Mother’s Birth-Related Anatomy
A woman’s birthing anatomy includes soft tissues and hard bones.
Our bones are held together by flexible tendons. In pregnancy, these joints become even more mobile. Waddling is an example of what happens when these joints get softer. The baby passes through the mobile pelvis.
The hormone relaxin helps make the pelvis a dynamic, flexible passageway.
The bony pelvis has four joints. In the front of the pelvis is the symphysis pubis joint. Movement here really isn’t that comfortable. Sometimes a pregnancy belt holds this joint stable for walking and rolling over in bed. Symmetry in the symphysis pubis (pubic bone) reduces spasm in the round ligaments and helps the sacrum, around back, to be aligned properly.
On either side of the sacrum are the SI joints (Sacroilliac joints). These are located where the dimples are. Many plastic baby dolls have SI dimples above their bum. The SI joints are a common location for aches when the pelvis is weak or crooked.
Symmetry in the SI joints will help the sacrum be lined up with the pelvic brim. Then the baby can get into a nice, head down position. A chiropractic adjustment helps get the symphysis and the SI joints aligned.
The sacrum, rather than fused, is slightly mobile and in the birth process actually moves to allow the head past.
The tailbone is connected by a joint to the lower end of the sacrum. Sometimes this needs an adjustment, too, especially after birthing a baby. Ligaments connecting to the sacrum and tailbone (coccyx) will become more symmetrical and their tone will be more relaxed and less in spasm after bodywork on the pelvis.
Four general pelvic types are taught in midwifery and obstetrical schools. Caldwell-Malloy (1933) taught that nearly half of Caucasian women have a Gynecoid pelvis (rounder at the inlet, but wider side-to-side and a little less room front-to-back) while nearly half of women of African descent are said to have an Anthropoid pelvis (oval at the inlet, roomiest front-to-back of all pelvic types).
About 1/4 of all women have an android pelvis, with it’s triangular inlet and a bit smaller outlet than its own inlet. Only about 5% of women are said to have a platypelloid pelvis.
The variety of pelvic shapes, combined with the variety of fetal head presentations, plus size variations, mean that labors vary greatly.
In the drawing above, we see pelvic inlet shape and the correlating shape of the pubic arch at the outlet.
The Gynecoid pelvis has a roundish brim which allows fetal rotation when the muscles and ligaments in and around the pelvis aren’t tight and twangy.
The pelvic arch in front would allow three fingers to cover the urethra during a “potty dance” – the type of grab yourself and try not to pee your pants dance of a child waiting to get to the bathroom. Buttocks are round.
Hip size doesn’t indicate the roomy inside and a petite woman can birth a large baby. When the pelvic floor and other soft tissues aren’t overly tight, the birth tends to go well and a posterior baby can rotate at several various phases of labor.
The android pubic arch may hang quite low, giving a fundal height reading higher than the compact bump may seem to justify. Closely-set, small buttock “muscles” of the android make small roundish or triangular cheeks to her “bottom.” The android pelvis definitely has a 2 finger arch, rather than the 3 finger of the gynecoid.
Posterior arrest is slightly higher for women with an android pelvis. Good fetal positioning, good flexibility in the pelvic joints and balance in the soft tissues help the natural labor progress. The posterior baby will hope to rotate before engagement or may not be able to rotate until the head fully passes the pelvis rotating on the perineum. Some posterior babies, the larger ones or if a mom can’t get out of bed to do some rotation exercises, will need a cesarean, even with a skilled baby spinner present. Manually rotating the baby’s head may be an option if a skilled doctor or midwife is present. A little help for the shoulders may be needed as the result of those women with low slung pubic bones. They may catch a shoulder.
Tall women with average size babies often birth without an issue. I recommend flexible and balanced muscles before labor begins. Some women will need to start working out chronic pelvic torsion early in pregnancy or even before.
Recently a woman told me her doctor felt she may not be able to have a vaginal birth after she previously had a cesarean for birthing her first child. She asked me what I thought. While I acknowledge there are more challenges with an android pelvis for some of these labors, most births through an android pelvis are going to be able to finish by the woman’s own efforts -and her baby’s. I said:
I do know that women in your shoes…in your hips… do give birth every day. 24% of Caucasian women have android pelvis, and, almost that for women of African descent. And these womens’ great great grandmothers were birthing their great grandmothers, and their grandmothers were birthing their mothers, and one of them birthed you.
Long pelvis front-to-back, perhaps a narrow arch, perhaps not. Buttocks muscles look longer up and down than the round buttocks of a gynecoid. The Anthropoid pelvic arch can vary.
The arch could be a narrow 2 fingers or a wider 3 fingers at the pubic arch (as shown here in the illustration). Measure the pubic arch about 1/3 of the way between the clitoris and the sitz bones, rather than the very top.
Common for breeches that don’t flip. More posterior babies who are born vaginally may be arriving through the anthropoid pelvis. Vertical maternal positions aid these fetal positions and help birth be more protected and finish by the mother’s own efforts.
The pubic arch is a wide 4 finger span in the platypelloid, that is quite wide. A woman’s hips may seem slightly wider side-to-side than her weight would demand.
In other words, a thin woman with a platypelloid pelvis has wide hips but her pelvis from front and back is quite narrow. Her sitz bones are quite wide apart, more than the width of her fist (if she can reach between them while lying down).
Baby really needs to be in the LOT position to get INTO the pelvic brim for engagement. Long early labor is common, but if baby isn’t LOT, the two days of labor will be all about getting baby rotated and strong contractions and mobility are essential. Once baby is into the pelvis labor tends to move along, within 5-8 hours of engagement. Pushing may not be very long because the outlet of the pelvis is large.
