ACOG Guidelines for Big Babies (tldr: induction not recommended)

rumslave

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

PhysChic7685

It doesn't sound like they're entirely sure on this:

"results are affected by small sample size and bias caused by the retrospective nature of the reports. " 

rumslave

Here is the full paragraph:

 INDUCTION OF LABOR.

In cases of term patients with suspected fetal macrosomia, current evidence does not support early induction of labor. Results from recent reports indicate that induction of labor at least doubles the risk of cesarean delivery without reducing the risk of shoulder dystocia or newborn morbidity, although the results are affected by small sample size and bias caused by the retrospective nature of the reports. Results from one randomized clinical trial reveal similar cesarean delivery rates in the induction group (19.4 percent) compared with the expectant management group (21.6 percent), with five cases of shoulder dystocia in the induction group and six cases in the expectant management group.

 

ACOG recommends a trial of labor with a csection in the event of mid pelvic arrest.

 Something else to think about: just because a baby is big doesn't mean that its lungs are fully developed.  Inducing early because the baby is big might mean a baby with undeveloped lungs (big or not) being born before its ready with all that comes with it, i.e. a nicu stay, breathing problems, etc. 

BitsKD13

I'm just going to point out that the article is from 2001.  ACOG does not condemn c-sections/inductions after 39 weeks. Also I know that AGOC and ADA both say that early induction is recommended in women with GD. 

gekeler6

Totally agree, just because a baby is larger than average (or in some cases HUGE), doesn't mean they are done developing.  Let the baby come when the baby is ready.

mamabear0813

gekeler6:

Totally agree, just because a baby is larger than average (or in some cases HUGE), doesn't mean they are done developing.  Let the baby come when the baby is ready.

Or at very least, wait until 40 weeks, do an u/s THEN and make a decision as to where the baby might be in size and weight and decide if a c-section is needed or if a vaginal birth could be possible.

In general, I just don't believe in inductions. If the situation is enough of an emergency to warrant a quick delivery, have a c-section. If it isn't wait until you can go into labor on your own. If you can't go into labor on your own, have a c-section. Trying to deliver a baby that is too large can cause both you and the baby damage, so just have the surgery, but don't do it until at least 40 weeks when the baby is most likely well developed. 

sapphirebride06

This is such a very sensitive subject.  I think women need to do research and understand their options, etc. but also trust their doctors - otherwise they should pick a different doctor.  I'd never go to a doctor I didn't trust, or didn't agree with their opinion. 

I have GD so my doctor doesn't want me to go beyond 39 weeks due to placenta issues.  So as of now the plan is to induce at 39 weeks, but if things keep looking good and DS does well on the NSTs and BPP/growth ultrasound then she is willing to let me have another before we induce - the day before my induction is scheduled.  If things are still looking okay, then I will likely have twice weekly BPP and NSTs instead of just weekly NSTs - that way we can be on the safer side and know before something bad happens. 

I'm working with my Ob and the MFM so I feel confident and if they tell me we need to induce, I will go along with that.  But from their standpoint, it is more related to potential placenta breakdown than size of the baby.  My point is there are many factors to consider and what works for one person is not an option for another. 

vanillacourage

mamabear0813:

In general, I just don't believe in inductions. If the situation is enough of an emergency to warrant a quick delivery, have a c-section. If it isn't wait until you can go into labor on your own. If you can't go into labor on your own, have a c-section. Trying to deliver a baby that is too large can cause both you and the baby damage, so just have the surgery, but don't do it until at least 40 weeks when the baby is most likely well developed. 

So you honestly think an induction is riskier than major abdominal surgery?  Do you have any background data or training to back that up?

