I was recently on-call and did three c-sections in a row. I REALLY hate when I do so many sections…..I thought to myself, “there goes my c-section rate.”
I pride myself on keeping it on the low side. I always tell my patients, “if you’ve ended up with a c-section, it certainly isn’t because we didn’t do everything possible to have a vaginal delivery.” Where as some physicians are quick to proceed to section, I like to give patients EVERY opportunity to deliver vaginally. Sometimes it just doesn’t work out that way.
Whether due to maternal or fetal indications, in light of recent events, I was reminded to mention the significance of the P!
Now lets keep this PG. Facebook is already all over me for posting blogs that mention things like breasts, vaginas, etc. Though there is that classic rap song, “The Power of the P.” I’ll let you all do the research to figure that one out.
The 3 P’s in labor and delivery are: Power, Passenger, and Pelvis. All three are considerations when women end up with c-sections. I’ve recently, as in a day or two ago, done c-sections due to the aforementioned.
Passenger: you guessed it, the passenger is the baby! While I don’t get so caught up in estimated fetal weights unless they meet certain criteria(4500 grams in a diabetic. 5000 grams in a non-diabetic); when a mom is laboring, has gotten to complete, and there is no descent into the pelvis….you have to start wondering why. Could it be that the passenger is too big to fit into the pelvis? Well, I recently encountered this scenario. While, the mom in question had previously delivered two babies vaginally with no issue, neither of the previous babies weighed 9 pounds!
Pelvis: during your new ob visit, and even the latter part of the third trimester when your ob starts doing cervical exams to check for dilation, a very important part of that pelvic exam is assessing the adequacy of your pelvis. Most women have an adequate pelvis to deliver baby.
Once upon a time, physicians used to do things like x-rays to measure certain bony landmarks, to determine “adequacy.” In reality, the pelvis is dynamic. The hormones of pregnancy cause the ligaments holding the bony pelvis together to become much more relaxed, which in turn, allows more flexibility of the pelvis during the birthing process.
The term CPD or cephalo-pelvic disproportion is used far too often. The only true way to determine if the birthing canal is “inadequate” is to undergo a trial of labor. By using the labor curve as a guide, there should/will be “telling” signs as to whether or not the passenger(see above) is going to fit into the pelvis.
Power: last but not least, we have POWER! I immediately think of the song, “I’ve got the power” by that group Snap from way back in the day. While I don’t see this very often, I do occasionally see a situation where a mom just isn’t a good pusher. It may be that she never quite got the hang of the technique, became exhausted after a long labor, or just couldn’t muster up enough energy/umph to push baby out. I see this one at least once a year. The last time I did a section for a power issue, the baby weighed just over 6 pounds. The pelvis was more than adequate, but hey, life happens.
Regardless of the indication for c-section, just remember. Delivery by c-section does not make you any less of a woman. And last but not least, it isn’t your fault!
Hoping this blog post adds value to your day!
Until Next Time,
Look Better. Feel Better. Be Better.
Dr. Angela
