Big Baby and Possible C-Section

rshamos

I had an u/s today and the baby is measuring in the 93rd percentile for size. OB said that I need to have another u/s in a month to see how big he is then. She told me to begin to think about a c-section as a serious possibility, possibly earlier than 39-40 weeks. Fortunately, everything else looks good. I took my GTT today so I will get the results in a couple of days. I am staying positive, but I am pretty bummed. OB said we will keep him in there for as long as possible. On the bright side, he looks super healthy and happy in there.

weezy29

I don't understand the C-Section recommendation. I know many tiny women who have delivered 9+ pound babies vaginally with no issues.

Of course, congrats on your big healthy boy!!

Cheekers2010

I'm sorry that you need to worry about this.  This is interesting because ACOG issued a statement that suspected fetal macrosomia is not usually a reason to perform a c-section.  Especially because u/s size estimates are extremely imprecise.  They can be a couple of lbs off either way.  Additionally, many tiny little women deliver 10 lb + babies with no difficulty.  I personally would be very wary of scheduling a c-section based only on u/s estimates. 

Here's a link to ACOG's paper.  Hopefully I've got the right one here.

https://www.aafp.org/afp/2001/0701/p169.html

ebilbao

Yeah-I feel like the big baby reason for a c-section is bullshit. Ultrasounds are notorious for measuring large. It's so hard to say anything but yes to one, though, when they bring up the welfare of the baby. You can ask the doc if you can give labor a shot and see how it goes, no?

Cheekers2010

Here is a specific paragraph on this topic from ACOG:

Suspected Fetal Macrosomia

Suspected fetal macrosomia is not an indication for delivery and rarely is an indication for cesarean delivery. To avoid potential birth trauma, the College recommends that cesarean delivery be limited to estimated fetal weights of at least 5,000 g in women without diabetes and at least 4,500 g in women with diabetes (Table 3) (99). This recommendation is based on estimations of the number needed to treat from a study that modeled the potential risks and benefits from a scheduled, nonmedically indicated cesarean delivery for suspected fetal macrosomia, including shoulder dystocias and permanent brachial plexus injuries (100). The prevalence of birth weight of 5,000 g or more is rare, and patients should be counseled that estimates of fetal weight, particularly late in gestation, are imprecise (Table 3). Even when these thresholds are not reached, screening ultrasonography performed late in pregnancy has been associated with the unintended consequence of increased cesarean delivery with no evidence of neonatal benefit (101). Thus, ultrasonography for estimated fetal weight in the third trimester should be used sparingly and with clear indications.

From this article:  https://www.acog.org/Resources-And-Publications/Obstetric-Care-Consensus-Series/Safe-Prevention-of-the-Primary-Cesarean-Delivery

ETA:  5,000 grams is more than 11 lbs by the way.

rshamos

Yes, I think she just wanted to let me know that it could be a possibility bc otherwise there would be no reason for me to have a c-secition. I like my OB bc she is very candid about treatment, but said that we would try to stick to my birth plan, which is vaginal with an epidural. Thank you for the great advice, ladies!

MaineMama

Around the same time (I think it was 28weeks for me) my OB started telling me how I was lucky to be having a repeat csection because my youngest was "Huge" I had multiple ultrasounds from 20weeks on and every time they would comment on how big he was.

He was born at 8lbs2oz, 21inches. He didn't become baby Hulk until after he was a year old. NOW he is huge (bigger than his 3yo sister)

Eora3

I guess I am confused as to why you would need to deliver early for sizing concerns if you OB wants to do a c-section anyway. What difference does it make how big the baby is if you have a c-section? That isn't even logical much less medically sound (unless you have some complication or medical issue you didn't mention).

I know you said you like your OB, but could your due date be conflicting with some holiday/vacation plans she has?

AllTheTeaInChina

My sister just had a baby. She was getting u/s to monitor baby's position(breech). He flipped by 36 weeks but she was told over and over he was going to be big. They were also monitoring the cord so she had another u/s around 38 weeks. They est him to be over 8lb at that time. She had to be induced just past 39 weeks due to other issues --he was a whopping 7.5lb.

