Pelvic Measurement: Will the Baby Fit?

In the late 1970’s a woman’s pelvic size was sometimes evaluated by an x-ray. When I was working in a labor/delivery unit, I had a dramatic lesson about x-ray measurements, and the importance of position change during labor.

One of our patients had stopped progressing in labor.  She was more than halfway dilated.  For several hours she made no further progress.  The attending doctor ordered an x-ray.  This patient had to get out of bed, sit in a wheelchair, and stand up for the x-ray.  She rode back to the labor room in the wheelchair and returned to her bed.  The resident doctor began assessing the x-rays, took measurements of the pelvis and the baby’s head.  He determined that the baby would not fit through the pelvis and called the attending doctor.

The doctor planned to do a cesarean section but suddenly a nurse at the patient’s bedside called out.  “She is crowning.  Tell her doctor to come NOW!!” She had a normal vaginal delivery.  During the course of position changes that took place for the x-rays, the baby shifted in the pelvis and moved down.  The cervix dilated completely, and she was able to give birth.

My experience at a home birth also illustrates the value of movement in labor.  I was attending Melissa* along with a doula and a doctor.  Melissa’s contractions were three to five minutes apart, and her labor progressed well.

At 12 noon she was almost completely dilated.  She had been up walking but she wanted to lay down because she was tired.  While she rested her water bag broke.  She had no urge to push and continued to rest. I encouraged her to eat something for energy and the doula brought her some toast with peanut butter and maple syrup.

After the snack, the doula encouraged a position change.  She and I assisted Melissa to get into a hands and knees position.  The doula applied counter pressure to Melissa’s lower back and hips.

Four hours later Melissa still did not have the urge to push, although she was completely dilated. The fetal heart tones were stable and regular.  We suggested that Melissa get up and try sitting on a stool in the shower.

After five minutes in the shower Melissa screamed, “I have to push!”Melissa gave birth a half hour later to a healthy girl.

Although the doula and I were giving Melissa guidance, she had an inner sense of what she needed to do.  Her activity and change of position enhanced the progress of labor.

*name is changed

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