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Thoughts on Pelvimetry

Last post 03-04-2009 8:03 PM by Doula Mary. 7 replies.
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  • 02-26-2009 8:27 PM

    Thoughts on Pelvimetry

     Dear Wise Counselors :)

    I am so glad the forum is back up and running! Several times in the past year I have wondered about something and really wished I would ask others who have so much more knowledge and experience.

      I was formally a member under the name, "midwestbabycatcher"- but that seemed really long, and I was having trouble loging in- so I changed my name.

      Here is my question. I was reading "Heart and Hands" 3rd Ed. (Elizabeth Davis) and came upon an idea I had not thought of before and was curious what your experiences and thoughts were.

    The author has just explained how to do pelvimetry and concludes her instruction by noting that it is somewhat of a lost art.

     "In recent years, pelvimetry has been replaced in conventional medical practice by cesarean section, forceps delivery, and vacuum extraction, i.e., "If the baby doesn't birth spontaneously, we'll just cut or pull it out." And due to the relative nature of pelvimetry's significance, some midwives have chosen to discard it altogether. Yet certain traditions in midwifery practice, such as the skill of manually repositioning a malpresenting baby, or safely delivering a breech at home, depend largely on the mastery of pelvimetry. As our practice is based on limiting the use of technology and artfully facilitating vaginal birth, we must uphold our competencies in this regard."  (Heart and Hands, 3rd Ed. Elizabeth Davis- Pages 23+24)

        Previously I held a strong- "no fiddling" stance. But this text has made me question my views. Any thoughts would be appreciated.

     

      

  • 02-28-2009 9:34 PM In reply to

    Re: Thoughts on Pelvimetry

    I still think it's a total waste of time. I think good knowledge of the pelvic anatomy in general is good of course, but think pelvimetry on each woman isn't helpful whatsoever considering how much the shape can change due to relaxin and maternal position.

    I think pelvimetry can be very limiting (ooh she has a narrow pubic arch so x, y, z) or destructive (you pelvis seems very android so you may have a long labor). Against my wishes, my midwife did pelvimetry on me in labor and not only was it excruciating but it was completely destructive to me once I realized what she was doing because I began to question her faith in my ability to give birth.

  • 03-01-2009 7:26 PM In reply to

    • ZoeysMom
    • Top 25 Contributor
    • Joined on 02-04-2009
    • Lincoln, NE
    • Posts 63

    Re: Thoughts on Pelvimetry

    littleredhen:
     but it was completely destructive to me once I realized what she was doing because I began to question her faith in my ability to give birth.
     

     

    That's great perspective!  Thanks littleredhen!

    Mandi
  • 03-02-2009 10:58 AM In reply to

    Re: Thoughts on Pelvimetry

    Understanding pelvic anatomy is important but I don't find pelvimetry to be necessary in my practice.  I may mentally note a woman's pelvic shape or anything out of the ordinary during an exam but I never really do pelvimetry.  I don't really agree that repositioning a malpresentation or safely delivering a breech baby depends "largely" of the mastery of pelvimetry.  The size of a woman's pelvis is definitely something I consider when considering a breech birth but I still don't really do pelvimetry but simply make a mental note if the pelvis is unusually small.

    I appreciate hearing from a client's point of view on this topic.  I don't know that I've ever considered that this might make a client feel like the midwife didn't trust her ability to birth but that is definitely something I will keep in mind.

  • 03-02-2009 3:37 PM In reply to

    • midwifea
    • Top 10 Contributor
    • Joined on 02-12-2009
    • Kailua Kona, HI
    • Posts 475

    Re: Thoughts on Pelvimetry

    As a baby midwife I was taught to do pelvimetry on all nulliparas.  As I grew as a midwife I realized it was mostly non important information that was uncomfortable for both mama and midwife and the best pelvimetry is a baby and it's mother's pelvis in labor.  As a middle aged midwife I don't employ it in my practice but I do measure (nulliparas, ybac'ers or a woman who has been told previously that her pervis was too small) the pelvic outlet by fitting my fist between the ishcial spines while mama is in a reclined position and with her panties or clothes still on.  I find this outlet doesn't change in labor and it can be very reassuring for mama to hear  'you've got plenty of room and a nice rounded pubic arch'.

