an unusual way but
I would not make it a self-fulfilling prophecy.
She gave birth to a seven pound girl and only
pushed about twelve times. She gave birth in a
water tub sitting on the lap of her young lover
and the scene reminded me of "Blue Lagoon"
with Brooke Shields- it was so sexy. So, that
pelvis ended the shoe size theory forever.
Another pelvis that came my way a few years ago
stands out in my mind. This young woman had had
a cesarean for her first childbirth experience.
She had been induced and it sounded like the usual
cascade of interventions. When she was being stitched
up after the surgery, her husband said to her
"Never mind, Carol, next baby you can have
vaginally." The surgeon made the comment
back to him "Not unless she has a two pound
baby". When I met her, she was having mild,
early birth sensations. Her doula had called me
to consult on her birth. She had a somewhat unusual
shape of body. She was only about 5'1" tall
and most of that was legs. Her pregnant belly
looked huge because it just went forward- she
had very little space between the crest of her
hip and her rib cage.
Luckily, her own mother was present in the house
when I first arrived there. I took her into the
kitchen and asked her about her own birth experiences.
She'd had her first baby vaginally. With her second,
there had been a malpresentation so she had a
cesarean. Since the grandmother had the same body-type
as her daughter, I was heartened by the fact that
she had given birth to one baby vaginally, at
least. Again, this woman dilated in the water
tub. It was a planned hospital birth, so at advanced
dilation they moved by car to the hospital. She
was pushing when she got there and proceeded to
birth a seven pound girl. She used a squatting
bar and was thrilled with her completely spontaneous
birth experience. I asked her to write to the
surgeon who had made the remark that she couldn't
birth a baby over two pounds and let him know
that this unscientific, unkind remark had caused
her much unneeded worry.
Another group of pelvises that inspire me are
the ones of the pygmy women of Africa. I have
an article in my files by an anthropologist who
reports that these women have a height of 4',
on average. The average weight of their infants
is eight pounds! This is like a woman 5'6"
giving birth to a fourteen pound baby in relative
terms. The custom in their villages is that the
woman stays alone in her hut for birth until her
membranes rupture. At that time, she strolls through
the village and finds her midwives. The midwives
and the woman hold hands and sing as they walk
down to the river. At the edge of the river is
a flat, well worn rock on which all the babies
are born. The two midwives squat at the mother's
side while she pushes her baby out. One midwife
scoops up river water to splash on the newborn
to stimulate the first breath. After the placenta
is birthed the other midwife finds a narrow place
in the cord and chews it to separate the infant.
Then, the three walk back to join the people.
This article has been such a teaching and inspiration
for me.
That's the bottom line on pelvises- they don't
exist in real midwifery. Any baby can slide through
any pelvis with a powerful uterus pistoning down
on him/her.
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