"large baby" and "lets schedule your induction"

magpiebride61210 · June 2011

ok so i know i'm putting the cart before the horse here. forgive me. but i feel the need to have a plan in case this happens:

baby has been "large" for a while. we've had weekly NST's due to lack of movement and a few growth ultrasounds to boot. he's been around the 90th% since 28 weeks. next week at my 36 week appointment my OB wants to do a "final growth ultrasound" to determine "what we're dealing with". Now from the stories around the block, I'd imagine that if all goes well my doc will simply say "yes he's a bigger baby but big babies are born naturally every day. there's no need to push labor, lets just let him come on his own. you can do it."

ok that would be great, but is that reality? not quite. If said above conversation does not happen, and instead I get the opposite which goes something like this "he's looking big, if you go to full term he'll end up being too big for you to deliver vaginally. so lets schedule your induction." What do I do?

how big is "too big"? how long is too long to wait? I have struggled this entire pregnancy with staying true to my desires yet balancing the guidance from the OB. who does have a medical degree, and I don't. they've also told me "lying on your back is best for pushing". and we all know that to be false. so i've got a clouded head here, and i'm looking for some ideas as to what I might prepare myself to say in response with "lets have you come in in two weeks to induce you". if that's truly an emergent medical need, then sign me up. but is it? I guess i could ask my OB this question, but again... i asked him about pushing positions and i was told to lay on my back for best results. this OB (and a few of the others in the practice) still think I'm going to just believe what they tell me.

so in short, have any of you been in a situation with a "too big baby" before, and what was your plan of attack? if you waited and refused the induction how did things go? if you went with the medical advice, how did the induction go?

thanks girls... can you tell i'm starting to panic?

chiromommyMichelle · June 2011

Barring physical complications in the mother (pelvis affected by disease or injury) or with the pregnancy (uncontrolled GD) a woman's baby will rarely grow a baby that she can't deliver. I had an 11 lb boy vaginally, and my mother (who stands five foot nothing) delivered two babies over ten pounds.

CurbsideProphet · June 2011

I do not have experience with this myself, but have read about it a bit in case it becomes an issue. From the various things I have read/heard it is quite rare for you body to produce a baby that would be too big for you to deliver vaginally. Unless you are malnourished or have some other medical condition, which I assume is not the case.

I have also heard that weight estimates based on ultrasounds can be off and they induce and then you end up delivering too soon.

I suppose I would try to avoid the induction if possible if baby seems to be okay.

Hopefully someone with experience can you some advice. Good luck!

MistyIN · June 2011

I would not induce based soley on size. I know quite a few moms who birthed 10 plus pound babies vaginally.

Also, I was told from my 20 week scan on that my baby was going to be big. They hoped I could deliver him vaginally....he was a whoping 6lb 15oz.

flyer23 · June 2011

ACOG does not recommend induction for suspected fetal macrosomia. And only suggests considering a scheduled c-section for babies estimated to be > 5000g (nearly 11 lbs). And BTW, they have medical degrees Smile

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

So, if you try to get pressured into an induction, I would ask your doctor why s/he is not following ACOG's guidelines. It's not like they're a bunch of natural birthin' hippies.

magpiebride61210 · June 2011

MistyIN:

I would not induce based soley on size. I know quite a few moms who birthed 10 plus pound babies vaginally.

Also, I was told from my 20 week scan on that my baby was going to be big. They hoped I could deliver him vaginally....he was a whoping 6lb 15oz.

i've heard this story so many times! this is why i'm so not feeling the induction based on size.

ok thanks everyone! you've reassured me that what I know about this process is true and there's most likely no need to induce just b/c he might be bigger than most.

Texas77again · June 2011

i totes agree with the others about most women not making babies that don't fit thru their pelvis.

i think if it were me i would just shrug it off and laugh when/if the dr mentioned that. i would say something like, "oh dr, you have no idea how powerful my vagina is." if you knew me you would believe me that i would say something like that. i would just pretend that the dr is talking crazy and not give it a second thought.

if the dr insists on it or keeps harping on it, maybe you could say that you are going to try to a vaginal birth and you'll see what happens. don't let them use scare tactics.

nosoup4u · June 2011

magpiebride61210:
I guess i could ask my OB this question, but again... i asked him about pushing positions and i was told to lay on my back for best results. this OB (and a few of the others in the practice) still think I'm going to just believe what they tell me.

