Supporting mom through Cephalopelvic Disproportion (CPD)

**EDIT** Original post in 2011

"The accurate definition of cephalopelvic disproportion (CPD) is when a baby's head or body is too large to fit through the mother’s pelvis. It is believed that true CPD is rare, but many cases of “failure to progress” during labor is given a diagnosis of CPD. When an accurate diagnosis of CPD has been made, the safest type of delivery for mother and baby is a cesarean delivery."

-American Pregnancy Association

I had the honor and privelege of attending my 9th birth (counting my own two lil' peanuts...I was *definitely* present for those two!) this past weekend. I knew from the moment I met this mama that she was a warrior mama (later defined as such after making some love-warrior decisions in those selfless, defining moments of labor). Mom's first birth was a Cesarean birth, and she contacted me to discuss doula services for her upcoming VBAC. She exuded strength, certainty, and knowledge along with an empowering femininity and beauty.

I've always prided myself on not being one of those "angry doulas." You know, the very passionate doulas who slam the "system", spout out their own agendas, blame doctors for ruining births, and know it all when it comes to the why's of birth outcomes. I pride myself on keeping an open mind, accepting that I'm constantly learning as I go, looking for the positive intention of doctors and other care providers, and providing a bridge to my clients to empower themselves and search for their own answers and conclusions. Though when I learned that the mama's baby didn't "fit" through her pelvis, I had some deeply entrenched reservations. Really? Baby didn't fit? I always heard this as an old-wives tale, dating back to times of yore when Rickets was running rampant, deforming mothers' pelvises far and wide, causing babies to get stuck inside and risking maternal mortality. Nah, this mom is of average size, eats healthy, believes in birth and more importantly in herself, and has a resolve of STEEL to birth this baby vaginally. I decided I'd just step it up as a doula, pull out all the stops, and support this mama with all my might. (Insert sarcastic tone here!) I was about to learn that even steeley resolves can't always control birth outcomes. I helped her to work through some emotional stuff, clearing the space in her head with a guided birth art process to encourage Opening, and her labor started the very same night/early morning. Baby was in an OP position (meaning sunny side up, or face up...otherwise pictured as the back of the head pressing against mom's spine which causes wicked back-labor contractions). Come on, super doula! We tried the rebozo to lift and shift mom's belly and encourage baby to change positions. We tried positional changes to encourage babe to swing anterior. I kept mom hydrated, calm and comfortable, using heat-therapy on her low back and applying a near-constant hip-squeeze to make more space in her pelvis during contractions. Fast forward many hours...We worked through some guided relaxation visualizations so mom could rest and power-up for the remainer of her labor. Snacks, drinks, massage, aromatherapy, laughter, encouragement, and lots and lots of time....But wouldn't you know it, labor stalled. Cervical dilation stalled. Mom is working hard as a warrior, doula is trying to support with all her might, doctor is as awesome as could possibly be and gives mom all the time in the world to labor as she wishes without ever imposing a timeframe or deadline. 12 additional hours go by without any further cervical dilation despite positional changes, epidural and nipple stimulation. In fact, dilation begins to go backwards. I suspect baby's arm is presenting along with the head (which can put inadequate pressure on the cervix perhaps causing irregual cervical dilation), but I don't suspect that the baby cannot physically fit through the pelvis. An awesome midwife friend is hanging out during the birth and begins to suspect true CPD, or Cephalopelvic Disproportion, meaning this baby can't fit through mom's pelvis. It's quite rare, yet it happens. Contractions are coupling up, another indication of true CPD. Mom has worked so hard, preparing prenatally, and has set all of her cards up in a neat row, doing everything "right." With the support of her family, doctor and doula, my hope is that mom experiences this birth as within her control, regardless of how it ends up. Now remember time is passing, mom is working hard through contractions and does NOT want to "give up," as she puts it. At least 20 hours have passed from labor's start until now. Everyone in the room is beginning to realize that labor truly is not progressing, despite our influence otherwise. After much contemplation and give and take, Birth Warrior mom agrees to birth her baby by Cesarean, surrendering to the powers of Birth Fate. I take a moment to remind mom that she can still be powerful and present for this birth, visualizing the moment the baby is born and the moment she becomes a mother again, and that she is the one birthing this baby regardless of the method of delivery. Doula (that's me) begins to understand that I had erroneously and, more noteworthy, *subconsciously* believed most ALL babies would adequately fit through most ALL pelvises these days. Hmmmm....I think on that....Time passes as I wait with dad in the Recovery Room, and we mull over the ever-present challenge of staying in the moment, immersing oneself in what actually IS happening instead of looking to the next event, figuring out why, or remembering the past. And we contemplate the inherent wisdom in this life-challenge. Baby was born healthy as could be, though large (9#7oz) and for this mom, baby truly matched up differently and a Cesarean birth was absolutely necessary. Baby's hand was in fact presenting up by her face. And she was nestled a bit too tightly against mom's pelvis. After nearly 24 hours of labor, one day later than we started on the calendar, in the wee hours of the morning, mom and dad welcome Baby Reese Elizabeth. I'm opening up even more, more than I even knew I needed to, to all possibilities in birth. Opening to new perspectives, new experiences, empathic understanding of unique birth journeys. Sometimes a Cesarean is a truly necessary and potentially life-saving method of birthing. Sometimes it's an enormously selfless decision by mom to surrender to birth and her body in whatever way is necessary in the moment. This mom gave it her all, and then even more, for her baby and her family. It had nothing to do with having a prior Cesarean. Not much to do with an OP presentation. And was beyond anyone's preconceptions of "Mind over Labor." And I'm learning, birth by birth, how to better support mom through unexpected and unwished for events in labor. What I know to be true is if you've had a Cesarean and intend on a VBAC, first and foremost choose your OB carefully. I have 2 recommendations of OB's in SWFL who truly believe in VBAC's and am happy to refer you to them. Sometimes you need some extra time, to make your decisions and know that you gave your VBAC every possible chance, and you'll need an OB who understands this on an emotional level. Thank you, Dr. George, for allowing mom this precious time and ultimate influence over her birth. Also, find a doula who believes in you and is willing to support your decisions, whatever they may be, regardless of method of delivery. Avoid the "angry doula" who bucks the system...You never know how your birth will unfold and you don't want to feel judged by your own support person because of a repeat Cesarean. It may take some time to understand your birth journey, and it's a gift to find someone who can listen and empathize without judgement as you go through your healing journey before, during and after your birth. Each of my birth experiences have brought me to a deeper level of empathy, understanding, and experience. Find your Birth Warrior. It's deep within.