U/s are not very accurate in determining the size of baby.

babycakes0408

With dd#2 there was quiet a disagreement with my regular ob and my perintologist. Reg US said baby weighed 7lbs at most 8lbs with possible error. Perintologist US said baby weighed 9lbs...this was at 34 weeks. Looking at 36 weeks perintologist begged me to amnio at 36 weeks to see if her lungs was developed enough to deliver. I finally agreed to avoid c section. My water broke on its own at 35 weeks. I labored until she had heart decels and rushed to emergency c section. Regular ob pulls her out and said "oh my god". She weighed 9lbs 13 oz. If I had carried to term easily 12 lbs baby they said.
**please note I am diabetic and this is not normal weight for baby**

You are still very early to decide that as others have said. If gestational diabetes is factor still don't expect a large baby...dd#1 I had GD then and she was 4lbs 6 oz at 34 weeks. Please don't just go with one ob opinion. You know your body better.

mlee116

Agree with PP's...this seems so early to be talking about a c-section just based on size alone.  I would get recommending one if there are other factors at play, but not just because they think the baby might be big.  And I definitely would not get one earlier than 39-40 weeks if there is no medical need to do so.

irishtriplets

I guess I'm going to be the lone dissenter in this one.  I measured 4 weeks ahead every single ultrasound from my anatomy scan on with my first two children.  No gestational diabetes, no issues that would make them suspect a large baby (aside from me being 5'9 and my husband being 6').  My children were 10.4 and 11 1.5.  So, trust your instincts AND your doctor.  They will tell you that an ultrasound can be off plus or minus 1-3 lbs, which is definitely a lot of discrepancy.  A mother in my area delivered a macrosomic baby vaginally and the baby has zero use of her right shoulder and arm because of it.  Don't rush out and schedule a csection out of fear but at least listen to your doctor.  A baby arriving healthy and safe is the ONLY important thing.  How it gets here does not matter.  Sure I probably could have delivered my children vaginally but I was not going to risk doing permanent harm to them or me in the process.  If they truly suspect macrosomia, odds are you will be monitored at the end and then a decision can be made.  Right now is still a little early to be predicting that outcome.  No one broached the csection subject with me until like week 37, I believe.   

irishtriplets

And I should also mention that both of my csections were not until 39 weeks exactly.  I had no issues other than giant babies so there was no need to rush and get them out.  This one is already scheduled for 39 weeks, just like her brother and sister.

MauraLou25

vjordan78 said:

trust your instincts AND your doctor. 

This. TRUST. I feel like there is a lot of doc mistrust and questioning ulterior motives. If that's the relationship you have with your physician, please find a new one. From what you've said, it sounds like your doc just wants to be sure you're prepared if this is a possibility. If you have a good relationship with your physician, you should feel comfortable questioning her if you want/need to, and having an open discussion.

rshamos

Don't get me wrong, I'm not bashing my OB. I really do trust my doc. I don't have a c-sect scheduled and vag delivery hasn't been taken off the table. She just wanted to prepare me that c-sect is a possibility. She is ordering u/s's for the rest of my pregnancy to keep really good track of his size. She said as long as mom and baby are healthy and not in danger, I can do a vag delivery. It just was a bit of a shock yesterday to learn that a c-sect was even in the cards. I (knock on wood) have had such an uncomplicated pregnancy that I never suspected there was a minuscule chance of having a c-sect.

DoctorWorm222

Just keep up with your testing and keep discussing with your doctor. Like others have said, ultrasound estimates are notoriously inaccurate. I thought I was going to have a 9+ lb baby, and she ended up being 6lbs8oz! 

mc0113

danisgossipgirl said:

I don't think it's doctor mistrust to wonder about a practice that falls outside what is recommended by ACOG, it's smart skepticism. I agree it warrants a conversation, but taking an active part in one's healthcare should be encouraged, not shamed.