(I say this having had a scheduled c/s with my DS)

danandbethg

I am figuring I will end up with a c-section. I am 5'2" and DH is 6'2". DH was a HUGE baby (just under 11 pounds and 23 inches long) and his mom is also 5'2". My LO is measuring large for his gestational age, and I am NOT GD. My DH was born via emergency C-section after getting stuck and the nurses lost his heartbeat. He was born dead and had to be resusitated. MIL was given a general, so she didn't get to experience the birth of her only child. I told my doc I would much rather have an elective c-section than labor for 36 hours, push for 8 hours and get cut anyhow. So, if LO is 9 pounds at 38 weeks, yes, I would rather be induced. Yes, I do have the education and experience to back this up. I am a respiratory therapist who has been attending high right deliveries for 10 years. I've seen babies born dead and mommys' hearts stop during delivery because they were so darn stuck on having "their" delivery, rather than just doing what is safe.

acaudill75

danandbethg:

I am figuring I will end up with a c-section. I am 5'2" and DH is 6'2". DH was a HUGE baby (just under 11 pounds and 23 inches long) and his mom is also 5'2". My LO is measuring large for his gestational age, and I am NOT GD. My DH was born via emergency C-section after getting stuck and the nurses lost his heartbeat. He was born dead and had to be resusitated. MIL was given a general, so she didn't get to experience the birth of her only child. I told my doc I would much rather have an elective c-section than labor for 36 hours, push for 8 hours and get cut anyhow. So, if LO is 9 pounds at 38 weeks, yes, I would rather be induced. Yes, I do have the education and experience to back this up. I am a respiratory therapist who has been attending high right deliveries for 10 years. I've seen babies born dead and mommys' hearts stop during delivery because they were so darn stuck on having "their" delivery, rather than just doing what is safe.

You can't argue scientific fact with knee jerk, gut reactions. Inductions seem to be up there with BFing when it comes to heated debates. Some people like to lord "natural" over those of us don't go all natural. If you induce you are a bad mom. If you have a c-section, you are a bad mom. If you have an epidural, you are a bad mom. If you give LO formula, you are a bad mom. Not every decision against "natural" is a decision made for convenience, but it might as well be in the eyes of the au natural fascists. No one gets a medal for going med free and ripping in four places while putting LO in danger of dying during delivery. And not everyone needs a c-section or an induction. How about letting the OB and the mom decide on a birth plan and let it go at that?

mamabear0813

vanillacourage:

mamabear0813:

In general, I just don't believe in inductions. If the situation is enough of an emergency to warrant a quick delivery, have a c-section. If it isn't wait until you can go into labor on your own. If you can't go into labor on your own, have a c-section. Trying to deliver a baby that is too large can cause both you and the baby damage, so just have the surgery, but don't do it until at least 40 weeks when the baby is most likely well developed. 

So you honestly think an induction is riskier than major abdominal surgery?  Do you have any background data or training to back that up?

(I say this having had a scheduled c/s with my DS)

I think it CAN be riskier. My evidence is anectdotal. For instance, the woman who posted yesterday who's LO has nerve damage because she delivered vaginally and the baby was too big and they had to use interventions to deliver the baby. She was trying to use it as an example of why you should induce when the doctor says, even if that means delivering early, but to me it made a point to let the baby mature fully in the womb, where the baby wants to be and is able to grow and mature safely, then have a c-section at 40 weeks.

I think the idea with this situation is to induce a woman before her due date, because her baby may grow too large to be delivered, but that poses risks of the baby already being too large and having trouble during the birth that could cause serious harm to mother and baby, or not developed enough and needing a stay in the NICU or that she tries the induction and since her body is not ready to deliver, she needs a c-section anyway, and her child may still need a NICU stay for lung development or jaundice. Having an induction puts a woman at twice as much of a risk of having a c-section anyway.

The risk of having a c-section at term, IMO, is less than trying to deliver a baby early vaginally. There may be a longer/harder recovery for the mother in that case, but the likelihood of there being serious life threatening complications of the delivery for mother or baby is less than trying to vaginally deliver a baby who isn't ready to be born. 

pinksweetpea2

mamabear0813:

vanillacourage:

mamabear0813:

In general, I just don't believe in inductions. If the situation is enough of an emergency to warrant a quick delivery, have a c-section. If it isn't wait until you can go into labor on your own. If you can't go into labor on your own, have a c-section. Trying to deliver a baby that is too large can cause both you and the baby damage, so just have the surgery, but don't do it until at least 40 weeks when the baby is most likely well developed. 

So you honestly think an induction is riskier than major abdominal surgery?  Do you have any background data or training to back that up?

(I say this having had a scheduled c/s with my DS)

 My evidence is anectdotal.

LOL  Exactly.... and you even spelled anecdotal wrong.  Priceless.