    A couple weeks ago I was in labor with a mama, no ve's during pregnancy and most of labor, she had a great pelvic outlet.  When she first called to describe labor patterns and feelings she described a constant pubic bone pain and I thought to my self that perhaps there was a narrow pubic inlet, but, that can change.  At birth as we got to end of 1st stage, I did a ve and found the weirdest pubic bone I have ever felt.  It was thick and rough edged on mama's right side at the crest of the bone.  Knowing this imediately made me question whether baby could pass through this bone or not but that was not for me to decide at that moment.  We tried patience, positional changes, rest, the tub, everything I knew to get baby to come by this bone. After many, many hours  and mama feeling satisfied that we had done all that we could, we transported, OB felt the pubic and bone and heard our story and off for a cs mama went. Baby had really tried to come, evident by the head moulding but just could not navigate this bone.  Would pelvimetry have changed this outcome? No, but at least we had no fear about trying to birth normally and gave her baby the many benefits from a naturally occurring labor.

    As the previous poster said, understanding pelvic anatomy is important, but I don't find pelvimetry to be of a benefit, prenatally.  Situations like breech and unusual lies may benefit from pelvimetry but those things can change right up to the moment of birth so a clinical diagnosis of inadequate pelvis is cruel and premature.

    Littleredhen,

    I am just playing devil's advocate here, and I really appreciate your statement and I take it to heart but, what if your midwife was mapping your pelvis so that she could better understand what position(s) would help you in birth and or to really understand you babys' position at the time?  I know I have done this and the information gained at this moment can be invaluable.  Could this have been the case?

    Blessings,
    April
    moderator

    "The Voice

    There is a voice inside of you
    That whispers all day long,
    "I feel this is right for me,
    I know that this is wrong."
    No teacher, preacher, parent, friend
    Or wise man can decide
    What's right for you--just listen to
    The voice that speaks inside."
    — Shel Silverstein
  • 03-02-2009 4:28 PM In reply to

    Re: Thoughts on Pelvimetry

    midwifea:

    Littleredhen,

    I am just playing devil's advocate here, and I really appreciate your statement and I take it to heart but, what if your midwife was mapping your pelvis so that she could better understand what position(s) would help you in birth and or to really understand you babys' position at the time?  I know I have done this and the information gained at this moment can be invaluable.  Could this have been the case?

     

    She may have been, but she still did not ask my permission to do it and I would have refused had she asked. I can still remember how it felt when she ran her fingers along my sacral curve - it gives me the chills. It felt extremely violating.

    I hired her based on her assurance that she could feel comfortable following my lead and would not try to coach me in any way. In the end though she was totally the opposite. It was vitally important to me to be able to follow my own instincts and not have a midwife who felt she might somehow have a certain trick or thing to make my labor easier or successful. My own personal practice philosophy is very, very hands off and I wanted someone who would practice the same but in the moment she just couldn't do that.

    Coming at it from a midwife's perspective, do we really feel that suggestions we make can really impact an outcome? I'm somewhere in the middle, but for the most part feel that many suggestions we could or do give make very little if any positive change but could cause great disempowering results (as in my own personal experience). If a mama needs to take a certain position to encourage baby to turn, wiggle down, etc. doesn't she do this instinctively if left alone? Does knowing the position really do anything in the long run other than heighten provider and mama anxiety? How do we know that the suggestions that we give mamas really makes a difference or if babies would have done that no matter what?

  • 03-02-2009 5:30 PM In reply to

    • midwifea
    • Top 10 Contributor
    • Joined on 02-12-2009
    • Kailua Kona, HI
    • Posts 475

    Re: Thoughts on Pelvimetry

    I am sorry your midwife so blatanty disregarded your birthing desires and did not ask permission before performing pelvimetry.  You stand as a great reminder to all of us who practice.

    You are probably right, in the end, any tricks, positions or suggestions we may give as providers ultimately have no impact on outcome and have the potential to cause disempowerment. 

    There are the exceptions.  As humans, as well as midwives, we may bask in that exception where an immediate suggestion resulted in a change for the better in a certain birth.  Our esteem may be wrapped up in those few moments and clinging to them may cause more harm than good.

    Thanks for the reminder.

    I have a mama in early labor at this moment and as I prepare to head to the birth, I will, with more fervor, ask my ancestors and guiding souls to keep me humble and in the moment, and above all, remind me of my most important function at births, to be, with women.

    Blessings,
    April
    moderator

    "The Voice

    There is a voice inside of you
    That whispers all day long,
    "I feel this is right for me,
    I know that this is wrong."
    No teacher, preacher, parent, friend
    Or wise man can decide
    What's right for you--just listen to
    The voice that speaks inside."
    — Shel Silverstein
  • 03-04-2009 8:03 PM In reply to

    Re: Thoughts on Pelvimetry

    Wise and lovely words as always April!

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