I second this! I think every person should fully research any decision they make about their body and baby. I actually read this the other day in an article... "The September 2011 issue of Obstetrics and Gynecology, the official publication of the American College of Obstetricians and Gynecologists (ACOG), reported that only one third of all obstetrics guidelines in the US are based on good scientific evidence, one third are based on limited or inconsistent evidence, and the remaining third are based on expert opinion, which is "subject to bias, either implicit or subconscious."

It doesn't hurt to educate yourself on everything and present your findings to your doctor. If you still are uneasy about a decision, you can always get a 2nd opinion. 

irishtriplets

Bottom line, you will ultimately make the right decision that is best for you and your baby.  I had the OB (not even my OB) tell me at that 37 week visit that he'd done many vaginal births he sincerely regretted and not a single csection he wished he had not gone through with.  That has stuck with me even 3 years later.  I went home and talked to my husband to make sure he was okay with my choice and called them the next day to schedule it.  Nobody will ever know if my body was capable of delivering such giant babies but I sure as hell am glad I didn't try and find out.  It's probably a good thing they're just opening the dialogue with you now instead of ordering all these ultrasounds and you start wondering if something is wrong with you or the baby.  Good luck! 

[Deleted User]

The user and all related content has been deleted.

soulcupcake

Cheekers2010 said:

I'm sorry that you need to worry about this.  This is interesting because ACOG issued a statement that suspected fetal macrosomia is not usually a reason to perform a c-section.  Especially because u/s size estimates are extremely imprecise.  They can be a couple of lbs off either way.  Additionally, many tiny little women deliver 10 lb + babies with no difficulty.  I personally would be very wary of scheduling a c-section based only on u/s estimates. 

Here's a link to ACOG's paper.  Hopefully I've got the right one here.

https://www.aafp.org/afp/2001/0701/p169.html

This.

The above states:

"Nonetheless, the results of these reports, along with published cost-effectiveness data, do not support prophylactic cesarean delivery for suspected fetal macrosomia with estimated weights of less than 5,000 g (11 lb), although some authors agree that cesarean delivery in these situations should be considered."

Considering weight estimates in the third trimester can be off by as much as 2 lbs in either direction it isn't reliable concerning estimation of macrosomia.

Recommending a c-section before the start of the third trimester based on a LGA guesstimation is bad science. But, consider the following:

"CONCLUSION: One third of the recommendations put forth by the College in its practice bulletins are based on good and consistent scientific evidence."

Journal

The recommendation to section due to suspected LGA falls outside of that one third.

soulcupcake

danisgossipgirl said:

I don't think it's doctor mistrust to wonder about a practice that falls outside what is recommended by ACOG, it's smart skepticism. I agree it warrants a conversation, but taking an active part in one's healthcare should be encouraged, not shamed.

My sentiments exactly. It definitely isn't mistrust. It's favoring evidence-based practice over "this is the way I do things because it's been done like this for a really long time, even if the evidence supporting its practice is severely lacking." Which applies to a host of routine obstetric practices.

soulcupcake

OP, this is a good site that can provide some reassurance about birthing a bigger baby. A lot of women birth 10, 11, and 12 lb babies. 

argyledogs

In the end, it's up to what YOU feel comfortable with. There's plenty of c-sections that are "unnecessary" and then there's babies who would've been saved or helped with that technology. 

No one here is your doctor or you. 

I believe every woman has the right to choose her own birth- unmedicated in a birth center, epidural in a hospital, planned c-section, etc. 

You won't get a special badge for delivering one way or the other, so when the time comes, do what feels right for you and your body.  

krystrist2014

MauraLou25 said:

trust your instincts AND your doctor. 

This. TRUST. I feel like there is a lot of doc mistrust and questioning ulterior motives. If that's the relationship you have with your physician, please find a new one. From what you've said, it sounds like your doc just wants to be sure you're prepared if this is a possibility. If you have a good relationship with your physician, you should feel comfortable questioning her if you want/need to, and having an open discussion.