Which conclusions about how to fit pelvic shape into a label or category is less important to me than having a set of skills to identify what is going on between the baby and the mother at the inlet or other diameters of the pelvis and what we can do to help when help is indeed appropriate.
Dear Gail: Just wanted you to know that the VBAC mom with the platypelloid pelvis had a successful unmedicated birth; surges were very intense with back labor for about 2 1/2 hours, mom was about 8cm dilated until the quality changed into a much more do-able intensity.
What helped was being on all fours, knee-chest position, strong hip squeezes, rebozo > standing did not work for a long time, just too intense, I think the walk to the car to transition to the hospital was helpful though – from there on it seemed so much easier. Active labor lasted just 3 hours, ½ hour pushing – the baby was sitting on the right side throughout the pregnancy, I think ROT; this mom was very dedicated, did chiropractic work (Webster technique) & craniosacral therapy – but the baby stayed on the right side; once we arrived in the hospital baby’s heartbeat was found on the left – I think the baby was born LOA; just saw this mom yesterday – she says hello to you – she worked with every bit of information.
Birth Anatomy; The soft tissues
More important than pelvic shape is the tone and relative symmetry of a woman’s uterine ligaments and muscles.
Our ability to stand depends on the psoas muscle pair. The psoas begins at T-12 vertebrae and sweeps around from the center of the sides of the spine over the pelvis to attach at the top of the thigh bone (femur). The muscle pair comes around like supporting arms, pulling up the legs so that our backs don’t fall over.
As the psoas comes across the pelvis, it makes a diagonal support for our organs. The support can be thought of as a shelf. When the uterus is large, at the end of pregnancy, a tight psoas can hold up a baby from descending and engaging in the womb. Many discomforts of the abdomen can stem from psoas tightness, but there are exercises to release the psoas. A great source is Liz Koch’s The Psoas Book, available at coreawareness.com.
As the psoas is balanced, so goes the birth!
The psoas is the lower triangle (pointing up) of two great muscle pair triangles that give core strength to the human body. The upper triangle (pointing down) is the trapezius, which is more of a diamond shape really, but I say two opposing triangles to help you to visualize of the polarity or pull between them to support our bodies.
The psoas additionally affects our pelvis and uterus because it shares the tendon connecting it to the thigh with another muscle pair, the iliacus. Together they team up to form the iliopsoas muscle group. The tone of the iliacus is dependent in part by the tone of the psoas. So, as the psoas goes, so goes the iliacus. This muscle spans from the top of the thigh (lesser trochanter) back over the pelvic brim to attach at the inside edge of the ilium (behind the hip bone but not as far to the center as the sacrum).
The womb is supported by a series of ropes and slings called ligaments and fascia. The ligaments of the womb have a unique mixture of fibrous tissue and muscle cells. The muscle cells allow the ligaments to become longer during pregnancy so that the ligaments can grow with the uterus. Symmetry of the ligaments helps the womb be held upright.
The cervix will be aligned properly, first aiming back in pregnancy and then, during birth, lined up with the birth canal. Dilation is less painful when the cervix is not held to the side or back by spasming cervical ligaments. The baby’s head is better positioned with symmetrical ligaments because the lower uterine segment is not in a twist.
Some spiraling and leaning to the right is considered normal for the uterus. But too much lean is not helpful for optimal uterine functioning, including birth.
The fascia is a membranous tissue that wraps every muscle, organ and bone in the body. The fascia moves with the moving body but also seems to store the “memory” of an abrupt halt. Whether that sudden stop has to do with a trauma or a long-time habit of poor posture, the fascia can get a wrinkle in it that pulls organs and bones out of alignment or symmetry.
Fortunately, craniosacral therapists, myofascial therapists and, to a lesser degree, chiropractic adjustments, can help to release the fascia and so, bring about a greater symmetry of the body. See more at Adrienne Caldwell’s blog. She shares insights and references about the fascia in her post which also talks about scar tissues after cesarean section and how multi-directional massage may reduce obstruction in motion and health.
Read a useful description of fascia for the person who is not studying anatomy http://breakingmuscle.com/mobility-recovery/the-top-5-ways-fascia-matters-to-athletes
Baby’s Birth-Related Anatomy
The fetal head is heavy in comparison to the rest of the baby’s body. The vertical positions of walking, standing and sitting help the heavy head settle lower than the body during the third trimester, and sometimes in the second trimester.
The fetal skull has not yet hardened and remains somewhat flexible for fitting through the pelvis. There are plates of bone and cartilage that are nearly finished coming together at birth. That nearly finished margin is what allows molding. These margins are called sutures.
The skull plates are held together by a coating for strong fascia. This membrane also wraps down the spine to the pelvis and legs. The fascia also connects to membranes that support the brain, called the tentorium cerebelli.
Which angle the head presses past, or onto, the bony pelvic passageway determines molding. When the crown of the head enters the pelvis first molding is most efficient. When a plate, rather than the margin between, or sutures, aims into the narrow part of pelvis, molding takes a long time and does less to reduce the diameter of the baby’s head. One example of this is the asynclitic baby. Second stage can take a long time and pushing can be quite strenuous when a baby is asynclitic.
The baby’s shoulders can also mold a bit for the birth process. The shoulder girdle is flexible and many times the shoulders are folded towards the chest for the actual emergence. Other times one shoulder comes out just ahead of the other in another natural variation to reduce shoulder breadth.
- Holistic Midwifery, Vol. II by Anne Frye
- Hands of Love by Carol Phillips
- The Female Pelvis by Blandine Calais-Germain
- A New Look at a Woman’s Body by Boston Womens’ Health Collective
- Gray’s Anatomy by Henry Gray