True Cephalopelvic Disproportion
by Jill Cohen

[Read this article in Spanish: Desproporción Cefalo-pélvica verdadera]

This first-time mom was 43 weeks pregnant with a large baby. We went for an ultrasound to ease her postdate concerns. That night she went into labor and her waters broke. The labor was slow but smooth. Fetal heart tones were regular and mom was handling everything quite well. I knew the baby weighed 10-11 pounds, but the pelvis felt roomy.

We reached transition after 24 hours of labor. When mom was ready to push I discovered an anterior lip that I was unable to push away. The baby's station was -3. I had mom squat while she breathed and I massaged the lip away.

Mom was pushing and fully dilated now. After one hour I checked mom again to find the anterior lip had returned and was swollen. The baby was strong but the station was still -3. We went back to deep breathing. I checked mom again in one hour to find she was 6 centimeters dilated, the lip was normal, the baby was at -3 station.

After a 24 hour period, we had regressed. I told the couple and they understood; we had a big babe. After discussing the situation, we decided to keep trying. We went into the 32nd hour of labor with little progress. By this time sunrise was approaching. We walked out to the chicken coop at the break of day, breathing in the fresh morning air. We talked some more. Where did we want to go? A decision was made. We left for the hospital. After arriving at the hospital mom was 8 centimeters dilated. With the manual aid of the doctor she went back to full dialation. For 2 1/2 hours she pushed with everything she had. Finally, the doctor, a compassionate man, informed the parents that even though mom could continue to push safely there had simply been no progress. Mom was tired and the baby's station was still -3. We prepared for a c-section.

I remember holding mom's hand while I stared, fascinated, at the doctor working to free the baby from the womb. I distinctly remember how the baby's head looked as the doctor lifted it out, how unmolded it was. I was sure this baby would not have come through his mother's bones. He was a healthy boy, 10 1/2 pounds, strong, sturdy, very clear. This was a true labor dystocia, a true cephalopelvic disproportion. Everything I had always questioned regarding the medical establishment's management of labor dystocia I was seeing with my own eyes.

Days later after sleep and much deliberation with myself, my assistant and the parents, I came to the conclusion that the mom had worked gracefully, with little resistance, to deliver her baby. We did everything possible to get her baby out vaginally but in this case, it was not physically possible.

A few weeks later I was told by friends in the community that one of my peers had remarked that this c-section was due to the mom's inner fears about birth. I was enraged at my peer's comments. Why was I so angry? First, I believe one midwife should not judge another midwife's actions, especially if she is not present at the birth. Without knowing the couple, the baby, the mom's body, how can anyone gauge the emotional or physical state of the mother?

I was angry also because I heard this concern through the community and not from the midwife herself. Recently, I have felt a growing need to pull together with my peers in my community to create positive power with other midwives.

However, this can never happen as long as midwives continue to judge one another. It is necessary now more than ever for midwives to join together and learn from each other. We must not allow ourselves to suffer from learning dystocia.

After I worked through my anger and was able to approach my peer calmly, I visited her at her home. I gave her my account of the birth. We discussed the birth. We agreed that the birth went as it was supposed to. It felt good to share one on one with each other. We moved beyond our particular dystocia with each other and birthed a better understanding between us. We understood the need to talk directly to each other to prevent miscommunication. This will help us on our path of midwifery.

Jill Cohen

Jill Cohen lives in Gates, Oregon, with her husband and two of her four children. After practicing as a lay midwife for 20 years, she has now returned to school to get a nursing degree. She has been with Midwifery Today since 1990, where she is associate editor of Midwifery Today magazine.

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