Responding to OB who wants to induce for big baby

TrendyTina · April 2012

How did you respond to your OB if they approached you with

the recommendation that you should be induced for a big baby? I do NOT want to be induced and do not believe my body would have produced a baby too large for me to deliver, but I want to be prepared for this conversation. I?m having the growth scan on Tuesday (39 weeks) and, although my fundal measurements have been average throughout the entire pregnancy, have a feeling the doctor is going to say the scan shows a large baby. I?m 5?11 and last week he told me I?m likely ?hiding? a big baby. I?m very annoyed by all of this and want to rehearse what to say in advance. When I request more natural methods, he is very dismissive and references what he would want for his wife and daughter and that I ?shouldn?t try to be a hero.?

How did you respond to the topic of induction for a "too large" baby?

lizzardb85 · April 2012

Although I am sure that seeing your LO again would be really fun, you can decline the growth scan. They can be really inaccurate anyway.

Sorry I can't be more help

DebateThis · April 2012

Decline the growth scan and then point out that ACOG does not recommend inducing for supposed macrosmia anyways.

https://icanwesternmd.blogspot.com/2009/07/aacog-practice-guidelines-on-big-babies.html This is just a blog post but it's full of good info.

ACOG Practice Guidelines on 'Big Babies'
Have you or someone you know been told induction or cesarean is needed because the baby is too big? This is definitely an issue to read more about!
Practice Guidelines- ACOG Issues Guidelines on Fetal Macrosomia- https://www.aafp.org/afp/20010701/practice.html

From the link

    "The term fetal macrosomia implies fetal growth beyond a specific weight, usually 4,000 g (8 lb, 13 oz) or 4,500 g (9 lb, 4 oz),"
    "Weighing the newborn after delivery is the only way to accurately diagnose macrosomia, because the prenatal diagnostic methods (assessment of maternal risk factors, clinical examination and ultrasonographic measurement of the fetus) remain imprecise."
    "According to the ACOG committee, the risk factors (excluding preexisting diabetes mellitus) for fetal macrosomia, in decreasing order of importance, are as follows: a history of macrosomia, maternal prepregnancy weight, weight gain during pregnancy, multiparity, male fetus, gestational age more than 40 weeks, ethnicity, maternal birth weight, maternal height, maternal age younger than 17 years and a positive 50-g glucose screen with a negative result on the three-hour glucose tolerance test. "

Comments on the above passages

1. Having suspected fetal macrosomia is not a necessary reason for a c-section according to ICAN's Cesarean Fact Sheet https://www.ican-online.org/pregnancy/cesarean-fact-sheet . "There are very few true indications for a cesarean section in which the risks of surgery will outweigh the risks of vaginal birth"

2. A good number of cesareans happen because of a "big baby scare" where a woman is told how large her baby will be and how she would never birth it vaginally. Read this for inaccuracies in ultrasound for predicting fetal weight- https://www.plus-size-pregnancy.org/Prenatal Testing/prenataltest-ultrasoundsafety.htm#Ultrasound for Estimating Fetal Weight According to one study referred to " 23% were more than 1 pound overestimated, and 50% of the babies predicted to be macrosomic weren't macrosomic at all." Read this commentary here https://ican-online.org/community/blogs/rachael-kelly/random-ramblings-stressed-out-student

3. Induction or cesarean purely based on risk factors and/or estimated fetal measurement does not dissolve all risk. One of the things that slightly increases with a bigger baby is shoulder distocia (but can happen with any size). Read this post from The Unecesarean https://www.unnecesarean.com/blog/2009/6/17/can-my-doctor-really-predict-shoulder-dystocia.html In it she quotes Munro-Kerr?s Operative Obstetrics (2007) by Baskettit "the risk of serious fetal injury associated with shoulder dystocia is rare. The hope that ultrasound prediction of fetal weight and more detailed ultrasound measurements such as shoulder width would provide an accurate level of risk have been unfilled. Indeed, for the macrosomic fetus clinical estimation of fetal weight is as accurate as that predicted by ultrasound. Even if one could predict fetal macrosomia accurately, it would be of limited value. About 95% of infants weighing over 4000 grams will not have shoulder dystocia. It has been suggested that elective caesarean for fetuses weighing more than 4500 grams would reduce shoulder dystocia and fetal injury. A decision analysis model has shown that this strategy would be both clinically and cost ineffective; it was estimated that to prevent one permanent brachial plexus injury 3695 caesarean sections would be required. Furthermore, the majority of cases of shoulder dystocia occur at fetal weight less than 4500 grams."

Past posts on how 'big babies' effect birthing trends- https://icanwesternmd.blogspot.com/2009/06/big-baby-scare-and-elective-primary-c.html https://icanwesternmd.blogspot.com/2009/05/cephalopelvic-disproportion-cpd-and.html

august8080 · April 2012

How annoying! I'm 6' and had a 9.8 baby, no problems, no tearing. You'll be fine.

