Does Being Short Disqualify a Pregnant Woman from Natural Birth?
By Maryanne Waweru-Wanyama
When Valerie Kasaya was in her eighth month of pregnancy, she one day noticed an unusual discharge. Having had a smooth pregnancy all along, the discharge deeply worried her.
A resident of Kawangware slums in Nairobi, 20-year-old Valerie decided to go for a checkup at a public health facility in Westlands, a distance of about 14km away. That is where she had been attending her antenatal clinics.
At the clinic, Valerie was informed that her cervix had started opening, that she could give birth anytime. The nurses further told her to begin preparing for a caesarean section as it would be impossible for her to deliver naturally.
“Nurses told me that because I was short, this meant that my pelvic bones were small, indicating that a natural birth would not be possible,” she recalls.
Valerie is just about five feet tall. The attending nurse then referred her to Kenyatta National Hospital (KNH) since the clinic did not have the facilities required for the surgery.
“Even though I was disappointed to learn that I would not deliver normally, I trusted the medic’s verdict because they are the experts,” she says. But back home, Valerie’s mother would hear none of it.
“My mother insisted that I could still give birth naturally. She said she had seen shorter women than me deliver naturally. She asked me to seek a second opinion, and accompanied me to a nearby clinic.”
Photo: Valerie Kasaya with her baby.
At FreMo clinic, a small privately-run health centre that serves the low-income population of Kawangware, Valerie and her mother were excited to learn that physical stature alone is not enough to determine if a woman will give birth normally or not.
“The midwife at FreMo said they would let me try natural birth first and if it failed, then they would refer me to KNH for a caesarean section,” recalls Valerie. She was then sent home and asked to return when labour started.
A few days later, labour started, and she immediately walked to the clinic — a distance of about two kilometres. During labour and while waiting for her cervix to fully dilate, the attending midwife helped Valerie engage in some exercises.
“She made me swing my hips, squat, and also instructed me on how to breathe. She said all this would help the baby descend, as well as ease my labour.”
Four hours after the onset of labour, Valerie delivered a healthy baby boy weighing 3.1kg. During delivery, it was just her and the midwife and she had a smooth delivery with no complications. She did not even have an episiotomy (surgical incision on the posterior vaginal wall during labour).
“I was surprised because I had successfully delivered my son naturally, yet other nurses had told me that I was a direct caesarean candidate because of my small stature,” she says.
Both mother and baby continue to enjoy robust health with no complications. Her son is now seven months old. Magdalene Katuku, the midwife who helped Valerie birth her baby, says that it is possible for short women to deliver naturally.
“Natural birth is determined by a number of factors, and it is wrong for one to make assumptions based on height alone. Having a small stature does not disqualify one from a natural birth. It all depends on the size of the baby, and the size of the pelvis. A big woman can have a small pelvis, which may not allow the baby to pass through, as her baby might be big. In the same breath, a small woman can have an adequate pelvis that may allow her baby to pass through,” she says.
At FreMo clinic, Magdalene says the emphasis is on natural delivery. Last year alone, of the 211 deliveries, 207 were natural births, with four being referred for caesarean section to KNH when there were obvious indications that a normal delivery would not be possible.
Magdalene says that their successful rate for natural births is by design, not coincidence. “Throughout the pregnancy, we help the women engage in certain activities that help keep her fit and which boost her chances for a natural birth,” she says.
Pregnant women who attend clinics at FreMo learn about chest stretches, which reduce pregnancy aches and pains and improve blood circulation. They also learn about exercises that reduce back pain — a common concern in pregnancy.
In addition, the midwives teach the women how to do special press-ups, which help prevent aches and pains due to the growing belly. “We encourage the pregnant woman to walk throughout her pregnancy. Walking is a good cardiovascular exercise, and helps keeps her fit. She should however be cautious not to walk to the point of exhaustion or breathlessness,” says Magdalene.
FreMo clinic also offers free childbirth classes for women in their last trimester. Here, they are given information about the birth process, where they are taken through the stages of a natural delivery.
“We encourage them to come with their spouses for moral support. It helps the couple prepare themselves psychologically for labour, and build their confidence about the birth process. During childbirth classes, we answer all their questions as they share their fears and expectations. We reassure them, helping them build confidence in the body’s ability to birth a baby,” she says. Their partners also learn how they can support the woman during labour, such as helping her with breathing exercises and massaging her back.
During labour, the pregnant women are encouraged to squat, as this not only speeds up labour but also fastens the opening up of the pelvis, providing room for the baby to descend. They are not encouraged to lie on their back, as this slows down baby’s descent therefore prolonging labour.
“We are also never in a hurry when the woman is labouring. We are patient with her, and attend to her throughout the birth process, the ultimate goal being a healthy baby. Due to the close monitoring, we are able to assess and anticipate any complications that would necessitate an immediate referral and transfer to KNH, which we facilitate as we offer them transportation. All the above are what we believe has led to our high success of normal deliveries,” she says.
An expert’s view
Is it possible to tell if a woman will not be able to have a natural delivery judging solely by her height? According to Dr Stephen Mutiso, an obstetrician / gynaecologist at Kenyatta National Hospital, a diagnosis of cephalo-pelvic disproportion (CPD) is often the key determinant in such cases. Cephalo refers to the size of the baby’s head, and pelvic means the size of the birth passage.
A diagnosis of CPD means that either the baby’s head is too big for the woman’s pelvis, or the pelvis is too small for a normal sized baby. In women diagnosed with CPD, normal delivery is difficult and at times impossible.
“Small women tend to have a small pelvis, and are likely to have difficulties during delivery. Any woman with a small pelvis and whose baby indicates being slightly bigger compared to her pelvis is not advised to try normal delivery,” he says.
However, Dr Mutiso clarifies that there are short women who have small babies and go on to have successful normal deliveries, hence the need for proper assessment by the health professional during antenatal care or when labour begins.
“This assessment will help determine if the pelvis is adequate enough to allow baby to pass through. If the baby’s size is small to average, then labour should be considered,” he says. Dr Mutiso warns of attempts to push a baby that cannot pass through a small pelvis.
“This could lead to prolonged labour and cause obstruction, which in turn may result in complications such as fistula, rupture of the uterus, serious infection, excessive bleeding after birth and foetal distress. In some instances both mother and baby may die.”
Dr Mutiso says that in the event vaginal delivery goes on to take place, the mother can sustain serious perineal tears or cause damage to her reproductive organs. Further, caesarean deliveries done when one has been trying to push are more difficult and associated with increased complications.
“In as much as most pregnant women plan to delivery naturally, it is necessary for them to understand that complications may arise during labour, and which may necessitate a caesarean section. These complications include failure for labour to progress despite good contractions, foetal distress and excessive bleeding.”
Article courtesy: The Star