Who Needs a Caesarean Birth?

Max Brinsmead MB BSMay 2015

Factors which influence the outcome of a trial of labour

The Passage

The Passenger

The Powers

The Psyche

The Passages

Stature (and maybe shoe size!) Shape of the pelvis

Gynecoid Android Anthropoid Platypelloid

Pelvic joint changes and position in labour Soft tissues

An effect from parity

Maternal obesity

The Passenger

Size Presentation Position

Adversely affected by epidural anaesthesia

Attitude Flexed or deflexed

Moulding Does this change with gestation?

Estimating Birth Size

Notoriously inaccurate: Ultrasound measures abdominal circumference

typically +/- 20% That is 2880 – 4320 g for average 3.6 Kg baby

Need to consider: BW of previous babies Mother’s size and weight gained in pregnancy Mother’s own birthweight Ethnicity Father’s size

Estimating Pelvic Size

Clinical pelvimetry Unreliable

X-ray or CT pelvimetry Abandoned

“The best pelvimeter is the baby” Engagement of the head before labour Engagement and descent in labour “Trial of labour”

Pelvic soft tissues are more important?

The Powers

The effect of parity Maternal age An effect from posture

Upright position in labour Fetal back uppermost when lying

Induction of labour Augmentation of labour

Amniotomy Oxytocin infusion

The Psyche

The place of birth Maternal anxiety Analgesia in labour Preparation for birth The role of a doula

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