ICAN of Richmond

Supporting & Educating Birthing Families

Cephalopelvic Disproportion (CPD)

Cephalopelvic Disproportion (CPD)

by Kelly Milotay

 

What Is CPD?

Cephalopelvic Disproportion (CPD) is the medical diagnosis used when an infant’s head is declared too big to fit through the mother’s pelvis. Often, this diagnosis is made after the woman has labored for some time, but other times, it is entered into a woman’s medical record before she even labors. A misdiagnosis of CPD accounts for many of the unnecessary cesareans performed in North America and around the world annually. This diagnosis does not have to impact a woman’s future birthing decisions. Many actions can be taken by the expectant mother to increase her chances of birthing vaginally.

 

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Pelvises I Have Known and Loved

by Gloria Lemay

© 2003 Midwifery Today, Inc. All rights reserved.


What if there were no pelvis? What if it were as insignificant to how a child is born as how big the nose is on the mother's face? After twenty years of watching birth, this is what I have come to. Pelvises open at three stretch points—the symphisis pubis and the two sacroiliac joints. These points are full of relaxin hormones—the pelvis literally begins falling apart at about thirty-four weeks of pregnancy. In addition to this mobile, loose, stretchy pelvis, nature has given human beings the added bonus of having a moldable, pliable, shrinkable baby head. Like a steamer tray for a cooking pot has folding plates that adjust it to any size pot, so do these four overlapping plates that form the infant's skull adjust to fit the mother's body.

Every woman who is alive today is the result of millions of years of natural selection. Today's women are the end result of evolution. We are the ones with the bones that made it all the way here. With the exception of those born in the last thirty years, we almost all go back through our maternal lineage generation after generation having smooth, normal vaginal births. Prior to thirty years ago, major problems in large groups were always attributable to maternal malnutrition (starvation) or sepsis in hospitals.

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Management of Suspected Fetal Macrosomia

MARK A. ZAMORSKI, M.D., M.H.S.A., and WENDY S. BIGGS, M.D.
University of Michigan Medical School, Ann Arbor, Michigan

Fetal macrosomia, arbitrarily defined as a birth weight of more than 4,000 g (8 lb, 13 oz) complicates more than 10 percent of all pregnancies in the United States. It is associated with increased risks of cesarean section and trauma to the birth canal and the fetus. Fetal macrosomia is difficult to predict, and clinical and ultrasonographic estimates of fetal weight are prone to error. Elective cesarean section for suspected macrosomia results in a high number of unnecessary procedures, and early induction of labor to limit fetal growth may result in a substantial increase in the cesarean section rate because of failed inductions. Pregnancies complicated by fetal macrosomia are best managed expectantly. When labor fails to progress as expected, the possibility of fetopelvic disproportion should be considered within the context of the best estimate of the fetal weight. (Am Fam Physician 2001;63:302-6.)

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