I sent this to a few people off the list already, and now I am sending it to
the list.  I will try REALLY HARD not to post on this topic here again, even
though it fascinates me.  To relate it to BF, think of 'trial of labor' as
analogous to 'trial of breastfeeding'.

Pelvimetry to predict CPD, whether by x-ray or by CT, is now categorized as
a 'form of care unlikely to be beneficial' by the authors of 'Guide to
Effective Care in Pregnancy and Childbirth'. (ISBN 0-19-263173-X)

It turns out that it is perfectly safe to wait until labor starts and see
how it goes.  Even after one or more previous cesareans for CPD it is safe
to wait for labor and see how it goes.  If you want to know your pelvic
dimensions for some other reason, both methods are good.  Estimating pelvic
dimensions from shoe size I would put in the same category as interpreting
chicken entrails to determine stock market trends.  Old husbands' tale!

For women living far from facilities where a cesarean could be performed,
this might mean traveling in advance of labor so as to be in the best place
when the time came, if they had reason to suspect abnormal pelvic anatomy.
But x-rays and CT don't have good prognostic value for who will have trouble
in labor.  We can measure the pelvis exactly, but we can't see the mobility
in the joints, nor the way in which the fetus will navigate through it.
Some women measure impossibly small and have normal labors, and some look
gigantic and have great measurements on pelvimetry but their babies just
won't come out.  So why irradiate gonads if there is nothing to be gained?

I have a large chip on my shoulder about this issue because it isn't long
since all women my height and even an inch or two taller, were referred for
x-ray pelvimetry in pregnancy here in Norway.  The danger of self-fulfilling
prophecy, and the at least ten-fold increase in serious maternal morbidity
following cesarean birth, are what motivate me in this information crusade.

Rachel Myr
midwife, IBCLC, and devotée of knowledge-based practice

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