Hispanic Female Pelvises are Better?

My OB said the most bizarre thing today.  At first it didn’t really strike me as bizarre, but the more I’ve thought about it, the more I’ve realized it’s a crock of shit.

I’m not exactly sure how we got onto this topic this morning, but he stated that the Hispanic female pelvis is bigger than the average white woman’s pelvis.  The best birthers are short hispanic women according to the doc.  And then said something about a study in Southern California that I didn’t really pay any attention to.

Let’s just break this down a bit.  According to this post over at The Unnecessarean (July 2010), the cesarean rate in Mexico’s private hospitals is 70% and 40% in public hospitals.  If Mexican women are so much more physically capable of using their pelvises, then why does their cesarean rate exceed ours?  Perhaps pelvimetry is not as much a factor as OBs would like us to think?

The Unnecessarean post, an article written by Cinthya Sanchez that appeared in El Universal on July 18, 2010, further points out:

A 2002 study based on public health data from 126 countries found that the estimated rate of cesarean sections in the world was 15%, while in Latin America and the Caribbean, the average rate was 29.2%: Mexico (39.1%), Brazil (36.7%), Dominican Republic (31.3%) and Chile (30.7%).

None of these cesarean rates support my doctor’s assertion that a woman’s genetic structure has anything to do with achieving a vaginal birth.  According to Jesús Lujan, an obstetrician-gynecologist specializing in human reproductive medicine and the director of Clínica Pronatal, other factors are at work here.

“Women are marked in advance by previous cesarean section, any uterine scar in general, and cephalopelvic disproportion, which is almost always an imprecise measure because not all professionals use the same parameters for diagnosis. Mothers are told that are too short and that we are sure your pelvis is smaller than the baby’s head, that they are too old and will be unable to handle birth, that the cord is tangled, that sex will never be the same, and many other lies,” says Lujan.

Aha!  I knew it.  I wonder if some jackass OB in Mexico is currently telling his patient that you need to be tall with a Nordic bone structure (my genes) to have a baby fit through the pelvis?  What do you think?

For more information on CPD (cephalo-pelvic disproportion) diagnoses (and what it probably doesn’t mean for you) and pelvises, I recommend:

The Bestest VBAC of All

So I got an epidural for my VBAC.  Get over it.”  What a great title!  You know exactly what kind of story you’re going to read and can even take a guess at the spectrum of responses to such a post.

I think this is an important post to read.  A VBAC doesn’t have to be a fully unmedicated waterbirth at home to be a ‘success.’  Yet, we run the risk of presenting a set of demands on VBAC mamas, and for many if not most this might be obstructive.

My sense of this woman’s story is that she got the epidural knowing what risks and benefits are involved.  If not, then yeah, maybe she got lucky.  My sense of other women’s stories who have had epidurals, is that even though in most women, the risks may outweigh the benefits . . . some women just don’t dilate or labor well without them.  Perhaps we can hindsight quarterback their birth preparation process, but I think that’s a fruitless discussion.

I agree with Andrea’s point that fighting about the best way to VBAC isn’t constructive.  Ideally, we wouldn’t even need to address the “best way to VBAC” if we had a medically-appropriate cesarean rate in this country.  And if “normal birth” (and I do mean natural) has a high degree of variability, so much so that we insist women be left to labor in peace without clock pressure, then we must be willing to accept variability in the way women pursue their VBACs.

Most of us, I would assume, who consider ourselves to be VBACtivists, are working so hard to re-educate women about patient autonomy, patient choice, informed consent, and participating in health care choices, that we start from the position that a woman who requests an intervention such as an epidural during a VBAC labor doesn’t know the risks.  And this is probably how the squabbles begin.

Further, plenty of “die hard” VBAC gals make “natural choices” that I find potentially risky.  I’m pretty specifically talking about the use of EPO for home induction and tonics such as 5w or PN6.  And some women say NO to induction but YES to augmentation.  And some women agree to AROM (having their waters broken).  Some women have their membranes stripped.  And I get it . . . because as soon as you get to 40 weeks, you’re treated as a ticking time bomb.

What will I do this time?  Only time will tell.  But you bet your butt that if I get exhausted laboring at home but think an epidural will help me regain the strength to birth this child vaginally, we’ll hop in the car and accept the the bad with the good.

Toilet Watch

I noticed something this evening . . .

I spent the first 6 weeks that I knew I was pregnant, examining the potty after doing any business.

I’m spending the last 6 weeks that I will likely be pregnant, examining the potty after doing any business.

Are #1s and #2s ever more interesting, exciting, and scary than when you are pregnant?

Update: 34 weeks

I can’t believe I’m 34 weeks(ish).  This pregnancy is moving sometimes at glacial pace or meteoric speed!  Since I haven’t done an update or a post lately, I thought I’d give an overview of where I’m at.

git out of me belleeee!

I posted this ‘self portrait’ yesterday on Facebook.  It doesn’t give the full effect, but hey, I think it’s cute!

