Pelvises I've Known And
Loved.
Gloria Lemay wrote
the following article that is appearing in an issue of
Midwifery Today.
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 twenty years of
watching birth, that is what I have come to. Pelvises open
at the three stretch points -- symphisis pubis (l) and
sacro-iliac joints (2). Those points are full of relaxing
hormones -- the pelvis literally begins falling apart 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, so do these four overlapping
plates that form the infant's skull 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 30 years, we almost all go back through our
maternal lineage generation after generation having smooth,
normal vaginal births. Prior to 30 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 and it curtailed this reason being put forward
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. I'm sorry she'll have a six week recovery to go
through for nothing." We do know that, at 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, in l999, 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 in l999, 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 hind sight 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 read-out) the cesarean rate goes down by
50% with no adverse effects on fetal mortality rates. Of
course, I am in favour of the abolition of electronic fetal
monitoring but it would be far more uplifting if this was
being done for some sort of health improvement and not just
more ways 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 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 water birth.
She had, up till that time, been under the care of a
hospital nurse-midwifery practise. She was Greek and loved
doing gymnastics. Her 18 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
7 lb 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 2 lb baby". When I met
her, she was having mild, early birth sensations. Her doula
had called me to consult on her birth. She really had a
strange shape of a 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 the grandmother in the kitchen and asked her
about her own birth experiences. The grandmother had had her
first baby vaginally. With her second, there had been a
malpresentation and she had had a cesarean. Since the
grandmother had the same body-type as her daughter, I was
heartened by the fact that she had had 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
to the hospital. She was pushing when she got there and
proceeded to birth a 7# 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 2# and let
him know that this unscientific, unkind remark had caused
her much unneeded worry.
Another group of pelvises that
inspire me are 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 8#! This is like a woman 5'6" giving birth
to a 14# 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. So 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.
*Gloria Lemay
Private Birth Attendant
Vancouver, B.C. Canada
February l999
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