Theresa says,

.<< We had a local obstetrician at the time who was scheduling C-sections
for women based on shoe size - small feet equal small pelvis, according to
him.>>

When I was a younger L & D nurse, I remember the nurses on one unit saying
that a woman could supposedly safely have a baby that was one pound bigger
than her shoe size!  So, Theresa, you should only be able to have a
six-pounder.  What a woman!  You had a nine pounder.  ;-)  There is all
sorts of folklore like that among labor staff.    Seriously, though, there
are measurements that can be taken prenatally that give a good idea of the
adequacy of the pelvic outlet.  Kathy referred to hip size, which is the
measurement of the iliac crests (hip bones) and that is not appropriate in
determining adequacy, as she said.  My maternity nursing books state this
and say basically what Kathy did, that the size of one is no indicator of
the size of the other.  The measurement that can give a fairly accurate idea
of pelvic outlet size is the diagonal conjugate, which is the distance
between the anterior surface of the sacral prominence (tailbone) and the
anterior surface of the inferior margin of the symphysis pubis (pubic bone).
It should be done by the 24th week of pregnancy for accuracy, though.

My book describes 4 types of pelvises.  The gynecoid is the female type,
which is well-rounded forward and backward, with a wide pubic arch.  The
anthropoid pelvis (ape-like) is more elongated, wide from front to back but
narrow from side to side.  The platypelloid pelvis  is the opposite of this,
wide from side to side, narrow from front to back.  The android pelvis
(male) is wide across the back of the arch, with a narrow pubic arch.  Of
course, the gynecoid is best suited for human birthing.  So I guess that
means men couldn't give birth even if they wanted to, unless they all had
c-sections of course, and then God help us all (just kidding to the men on
this list!  We love you.)

As far as size goes, two of my more memorable patients had 11 pound babies
and I almost didn't get the doctor in the room in time to deliver them, they
came so fast!  Neither mother was extraordinary in size or build.  I have
"caught" 11 babies myself while working in outlying hospitals where there
isn't always a doctor in house to do it and the ER doc would just as soon
have you do it!  Those babies, the parking lot babies previously referred to
(sorry I don't remember who said it) usually do great.  Oh, and you can have
a precipitous delivery without having a precipitous labor.  This has
happened to me once and my patients many times.  I love it when it happens
so fast they don't have time for medication!  Maybe that's one reason why
these babies do so well!

OK, I have to share one of my funnier experiences  Please indulge me...on an
extraordinarily busy Christmas night, we were short-staffed (it was
Christmas night, after all.  We weren't expecting a blue light special!).  I
had one mom whom I had put in a hands and knees sort of position, kind of
leaning over the head of the bed, for serious back labor and probably
posterior presentation.  She had come in only a couple of centimeters and we
were so busy, I couldn't keep a close eye on her.  I stuck my head in her
door a couple of times, and she really liked the position and was doing
fine.  Anyway, a few hours later, I heard her scream, "it's coming".  Now, I
long ago learned that when they say that, or rather scream it, it IS coming!
So I dashed down to her room, sent someone to get her doc who was right
across the hall sleeping and proceeded to catch a baby upside-down!  She was
still leaning against the head of the bed!    Now I'm thinking, "ok, baby's
head usually goes down first, then up to clear first shoulder, but this is
going to go up first, then down...!"  It was great!  The doc, a lady, came
in about half-way through and said, "you're doing fine.  Go ahead", when I
started to get up so she could finish.  So I did.   I'm thinking this woman
doesn't realize she's pretty lucky it happened this way!

Marsha, who just read the statistics for my facility where, last month, 100%
of mothers got something for pain!  (I accept no responsibility.  I do
lactation here, not labor and delivery!)


~~~~~~~~~~~~~~~~~~~~~~~~~~~
Marsha Glass RN, BSN, IBCLC
Mothers have as powerful an influence over the welfare of future generations
as all other earthly causes combined.
John S. C. Abbot
~~~~~~~~~~~~~~~~~~~~~~~~~~~

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