CPD… Fact or Fiction?

I was horribly bored at work today, so I twittered and asked what people wanted me to write about, and I had a reply about CPD and its overdiagnosis.

I have been wanting to research this since I heard about a friend that knew someone that was diagnosed with this, and I am pretty sure it is one of the most valid cases I have ever heard.

CPD (Cephalopelvic Disproportion) is where the baby’s head or body is too large to fit through the pelvis of the mother during a vaginal delivery.

It is a highly rare condition, with the ACNM rating it as 1 out of every 250 births, meaning we have 16000 cases of this every year, just in our country. This is less than 0.5% of the births in our country. And I hear it being diagnosed ALL the time. A lot more than 0.5%.

The causes of CPD include:
-large baby due to:
=Post maturity (which most sites list as going past your due date, but it is actually going past 42 weeks)
=Multiparity (this is not your first child)
-Abnormal Fetal Position
-Small Pelvis
-Abnormally Shaped Pelvis

The diagnosis of this cannot be assessed until labor. Since your pelvis and the baby’s head both mold during labor and delivery, no one can say what your pelvis will be able to do. They diagnose it if your labor is not progressing (Failure to Progress) and synthetic oxytocin (Pitocin) is not working like it should (dilating you 1 cm every two hours). They say a physical exam is the most accurate way to determine this, and can be done while they are checking your dilation.

There are two kinds of CPD. Absolute and Relative.

Absolute CPD occurs when your pelvis has been through a major trauma or some other illness. Rickets is a big one. 68% of those diagnosed with Absolute CPD go on to have vaginal births with subsequent births (so they either grow smaller babies, which never happens, or the diagnosis was incorrect).

Relative CPD, or Fetal-Pelvic Disproportion (FPD) is the inability of the baby to move through the pelvis because of:
=Head position
=Nuchal arm/hand (the baby’s hand or arm is up by their face)
=Posterior position (Sunny side up, as some people refer to it as)
=Other malposition of the baby’s head
=Misalignment of the pelvis (which can happen if you aren’t able to move around in labor)
=Restriction of movement
=Rupture of membranes (if the membranes are ruptured before you are ready or your baby is ready, it can drop into the pelvis into a bad position and be unable to move around)

My absolute favorite is the myths about CPD that some doctors still adhere to.

  • Your sacrum is prominent, protruding, or flat.
  • You were previously diagnosed with CPD or Failure to Progress (FTP).
  • Your baby is too large.
  • You have a narrow pubic arch.
  • Your pelvic dimensions are too small.
  • You have an android/platypelloid pelvis.
  • Your partner is tall.
  • You are too short.
  • Your shoe size is too small.
  • You are petite.
  • You and your partner are different races.
  • You are obese and fatty tissue is padding your pelvis making it more difficult for your baby to fit through.

Seriously… your shoe size ??? That’s the same as saying a man is packing just because they have big toes.

Another interesting fact about CPD is VBACs after being diagnosed with it. Studies report two-thirds of women will have a successful VBAC despite a previous diagnosis of CPD. One study showed an 80% VBAC success rate for women who had undergone a cesarean for arrest during the second stage of labor (CPD). In another study of women who had undergone two previous cesareans for CPD/FTP, 56% delivered vaginally.

Those numbers are huge!! If women are able to have a VBAC after being diagnosed as never being able to deliver vaginally, you have to wonder why.

True cases of CPD do exist. No one is saying they don’t. But I do not think that the number of cases our country actually has is an indication of real CPD.

I heard a story of a woman that pushed for 3 hours with her baby, and he just wouldn’t descend. The doctor had her try all the positions for pushing he can think of and finally gave her a cesarean. The baby came out with a fractured skull from being crammed in a hole that was truly too small.

One thing that I truly hate about the diagnosis of CPD is that they artificially augment your labor just because you aren’t dilating and then if you don’t dilate fast enough on that, you have CPD and can’t have a baby vaginally. You are given a cesarean, and with the rates of VBACs in our country, you will probably always have cesareans and wonder why your body was made wrong.

Your body wasn’t made wrong! Your babies were made for you! If a doctor tells you, before your due date, that you should schedule your cesarean because your baby is growing too big for you, please change doctors! There is nothing like an unnecessary cesarean to make you completely regret your decision. You wonder why God made you so inadequate that you can’t even birth your own babies.

If as many women that have CPD now had had this condition 50, 100, 2000 years ago, the human race would not exist. We would slowly die out because no one would be able to give birth to their own babies. Could you just imagine a world like this?

I wish someone would bring to light how completely retarded the idea of CPD is just because you don’t dilate as fast as the doctor would like you to. This again goes back to having a time limit in labor. Labor isn’t the same for everyone. Your labor might go fast, slow down, stop, then start again. God designed a genius system for bringing a baby into the world. Women can’t be in pain for days without some rest. It wouldn’t be feasable. So, you never know what will happen in your labor. You might be one of the women that dilate and push their baby out in under 4 hours, but you might also be one of the women that labor for 3 days and then push for 3 hours before your baby is born.

Please don’t give up on yourself and your ability! Your body truly wasn’t made wrong! There is nothing like someone telling you that your body is broken to lose every ounce of self-confidence you possess.

If you were diagnosed with CPD, please research your options. Don’t just say, “Oh, my babies are bigger than my pelvis and my doctor is always right. I need cesareans because I am just made different from other women.” Don’t have blind faith.

The research on this topic is completely extensive. And yet, it is diagnosed unnecessarily everyday. Right now, there is a woman getting a cesarean because she was made wrong. And also right now, there is a woman having a vaginal delivery, even though her doctor said she could never.

The odds are completely in your favor. God doesn’t make mistakes.


3 Responses

  1. I really liked this post. One reason I have heard for the increase in CPD cases is that now women are getting better prenatal care and better nutrition so babies are healthier and bigger which means they can be too big to deliver vaginally. I think it's ridiculous. It's just an excuse. I know most women can and certainly should deliver vaginally!

  2. Wonderful! Thanks. :-)Check out this video! SO cool!http://www.youtube.com/watch?v=roFVkDV45MM

  3. Could you source the study that claims women who have had 2 previous cesareans because of CPD birth vaginally 56% of the time? I am in that boat and would like to read as much research as I can.

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