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Dr. Andrew Rynne

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Does a child's position and its head size affect the vaginal delivery?

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Dr. Rhea Chanda

OBGYN

Practicing since :2005

Answered : 3163 Questions

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Posted on Sat, 5 Jan 2013 in Pregnancy
Question: When I had my 1st child 3 years ago, I was overdue by 1 day. I was induced and went into labour smoothly and dilated normally. I chose to use epidurel and everything was going fine until I had to push. When my child crowned, I had the most unbearable pain I have ever encountered (despite having epidurel).

I couldn't deliver vaginally because of the unbearable pain and elected to go for a c-sesction.
I was later today that I had the pain for 2 reasons:
1- Baby was in posterior position
2- Baby's head was too big for my pelvic bones

My question: is there some measurements or controls that can be done ahead of time in my current pregnancy (am 30 weeks in) to determine whether there is a possibility I won't be able to delivery vaginally because of the baby's head size and my pelvic bone measurements?

I would rather not go through hours of labour and be disappointed at the end when I can't deliver vaginally and opt for c-section.
Many thanks for your help.
doctor
Answered by Dr. Rhea Chanda 17 minutes later
Hello XXXXXXX,
If your first delivery was by C section due to cephalo-pelvic disproportion,then its most likely that your second child will be delivered by C section.
Ideally, CPD is a clinical diagnosis done after a pelvic examination.But as you have mentioned that the position was occipito-posterior,due to which vaginal delivery was difficult.Its not possible to tell for certain whether the position is posterior unless in active labour. In this pregnancy, its not possible to tell the position unless you go into labour.But in case of a big baby,it can be clinically diagnosed upon examination.
Now its up to your obstetrician to decide if you have CPD.Nowadays,most obstetricians dont like to try vaginal delivery in post C/S patients.You should discuss your issues with your doctor so that an elective LSCS can be planned.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Rhea Chanda 6 minutes later
Thank you for the quick response, Dr XXXXXXX I have a few follow-up questions:

1) How does the OBGYN determine whether I have CPD?
2) At what stage of the pregnancy can the diagnosis be made?
3) Is the diagnosis completely conclusive?
4) What is an LSCS?
5) If I am in active labour and it is determined that the baby is posterior, can that be changed during labour through manual/otherwise manipulation to make it the normal position?

Many thanks for your prompt response.
doctor
Answered by Dr. Rhea Chanda 13 minutes later
CPD is a clinical diagnosis that the obstetrician will make after pelvic examination.Its not completely definitive but accurate enough when done correctly.Its done in relation to bony markings on the pelvis.Basically its a way to determine whether the baby will be able to pass through the pelvic outlet.Gross CPD is easy to diagnose but sometimes even though the pelvis seems adequate due to other complications during labour,vaginal delivery may not happen.As in your case.It can be diagnosed at term.
LSCS is a technical term for ceasarean section. Occipito posterior positions can be delivered vaginally sometimes if spontaneous rotation occurs during labour,but sometimes it may not.Manual manipulation cannot be done.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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