Maternal Height Alone Not Enough to Predict Childbirth Complications, Indonesian Study Finds
New research from Pelita Ibu Health Sciences College reveals that maternal height alone is not a reliable predictor of cephalopelvic disproportion (CPD), a serious childbirth complication that can obstruct normal delivery. The study, conducted by Juli Purnama Hamudi, Lisnawati, and Astri Yunita, analyzed delivery cases at Bahteramas Regional General Hospital between 2020 and 2024.
Published in 2026 in the International Journal of Contemporary Sciences, the findings challenge the long-standing assumption that shorter women automatically face a significantly higher risk of CPD. Researchers found that while shorter mothers showed slightly higher odds of the condition, the relationship was not statistically significant.
The findings are important for maternal healthcare in Indonesia, where childbirth complications remain a major public health concern and screening systems often rely heavily on simple anthropometric indicators such as maternal height.
CPD Remains a Serious Obstetric Emergency
Cephalopelvic disproportion occurs when the baby’s head cannot properly pass through the mother’s pelvis during labor. The condition can lead to prolonged labor, emergency cesarean section, severe bleeding, infection, uterine rupture, and even maternal or neonatal death if not managed quickly.
According to data cited in the study, CPD contributes to approximately 8 percent of maternal deaths globally, accounting for around 23,000 maternal fatalities every year. In Indonesia, the 2023 national health survey reported a CPD prevalence of 4.9 percent, with some provinces recording even higher rates.
At Bahteramas Regional General Hospital in Southeast Sulawesi, researchers documented 114 CPD cases between 2020 and 2024. Although annual cases gradually declined over the five-year period, the researchers noted that the complication still represents a major challenge in obstetric care.
For years, maternal height below 145 centimeters has been widely used as a risk indicator for difficult labor because shorter women are often believed to have narrower pelvic dimensions. However, the latest study suggests the relationship is more complex than previously assumed.
Researchers Examined 114 CPD Cases
The study used a quantitative design with binary logistic regression analysis. Researchers reviewed secondary data from hospital medical records collected at the Tumbudadai Ward of Bahteramas Regional General Hospital.
All 114 mothers diagnosed with CPD during the study period were included in the analysis.
The research focused on whether maternal height significantly influenced the type of CPD experienced during childbirth.
Participants were grouped into two categories:
- Mothers shorter than 145 centimeters
- Mothers 145 centimeters or taller
Researchers then analyzed whether maternal height affected the likelihood of developing absolute CPD or relative CPD.
Absolute CPD refers to a condition where the mother’s pelvis is anatomically too small for vaginal delivery, making cesarean section unavoidable. Relative CPD, meanwhile, may occur because of fetal positioning or labor complications rather than pelvic size alone.
Maternal Height Showed Limited Influence
The findings showed that maternal height had only a minimal statistical relationship with CPD outcomes.
Key findings included:
- 28.07 percent of mothers were shorter than 145 centimeters
- 71.93 percent had a height of 145 centimeters or more
- 57.01 percent experienced absolute CPD
- 42.99 percent experienced relative CPD
Logistic regression analysis produced a p-value of 0.346, exceeding the significance threshold of 0.05. This means maternal height did not significantly affect CPD incidence in the study population.
Researchers also reported a Nagelkerke R Square value of only 0.011, indicating that maternal height explained just 1.1 percent of variation in CPD outcomes.
Although taller mothers showed approximately 32.7 percent lower odds of absolute CPD compared to shorter mothers, the difference was not statistically meaningful.
The findings suggest that childbirth complications such as CPD cannot be accurately predicted using height alone.
CPD Is Influenced by Multiple Factors
The researchers emphasized that CPD is a multifactorial condition shaped by a combination of maternal, fetal, nutritional, and obstetric factors.
Other important contributors may include:
- Fetal size and birth weight
- Pelvic shape and dimensions
- Maternal nutrition during adolescence
- Obesity
- Gestational diabetes
- Fetal position during labor
- Ethnic and genetic factors
The study highlighted that adequate nutrition during puberty may play a major role in pelvic development. Women with shorter stature may still develop sufficiently wide pelvic structures if they received proper nutrition, including calcium, vitamin D, phosphorus, and protein during adolescence.
The researchers also noted that pelvic anatomy may vary among ethnic groups in Southeast Sulawesi, including Bugis-Makassar and Tolaki populations, potentially influencing CPD risk differently from other regions.
According to an ethical paraphrase of the study findings, the research team from Pelita Ibu Health Sciences College explained that maternal height should not be used as the sole screening indicator for childbirth complications because CPD involves multiple interacting biological and obstetric factors.
Implications for Maternal Healthcare
The findings carry important implications for midwives, obstetricians, and public health policymakers.
Researchers recommend that healthcare providers adopt more comprehensive risk assessment systems for childbirth complications instead of relying mainly on maternal height measurements.
Recommended approaches include:
- Clinical pelvimetry examinations
- Ultrasound monitoring of fetal size
- Detailed obstetric history assessment
- Monitoring labor progression
- Nutritional evaluation during pregnancy
The study also supports stronger adolescent nutrition programs to improve skeletal and pelvic development before women reach reproductive age.
Researchers believe preventive maternal health policies focusing on adolescent nutrition could help reduce future CPD cases more effectively than height-based screening alone.
Study Limitations and Future Research
The authors acknowledged several limitations in the study. Because the research only analyzed mothers already diagnosed with CPD, the findings may not represent the broader obstetric population.
The study also focused solely on maternal height without controlling for other variables such as fetal weight, maternal body mass index, pelvic measurements, or labor mechanisms.
Future research involving larger populations and multiple clinical factors is expected to provide more accurate insight into the causes of CPD in Indonesian women.
Author Profiles
- Juli Purnama Hamudi, S.Tr.Keb: Midwifery researcher at Pelita Ibu Health Sciences College specializing in maternal and reproductive health.
- Lisnawati, M.Keb: Lecturer in midwifery at Pelita Ibu Health Sciences College with expertise in obstetric care and maternal health research.
- Astri Yunita, M.Psi: Psychology researcher at Halu Oleo University focusing on psychological and public health aspects of maternal wellbeing.
 in Mothers Giving Birth at RSUD Bahteramas, Southeast Sulawesi Province){kind=link}
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