Ask him!! It's definitely better to know what he would want to do with a suspected big baby ahead of time, rather than getting caught unprepared at a later point in time. And that way you can research on your own, and come up with a counter offer or arguments not to (though it sounds like you have a good amount of knowledge already!).

If the baby *is* big, going into labor on your is going to give your body the best chance at a vaginal birth. FWIW, my second son was 10.5 lb, birthed without meds (and totally not in an upright birthing position. I was too out of it and tired to move at that point, heh heh). But I didn't have any sizing estimates during my pg with him (which frankly, was probably a good thing). Oh, which reminds me, you could just refuse the final sizing u/s if it makes you feel better.

Good luck!

PBugMom · June 2011

magpiebride61210:
"he's looking big, if you go to full term he'll end up being too big for you to deliver vaginally. so lets schedule your induction." What do I do?

You call BS - my cousin's "8.5 lb baby" weighed more like 6, and my "almost 10 lb baby" weighed 7.5. Sonograms just aren't genius at telling the weight.

As PP said - it's so rare for your body to grow a baby so big you can't deliver it, that I wouldn't even consider this a likely possibility for it to actually happen. What is likely is that the OB will have a tee time or a vacation date, and be creative with the truth to get you to agree to an induction, but that's where consent comes in.

KateLouise · June 2011

My baby was measuring big.

I went for a growth scan at 36 weeks. The Dr suggested she could be 8 1/2 - 9 pounds (which to my mind isn't that big anyway, but I know it's bigger than average).

My midwife just said, "well she's bigger than average but that's ok." Then looked at my hips and said I had fine hips so no big deal. A;though going into the scan she said, this won't change how we approach things, it's just nice to have a clearer picture.

As it turns out the Dr's prediction was right, she was bang on 9 pounds. Delivered vaginally, no issues.

miababy · June 2011

I think it's important to make sure your OB know's your desires before delivery day. Continually mention to her that, ideally, you want a natural birth. It's not the norm so many OB's just assume a woman will want a induction.

cottonlily84 · June 2011

I don't have any specific or experienced suggestions except ask your doctor. I'm like you. I don't really want to worry about things but I have to think about them in advance to be prepared. I play over all kinds of scenarios in my head about the tests and appointments. So I applaud you for being proactive and having a plan for the what ifs! If you don't like the answer he/she gives you then tell him/her why. Discuss it. You have to come to some middle ground you're both comfortable with.

And I think - medical degree or not - anyone who says birthing on your back is best is a DA! The correct answer would be everyone's body is different and various birth positions could work for each woman. They also tell you to push like you're having a bowel movement...who does that lying on their backs? We even toilet with gravity on our sides. Lying flat is best for drs, not necessarily birthing women.

beedale862003 · June 2011

You could bring up the fact that you believe that pushing on your back may be the best position for him (the doctor) but its certainly not the best position for the laboring woman. So is that what he is using to decide that an induction would be best...best for him not you.

Rosepetals45 · June 2011

When they talk about baby being too big I feel as though they are addressing the size of the head when it comes to delivering vaginally or by c-section. A person cant tell just by looking at your body (hips) if you will be able to deliver a big baby because the opening of the pelvic canal doesnt necessarily correlate with how wide your hips are. Personally I dont know I would do everything the Dr. says if what they are saying seems too extreme, I would get a 2nd opinion and then weigh my options because ultimately its your decision. Remember there are cases where women labor for 24 hours and dont deliver because the baby's head wont pass through the pelvic canal (thats a c-section). I hope you deliver how you ultimately want but better to be prepared for the other options.

rjveldman · June 2011

My baby measured big my entire pregnancy. At 36 weeks, he measured at 8 lbs.13 oz. And at 40 weeks, he measured over 10. The doctor said the only reason he wasn't measuring bigger was his head was measuring smaller proportionally - the rest of him was measuring at 11 or 12. She strongly wanted to induce me, but I stuck to my guns. Labor started naturally at 41 weeks 6 days and I delivered my son naturally. He weighed a whopping 8 lbs. 13 oz. And 20 1/2 inches long.

Those ultrasounds are a crock of crap if you ask me. Don't bother taking any stock in them. Don't force your baby to come before it's ready - that's far more dangerous than the big baby you might have.

StacieJane · June 2011

PP's link from the ACOG would be my suggestion too ... print that out and take it with you.