What I’m doing

  • cleaning – yesterday, I lightly organized and fairly thoroughly swept out the nasty garage; it’s really that gross – my friends’ comments on FB kind of embarrassed me…
  • shopping – groceries, plants, flowers, wish lists, baptismal dresses, you name it, I want to shop for it (who am I?)
  • reading – ICAN & BAC lists, twitter, Facebook, blog posts, MDC, pregnancy books, etc.
  • belly dancing!
  • going to appointments – midwife, OB, chiro; I need to take the dog to the vet and I need a haircut too
  • hanging out – with my kids, with good friends!

How I’m feeling

  • tired (gone are the days of sleeping well; hello to daily naps – TG I’m done teaching for the year)
  • restless in an excited and nervous way
  • achy – when I do too much physical activity
  • big
  • sexy
  • energetic in spurts
  • cluttered – still so much to organize here at home before the baby comes; too many birth resources at my disposal
  • anxious
  • ready to get the show on the road!

Choosing the care provider or not…

Unassisted birth (UC, UB) seems like an all or nothing adventure.  “Either you’re in or you’re out,” says Heidi Klum of Project Runway.  No smile.  Somewhat smug too.  I’m trying to sort out my feelings about UC because even though it’s not something I’m likely to do, it is a birth choice and therefore should be studied at the very least.  I read a lot of unassisted birth posts/forums and have gained so much knowledge and strength from it.  I wish I had that kind of confidence and peace.

So, like I said, it seems like UC is an all or nothing thing.  Most care providers (CP) won’t continue to see you for prenatals if they know you’re planning a UC.  (Maybe that’s not universally true, but that’s the impression I’m getting.)  And if you decide to have a UC then it also means that you’re providing immediate care for your newborn.  That seems a lot to ask of myself much less my husband.

My feelings on care providers seem to change by the second.  One minute I’m ok midwife only.  Then I’m ok with planning for homebirth and hospital birth simultaneously.  And then I’m ok with MW and ‘shadow care.’  And then these plans seem so unsatisfactory in different ways.

 The only ‘universal’ is that I want to have this baby as ‘naturally’ as possible.  But I still don’t have any idea how to accomplish this.

I have lots of wishes for me and our baby.  I want it all, and none of it seems like having it all because ‘having it all’ was stolen from me in 2004 with that first cut.  I know even that is still just a perception, not a ‘truth,’ but for me it feels like a ‘truth.’

  • Ideally, I would continue prenatal care with someone – the midwife or OB, whatever.
  • Ideally, I would birth this baby with my husband and maybe a close friend or two but no one acting as a ‘care provider.’
  • Ideally, someone else would swoop in and take care of the baby.

My ‘ideal’ may have to remain on a pedestal.

Pregnancy Update: 20 weeks

I had my 20 week ultrasound today.  I was thankful that the baby looks healthy and is measuring consistent with her “due-ish date.”  Yeah . . . her.  This is my fourth and final baby.  This is also my fourth and final baby GIRL.  My poor husband.

Many concerns were ruled out today.  At my “advanced” age, and after several losses, and after three perfect children, I was sort of anticipating something “different.”  Different, how, I wasn’t sure.  But I wasn’t feeling like it was going to be different good.  The previous indication of an anterior placenta was wrong – my placenta is high and posterior.  I’m thrilled.  All of the measurements were good.  Nice looking spine.  Nice looking skull.  Nice looking upper lip.  Nice looking kidneys and stomach.

So, as far as I’m concerned, I’m done with obstetric care unless something develops that necessitates that type of care.  I can’t wait to talk to my midwife!

Bellydancing a Better Pregnancy

Oh bellydancing . . . where have you been all these years?  Of course I’ve known about bellydancing, but I don’t fancy myself the bellydancing type, so I’d never done it.  In fact, the last time I saw someone bellydance – and this is going to sound horribly judgmental – I was somewhat traumatized by the woman’s body.  She was one proud mama, I’ll give you that.  But it was just more evidence that I am not meant to bellydance, and certainly not in this town.

This is a very different pregnancy for me.  I’ve thought I’ve had different pregnancies before, but I can honestly say that I’m making this one different.  Those of you who follow this blog with any regularity know that I have posted plenty of academic pieces full of statistics and analysis.  But that’s not my path this pregnancy.  Of course, I’m trying to keep up on all of that – but I’m more interested in building trust, faith, strength, and peace.

So the short of the long of it is I decided to look into bellydancing.  After much deliberation, I decided to purchase Amira’s DVD.  It’s not the most exciting DVD, but it feels amazing.  I rely on my chiropractor to put my aching pelvis back together on a regular basis.  However, since starting the bellydance DVD and alternating it with prenatal yoga DVDs, but pelvis has stopped yelling at me so much.

I also suffer from symphasis pubis dysfunction.  I know the aches and pains are coming, but I’m sure they started earlier at least in the last pregnancy.  Other than some pulling in the left round ligament, I’ve had very little pain in the front.  I’m also noticing now that my adhesions don’t hurt – they sure did when I started the DVD.

If you suffer from pelvic instability – you MUST try bellydance.  I don’t know why this isn’t emphasized as strongly as yoga, but it has made a world of difference for me.  Next up, Dance of the Womb, which you can purchase through ICAN, and actually it’s the best price I’ve found.  I’m also going to try and work a beginning belly dance class into my schedule.  I’ve checked with the teacher, and she says this particular class is safe for pregnancy.