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Cephalopelvic disproportion (CPD) is a rare condition where the baby’s head or body is too large to pass through the birth canal. While true CPD is rare, it is often diagnosed when labor does not progress, leading to unnecessary C-sections. CPD is decided on a case-by-case basis, and some women with pelvic abnormalities can still give birth vaginally. There is concern about the overuse of CPD diagnosis and unnecessary C-sections.
Cephalopelvic disproportion (CPD) refers to a rare condition present in approximately 4 out of 1000 births. In this condition the baby’s head or more rarely the body is too large to pass through the birth canal, and it is thought that the cesarean section is the preferred option for labor. While true CPD is rare, this diagnosis is used more often than true onset rate in case a labor does not progress. When labor is not progressing, it may simply be diagnosed as cephalopelvic disproportion and a C-section may then be performed. There are several opinions on the use of the diagnosis in this way.
There are times when cephalopelvic disproportion really exists and certainly labor may not progress for a variety of other reasons. For example, a cesarean may definitely be necessary if labor goes on for a long time after the water breaks, as there is an increased risk of infection. Some define CPD as more common when there are abnormalities in the shape or bone structure of the pelvis or if a woman has rickets. It does not necessarily occur in circumstances where a woman is short or smaller and the baby’s father is tall, or if a woman has a large amount of fatty tissue intruding into the pelvis. Nor is it the case that C-section is inevitable if a baby is sized via ultrasound, so large, as these estimates can prove inaccurate.
Generally, cephalopelvic disproportion is decided on a case-by-case basis at the time of delivery. Some women with conditions such as rickets or who have pelvic abnormalities can still give birth vaginally. If this is their preference, they should seek a doctor or midwife who supports this decision. Even with the support of a doctor, things can change quickly at the time of labor if labor does not progress within a specific amount of time.
There is no doubt that cephalopelvic disproportion exists and can affect labor in a small percentage of women. However, there is concern about the many times this condition is diagnosed when it’s not really the factor that could stop or slow labor. Additionally, some people advocate a decrease in the number of C-sections performed and often view looser definitions of CPD as problematic for women, because there may be other ways to manage complicated labor and delivery other than performing a C-section. Obstetricians/gynecologists refer to a caesarean section when they believe that labor is putting the life of a mother or baby at risk; however there is a strong argument among those opposed to caesarean section that it is not always the best choice for the mother and future delivery.
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