And anecdotally, every friend I've had who was warned about her "big" baby has ended up having a totally normal size baby. And all, with the exception of one, delivered vaginally. My MIL, a teeny tiny Japanese woman, gave birth to almost-three-weeks-late H vaginally and without meds ... he weighed 10 lbs 8 oz.

Yules · June 2011

Dont listen to anyone on these boards including myself. When i was faced with a huge measurement at my 38 week ultrasound, I was in a state of panic.Everyone on the bump knew a mom or a sister or cousin who delivered naturally, once in a while the person resoponding actually managed this ordeal themselves.For me, it all came down to what was safest for the baby. You are risking should dystocia and nerve damage if the baby is to become trapped in the birth canal.I'm sure that your ob has already discussed these risks for you. I decided to get a csection, and to this day I think this was the best decision. I didnt put my child at risk,the recovery wasn't as bad as I thought it would be.And I didn't end up with 3rd degree tears that would have been inevitable with a natural delivery.Good luck on your decision and don't let any one of us steer you in the wrong direction.

Yules · June 2011

...oh and to those who consider medical advances a crock or crap. My growth us estimated my boy to be 9.2 a week before he was born. At birth, he weighed 9.12 lbs. I consider that final growth ultrasound a godsend.

macdidlyicious · June 2011

Just because an induction is scheduled doesnt mean you have to show up. In the end, its ultimately your choice. Go in, discuss things with your doc with the "ammo" the ladies above gave you and stick to what you believe.

flyer23 · June 2011

Yules:
Dont listen to anyone on these boards including myself. When i was faced with a huge measurement at my 38 week ultrasound, I was in a state of panic.Everyone on the bump knew a mom or a sister or cousin who delivered naturally, once in a while the person resoponding actually managed this ordeal themselves.For me, it all came down to what was safest for the baby. You are risking should dystocia and nerve damage if the baby is to become trapped in the birth canal.I'm sure that your ob has already discussed these risks for you. I decided to get a csection, and to this day I think this was the best decision. I didnt put my child at risk,the recovery wasn't as bad as I thought it would be.And I didn't end up with 3rd degree tears that would have been inevitable with a natural delivery.Good luck on your decision and don't let any one of us steer you in the wrong direction.

Gah. I don't even know where to start.

~ My DD was 9 lbs 7 oz. Delivered vaginally with no complications. I did have a third degree tear. Recovery was a breeze. I would take that any day over a c-section.

~ Yes, shoulder dystocia is a risk with a large baby. But only 10% of babies weighing between 4000-4500g (about 9-10 lbs) will experience shoulder dystocia. And 80% of all shoulder dystocia deliveries resolve with NO injury (temporary or permanent) to the baby. That means that only about 2% of all babies weighing between 9-10 lbs will experience a shoulder dystocia injury. (For babies over 10 lbs, it's about 5%.)

~ Also, half of all cases of shoulder dystocia occur in babies weighing less than 9 lbs. Maybe we should all just have c-sections?

~ You didn't put your child at risk because you had a c-section??? Really??? Risks of c-sections to babies include premature delivery, breathing problems, low Apgars, and fetal injury (getting nicked while making the incision). Risks of c-sections to mothers include infection, hemorrhage, injury to organs, adhesions, extended hospital stay/recovery time, reactions to anesthesia/other medications used, and death. And the risks go up with every subsequent c-section -- and once you've had a c-section, you're likely to have c-sections for future babies, given the current attitudes towards VBAC in this country.

But don't listen to me. No, really... don't. I'm not a doctor. Listen to ACOG. They are doctors. I provided a link to their guidelines for management of suspected fetal macrosomia earlier, but here it is again, along with what they have to say specifically on the question of prophylactic c-sections:

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

"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)."