Full disclosure: I have a natural distrust of doctors who jump to the possibility/plan of a C-section. That being said, I have to agree with the quoted comments... If you trust your doctor and you are okay with the possibility of a C-section, then that's what is important. So long as you are comfortable in the care you are receiving.

Like many others, I personally have heard too many stories of doctors claiming baby was huge and jumping to C-section. When one of my closest friends was pregnant, she was over her estimated due date by 2 weeks and they chose to induce. During the ultrasound on day of induction the doctor told her the baby was pushing 10 lbs. After trying for a vaginal delivery, the doctor the baby was too big and she wound up with a C-section. Turned out baby was not even 7 lbs!!! When talking to her recently about her experience, she said that if she had to do it all over again, she wouldn't have gotten induced because she thinks that that is where the problems began.

rshamos

LimaBeanMOM said:

Okay I don't know why they are telling you c section. At 8 months with B they told me he was 5 pounds and in the 90 something percentile to grow and would be a big baby. We discussed possible induction which would take place at 38 weeks. We did another ultrasound at 36 weeks to see what the baby looked like and the percentile for growth was lower and they said he would be a little over 8 pounds which is a little big but normal sized. B was delivered vaginally at 9 pounds 8 ounces! I was 115 pounds before pregnancy and 5'3 -I am a small person and was able to deliver a very large baby vaginally. I would not let them convince you into having a c section! Def have another ultrasound and maybe even another opinion!

Yes, they are doing another u/s and monitoring me more closely. There is no c-set planned, she just wanted to let me know that it is a possibility. She was doing the right thing by mentioning it early bc it wasn't even a thought before. I've done my research and we had a really good conversation at my appt about it. It is also a group practice, so no one is missing vacation, etc. it's whomever is on call that delivers. It is just weird thinking that it could be a possibility. Thank you again for the kind words everyone!

weezy29

I would also check into the C Section rates of your Dr as that is a good indication of how willing she is to let you go vaginally. Many Drs can be awesome but still prefer C-Sections.

I'm trying for a VBAC 2 and will have my babies size monitored beginning at 37 weeks. Even being higher risk(and having a previously big baby that got stuck in pelvic canal) my Dr is willing to let me VBAC unless this baby is abnormally big. I've had 2 previous c sections and I just want to say, avoid one if you can. Taking care of a newborn and recovering from major surgery pretty much sucks!!

rshamos

@gradschoolmom1234‌ Exercise? Can't I just have a special massage right before? But seriously, that is great advice. One more reason to bust out my barre DVD!

rshamos

gradschoolmom1234 said:

rshamos said:

@gradschoolmom1234‌ Exercise? Can't I just have a special massage right before? But seriously, that is great advice. One more reason to bust out my barre DVD!

@rshamos - I think you're already in on this, but I can't remember off the top of my head - megbmeg runs an awesome fit friday check in. It's really nice to have some accountability and encouragement to get moving  

I kind of am. I mostly lurk on there. I finally have some energy back so I have started back with a routine. It's crazy how much harder it is working out with a big ol' belly!

BayCamp

I work on my feet, that counts as exercise right?

AngelSong76

Just throwing this out there - I ended up having to have a c-section because my son was too big - or because I was too narrow.  The doctor was concerned about it and recommended c-section, but I wanted to give it a try.  11 hours of labor later (and only 4 cm dilated with a baby who was stuck and a blood pressure that shot up super high) we did the c-section anyway.  

It's not always bullshit.  Sometimes the baby just won't fit.  I'm not saying OP should blindly trust the doctor and not do any research, but I sure wish I would have gone ahead and done the c-section when she suggested it.  It would have avoided some complications.

lynelise04

I hope you get to try and deliver. Growth ultrasounds have been wrong too often for me to electively chose a Cs. But to know baby may be larger is good, can prepare you all.
I vaginally delivered my second baby who was supposed to be a normal size. No meds, no drugs. All in an hour from checking in, she was 11lbs.

