Many women have been told the lie that their pelvises are “too small” to give birth to their babies. Often, this is diagnosed during a pelvic exam where the woman is lying on her back. Guess what? Lying on your back closes the pelvic opening into the very smallest it could possibly be. Lying on your back also prevents your tail bone from moving out of the way. Moving onto your side for pushing and birth will at least give your tail bone somewhere to go so that your baby has more room to move through your pelvis. Squatting widens the pelvic opening by as much as 30%, which can mean the difference between a normal, vaginal birth and major abdominal surgery (c-section).
Sometimes doctors will say that the baby is “too big” either after feeling the mother’s belly or via ultrasound. Neither of these methods are accurate ways to determine the baby’s weight. Ultrasound can be off by as much as +/- 2 lbs. A supposed “giant” 9-pound baby could really be 7 pounds (or 11). The bottom line is that it is extremely rare for a woman to grow a baby too large for her to birth. Baby fat squishes. Baby heads mold. Upright positions such as sitting on a birth ball, rocking in a chair leaning forward, walking, squatting, and kneeling all gain the added benefits of gravity pulling the baby’s head onto the cervix (speeding up progress) and getting the baby into a good position. Movement during labor is also important. Changing positions every half an hour or so rocks the baby through your pelvis, much like rocking a ring over the knuckle of your finger.
I’ve known doctors to comment along the lines of “well, your pelvis isn’t going to get any bigger, we should induce early to make sure your baby will fit.” First of all, your pelvis does get bigger with a spontaneous (not induced) labor due to the hormones that cause the ligaments in your pelvis to soften and loosen. Second of all, inducing labor increases rather than reduces the chance of cesarean section due to the fact that the cervix will only dilate when it is ready. Many inductions do result in vaginal births, particularly if the woman’s Bishop’s score is higher than 9, but labor tends to be harder, longer, and filled with many more interventions (all of which increase the risks to mother and baby).
True CPD can only be determined after a spontaneous (not induced) labor during which a woman has used upright positions such as squatting. If a baby still doesn’t move down into the pelvis after many hours of encouraging the baby to get in the perfect position (alternating with periods of rest) and the woman feels like she’s done everything she can, a c-section may indeed be preferable. It really should be the woman’s choice. If she’s willing to keep going, everyone else needs to keep going with her, without pressuring her to comply to their wishes. Most of the time when a baby isn’t descending, the baby simply needs to adjust his or her position (which means the mother needs to adjust hers) . Patience is one virtue that is required for anyone in the birth room. Once a baby has reached 0 station in the pelvis, that is a pretty clear indication that the baby will indeed fit.
Observe now, a group of women who had c-sections for babies that were “too big” or for pelvises that were “too small” who have gone on to birth even larger babies vaginally (VBAC).