Yules · June 2011

Thank you flyer23 for all that eye opening research that you are assuming I didn't do myself.I blame militant anti-cesearean people like you for making me feel like a failure during my last weeks of pregnancy.Women are made to feel ashamed for choosing cesereans, not being able to breastfeed, leaving their children at daycare centers...etcInstead of thoroughly enjoying my little boy, I dealt with post partum depression because I didn't deliver him vaginally...because or recurrent mastitis and not being able to bf.No one should ever be made to feel guilt over the shooter cards nature may hAve dealt us. Now that I'm physically and mentally well, I'm proud of my csection scar and the opportunity it provided my son to be born safely and perfectly healthy.The risks you mentioned pertaining seemed trivial compared to a 1 in 10 risk of having my son come into this world with a broken collarboneAs far as recovery from 3rd degree tears vs a successful cesearean, it all depends on the individual. Besides all the research you've provided you fIled to mention thAt the assessments for risk aren't only based on e size of the baby. The mothers size plays a huge role too.This is why there is a medical term, called Cephalo-pelvic incompatibility.Maternal size of 5'3 or below and fetal size >8.7 constitutes a much larger risk of shoulder dystocia.In my case it was 5'3, 108 lbs, and lo weighing 9.12I feel proud of my decision to have a ceserean. The anger of how I was made to feel by the "natural birth" community will probably never cease to exist.Every mother deserves to feel pride and joy of bringing life into this world, no matter what path she chose.To attempt to undermine anyone's decision on their birth practices is antifeminist, elitist and just plain rude.I will reiterate, the op shouldn't listen to any one of us. In fact, in situations like this one is best off stepping away from the computer and listening to their own intuition.

flyer23 · July 2011

Yules:
Thank you flyer23 for all that eye opening research that you are assuming I didn't do myself.I blame militant anti-cesearean people like you for making me feel like a failure during my last weeks of pregnancy.Women are made to feel ashamed for choosing cesereans, not being able to breastfeed, leaving their children at daycare centers...etcInstead of thoroughly enjoying my little boy, I dealt with post partum depression because I didn't deliver him vaginally...because or recurrent mastitis and not being able to bf.No one should ever be made to feel guilt over the shooter cards nature may hAve dealt us. Now that I'm physically and mentally well, I'm proud of my csection scar and the opportunity it provided my son to be born safely and perfectly healthy.The risks you mentioned pertaining seemed trivial compared to a 1 in 10 risk of having my son come into this world with a broken collarboneAs far as recovery from 3rd degree tears vs a successful cesearean, it all depends on the individual. Besides all the research you've provided you fIled to mention thAt the assessments for risk aren't only based on e size of the baby. The mothers size plays a huge role too.This is why there is a medical term, called Cephalo-pelvic incompatibility.Maternal size of 5'3 or below and fetal size >8.7 constitutes a much larger risk of shoulder dystocia.In my case it was 5'3, 108 lbs, and lo weighing 9.12I feel proud of my decision to have a ceserean. The anger of how I was made to feel by the "natural birth" community will probably never cease to exist.Every mother deserves to feel pride and joy of bringing life into this world, no matter what path she chose.To attempt to undermine anyone's decision on their birth practices is antifeminist, elitist and just plain rude.I will reiterate, the op shouldn't listen to any one of us. In fact, in situations like this one is best off stepping away from the computer and listening to their own intuition.

Actually, I make no assumptions about the research you did. My post was more for the OP, who might not have done much research yet and therefore might not realize that your first post contained many incorrect statements.

As for your post above, the medical term is actually cephalopelvic disproportion (CPD), not cephalopelvic incompatibility, and it has nothing to do with shoulder dystocia. CPD happens when the baby's head is too big to fit through the birth canal. Shoulder dystocia happens when the head fits through just fine but the shoulders get stuck on the mother's pelvis during delivery.

Do you have a link backing up your statement about maternal size playing a "huge" role in determining the risk for shoulder dystocia? It's not mentioned as a risk factor on the March of Dimes page, for example.

And do you have another link backing up your statement about a 10% risk of a broken collarbone? As I mentioned in my previous post, the risk of any type of injury due to shoulder dystocia in a baby the weight of yours and mine is about 2%. A fractured clavicle can occur even without shoulder dystocia, so it's possible that the risk of a fractured clavicle is higher than the risk of injury due to SD. The only link I could find puts the risk of a fractured clavicle at just under 1%, but that doesn't take macrosomia into account. So -- I'd love to see your source.

Regardless... again, all of this is directed at the OP, to help her with her decision. It was not at all my intention to make you feel guilty over YOUR decision. I honestly don't care how other women give birth. What I do care about is seeing every woman getting the data she needs to make informed choices. To that end, when I see someone inflating the risk of shoulder dystocia, and downplaying the risk of c-sections, I feel compelled to respond -- not to make her feel bad or say that she made a wrong decision, but to ensure that women reading that information don't take it as fact.

If you wish to dispute anything I've posted, please, go right ahead -- and include links! I'm always looking for more information on the risks of having a macrosomic baby, since they tend to run in my family Smile And you are absolutely right that it's about what is safest for the baby! So if there's information that I'm missing that could help me make a more informed decision, I definitely want to see it.

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