BankerBSN

lynelise04 said:

I hope you get to try and deliver. Growth ultrasounds have been wrong too often for me to electively chose a Cs. But to know baby may be larger is good, can prepare you all.
I vaginally delivered my second baby who was supposed to be a normal size. No meds, no drugs. All in an hour from checking in, she was 11lbs.

This just made my vagina scream.

I hope, come December, I have your strength.

AngelSong76

I'm aware it's not the same, but even if I had been fully dilated, he still would not have fit.  His shoulders were too broad and my pelvis was too narrow.  It was something she was concerned about from about 30 weeks on, and she ended up being right.

rshamos

I am glad that she mentioned it as well. She did also mention induction and the fact that he may just come on his own early, without intervention. I am the type of person that likes to know what ALL of the options are beforehand, so I can be informed before  it happens. I guess it's my ENFJ personality.

Cheekers2010

@rshamos - can I just tell you that I really appreciate how open you are to this conversation and how much I appreciate that you don't get defensive. I think we are all just wanting the best for each other and trying to help out.

rshamos

Cheekers2010 said:

@rshamos - can I just tell you that I really appreciate how open you are to this conversation and how much I appreciate that you don't get defensive. I think we are all just wanting the best for each other and trying to help out.

Thanks! I like to hear the whole spectrum of opinions. That's why I posted it, I knew that this is kind of a hot topic and it's good to hear from everyone. 

rshamos

@LimaBeanMOM you are fine! It takes waaaaaay more than that to upset me. 

Funny story, I was diagnosed by an orthopedic surgeon with "birthing hips" last year. It has caused me to have knee problems. So, I think I can do this!

irishtriplets

I guess for me personally I get a little defensive when people get all anti csection from the get go.  Nobody knows someone else's situation, at all.  When all is said and done, I will have had 3 csections in 2 weeks shy of 3 years (12/16/11, 1/25/13 and 12/4/14) and I am no worse for the wear because of it.  No issues whatsoever.  To automatically assume that a mom HAS to at least try to labor isn't very fair.  The end result is a healthy baby and mom.  Period.  It'd be a very different scenario if they'd already scheduled a csection for her this early but to at least open up the dialogue isn't a bad thing.  My doctor asked me if he was going to be tying my tubes at my very first prenatal visit. 

amieeyoung

I wish you the best of luck. It is good to know it can happen though. It didn't even enter my head with my first one, but fully dialated, little over 2 hrs pushing and there was just no way my son was coming out. Now, that maybe have been b/c his face was the opposite way it was supposed to be, but I do have narrow hips and am very petite. On the other hand my mom is only 5 inches taller with a little wider hips than me and had almost all of us natural -though 5/6 were born early. I say see what happens and just know that it is a possibility!!

My doctor said that this time we will see how big the baby is and how she is positioned closer to full term, but is ok with me trying a vbac barring any serious medical thing popping up between now and then.


We will see how it goes this time.

path75

I had a similar conversation with my ob my last visit. I was measuring a couple weeks ahead and in the 97th percentile. Although she didnt specifically mention c section it was implied. Her exact words were women cant deliver 12lb babies vaginally. It kind of caught me off guard at the moment. She did say not to worry and we can revisit after my growth scan at 32-34 weeks. I might schedule it for 33 weeks. I guess I have time to decide how I would want to proceed. My sister was induced due to the baby's suspected size and was a little over 8lbs. I would just recommend making a choice in how you want to proceed after the scan.

brittandjp

Telling you a C-section is possible this early based on their predicted size of baby is a load of crap. Ultrasounds are notorious for being a couple pounds off in either direction. Not that you're worried per say, but making you contemplate it and leaving you feeling bummed is not cool. I'm sorry she made you feel that way. I think continuing to monitor baby's growth is a great idea, but do NOT let her talk you into a C-section because of a big baby.

They told me DD was going to be a really big baby. She was born (vaginally) at a perfect 7 pounds 8 ounces.

And for the record, I haven't exercised once this pregnancy. I run after a toddler all day long, so I feel like that counts for something. Right???