Present him with the ACOG information:

ACOG Practice Bulletin No. 22 which appeared in the November 2000
issue of Obstetrics and Gynecology found no value in inducing for ?big
baby? since it simply doubles the CS rate and does not prevent
shoulder dystocia or reduce newborn morbidity. Nor do they support
cesarean section for ?big babies unless the baby is suspected to be
ELEVEN POUNDS:

?While the risk of birth trauma with vaginal delivery is higher with
increased birth weight, cesarean delivery reduces, but does not
eliminate, this risk. In addition, randomized clinical trial results
have not shown the clinical effectiveness of prophylactic cesarean
delivery when any specific estimated fetal weight is unknown.

Results from large cohort and case-control studies reveal that it is
safe to allow a trial of labor for estimated fetal weight of more than
4,000 g. 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.

Here's the full text:

https://medcenter.usc.edu/files/practice%20bulletin%20022%20fetal%20macrosomia.pdf

Bonidiebabe · April 2012

PP gave some really good info so I just wanted to say good luck to you. If I were in your shoes I would most likely not go for the growth scan. If you had worries of some sort of issues or development I'd say go for it. It seems to me though that it can only fuel what you don't want....pressure from your OB.

honkytonk_kid · April 2012

"Is there a reason you would recommend this despite clear ACOG guidelines to the contrary?"

"I'm not your wife or your daughter, and even if I were I would appreciate your consideration of MY desires for the well-being and safety of MY body and MY child."

Or just a good old fashioned, "No, thank you!"

Good luck, mama. Oh, and skip the growth u/s.

DebateThis · April 2012

I should say, too, that my initial reaction to a medical professional telling me not to be a hero would be to shove his speculum up his arse - so there's always that approach, lol. Stick out tongue

And is there any possibility you could switch care providers? I know it's late in the game but there's no way I could stay with an OB who was that unsupportive of me. GL.

tokenhoser · April 2012

I agree with asking why he chooses to go against the ACOG recommendations... and skipping the u/s. I didn't have one. Most Canadians don't. I would decline u/s until you're overdue and need to actually check on the health of the baby.

pinksweetpea2 · April 2012

I guess I don't understand why you are trusting your birth to this person in the first place? Has he always been like this or is this more of a bait and switch situation?

If you can't find someone else, then I would just skip the u/s. I doubt there is anything you can say to someone like this that will change his mind.

lily225 · April 2012

I only looked at the first posters comment, but agree. You don't have to have a growth scan. I went two weeks over withmy last and never had a growth scan, just u/s's to check fluid levels. I'm very happy for that since DS was over 9lbs. While he was a cinch to push out (2 contractions) it probably would have made me nervous going into it.

If you're a first time mom, you and your dr. should have no opinion on how hard/easy it might be for you to delivery a large baby. Many small women easily birth large babies, which is often a reason for c-section or inducing early.

Just be confident in yourself. He can't force you to do anything.

julyjennifer · April 2012

The PPs have made good points. Decline the growth scan unless there is something else you haven't mentioned that would indicate that this is a good idea to have.

nosoup4u · April 2012

honkytonk_kid:
Or just a good old fashioned, "No, thank you!"
Good luck, mama. Oh, and skip the growth u/s.

This.

Are there other doctors (or even midwives) who practice with your current OB? Can you switch to someone else? Will he be there for your whole labor, or do you just get whoever is on call? Hopefully it's the latter, bc it sounds like you're being set up for not achieving a low-intervention birth, quite honestly.

You might have to sign an AMA if you decline a late u/s, at least if it's part of a non-stress test. I declined the u/s part, and had to sign one, and also had to explain to a MW my reasons for doing it. So just a heads up on that one. Try to make sure you have your partner or a friend/relative who can back you up, I wouldn't go alone to appointments if he's that hostile.

And FWIW, I'm 5'10" and gave birth to a 10lb 10oz baby vaginally, with no complications other than a second degree tear.

RingOfFire11 · April 2012

I agree with declining the growth scan!! I'm a very smal 5'2" and had a vaginal birth to a 9 lb, 22 in baby with no problems....which is pretty big for my size person. GL!!

bootcampbride · April 2012

Funny - my OB last week said he thought I'd be a good pusher (I'm going for a VBAC) because tall women have larger pelvises (of course) so he does not anticipate any problems. I'm 5'9" so your pelvis should be even larger right?

(and then see PP at 5'2"!)

TrendyTina · April 2012

THanks to everyone for the great information and responses. Unfortunately it is too late for me to switch practices. My experience has been a total bait and switch. They told me they would go along with everything I wanted in the beginning and now, even though I've had a perfect textbook pregnancy with NO issues or complications, they are changing their stance on everything. It's very frustrating.

The one positive I have going for me is that the practice is 2 male OBs and 2 female MWs, so I have a 50% chance of not dealing with the evil OBs. Now, we just wait and see who is on call when I go into labor. I do have a very supportive husband who will not be pushed around or emotionally influenced by a medical provider as well as an amazing doula.

Now we wait until baby comes....

gimmietimmies · April 2012

nosoup4u:
honkytonk_kid:

Or just a good old fashioned, "No, thank you!"

Good luck, mama. Oh, and skip the growth u/s.

This.

Are there other doctors (or even midwives) who practice with your current OB? Can you switch to someone else? Will he be there for your whole labor, or do you just get whoever is on call? Hopefully it's the latter, bc it sounds like you're being set up for not achieving a low-intervention birth, quite honestly.

You might have to sign an AMA if you decline a late u/s, at least if it's part of a non-stress test. I declined the u/s part, and had to sign one, and also had to explain to a MW my reasons for doing it. So just a heads up on that one. Try to make sure you have your partner or a friend/relative who can back you up, I wouldn't go alone to appointments if he's that hostile.

And FWIW, I'm 5'10" and gave birth to a 10lb 10oz baby vaginally, with no complications other than a second degree tear.

5'9" here, last one was 10 lb 12 oz, all natural, no tears. All big, only had stitches with #2 (2, minor tear). I also bow down to DH's aunt, who at 5'4" has had much larger babies than mine, natural vaginal births. And ditto tokenhoser, we don't do u/s here for that. I had a fluid level u/s check with S, knowing she was at nearly 11lbs, they still wouldn't induce before 42 weeks unless the NST and wellness ultrasounds supported fetal distress.

ETA: I'm curious WTH he thinks a large baby is, weight wise. And pp's have excellent advise, there are guidlines he needs to follow.

liztothemax · April 2012

Hey, I just wanted to weigh in with my experience for additional support, though your resolve appears to be strong.

I'm diabetic and having my first baby. She's predicted to be a big 'un currently at 38 weeks (9.1 lbs according to the u/s), as babies of diabetics typically are large (plus, big babies run in my family on BOTH sides and my husband was a big baby, so I was fully expecting this diabetes or not).

Before my u/s the other day, while my doctor was talking to me about what he thinks of induction/cesarean in my case (they just LOVE to cut you open if you're a diabetic, jeez give me a friggin chance here!), I specifically asked him: "If the baby is large at 38 weeks is it better to induce her then instead of continuing to let her grow for 2 more weeks?"

And he said: "There has been no medical evidence to suggest that inducing a large baby will make the process of delivery any more successful." That's a direct quote from a doctor who's been delivering babies for longer than I've been alive (ie, 27 years). My doctor is very pro-c-section and has no problem inducing me if I go past my due date, so he's not one of these super hands-off types of OBs, but he's not an idiot and won't intervene if it isn't necessary.

Honestly, it sounds to me like your OB is just trying to bring your baby into the world on his schedule. >:

TrendyTina · April 2012

liztothemax:
Hey, I just wanted to weigh in with my experience for additional support, though your resolve appears to be strong.
I'm diabetic and having my first baby. She's predicted to be a big 'un currently at 38 weeks (9.1 lbs according to the u/s), as babies of diabetics typically are large (plus, big babies run in my family on BOTH sides and my husband was a big baby, so I was fully expecting this diabetes or not).
Before my u/s the other day, while my doctor was talking to me about what he thinks of induction/cesarean in my case (they just LOVE to cut you open if you're a diabetic, jeez give me a friggin chance here!), I specifically asked him: "If the baby is large at 38 weeks is it better to induce her then instead of continuing to let her grow for 2 more weeks?"
And he said: "There has been no medical evidence to suggest that inducing a large baby will make the process of delivery any more successful." That's a direct quote from a doctor who's been delivering babies for longer than I've been alive (ie, 27 years). My doctor is very pro-c-section and has no problem inducing me if I go past my due date, so he's not one of these super hands-off types of OBs, but he's not an idiot and won't intervene if it isn't necessary.
Honestly, it sounds to me like your OB is just trying to bring your baby into the world on his schedule. >:

I agree 100%, but I won't let it happen. I'm strong willed and will advocate for myself. There is no way I would agree to an induction if the only rationale was a chance of macrosomia. I will be referencing ACOG's recommendations tomorrow and will be firm on my stance. No one in the practice can force me to do anything and I won't be bullied.

dmhrn13 · April 2012

American College of OB/GYN's (ACOG) has an official statement that macrosomia or a "big baby" is NOT a reason to induce someone. Additionally, if someone is having a big baby- forcing it through induction can get the shoulders stuck. If anything- induction alone increases you chance of having a c-section to 50%. Sorry, but it sounds like your OB is a jerk- making a statement like "trying to be a hero". I'm a nurse midwife- I've caught 9 pounders from women a lot smaller than 5'11''.

That probably wasn't helpful regarding what to say- but perhaps saying you researched it & know that ACOG has a statement against it- is a good start. Good luck.

liz37 · April 2012

I agree 100%, but I won't let it happen. I'm strong willed and will advocate for myself. There is no way I would agree to an induction if the only rationale was a chance of macrosomia. I will be referencing ACOG's recommendations tomorrow and will be firm on my stance. No one in the practice can force me to do anything and I won't be bullied.

Good for you, mama! Sounds like you are well informed and have supportive people around you that will be at the birth and will be able to give you good information. Hoping that you end up with one of the midwives instead of the OBs.

I'm 5'4" and have had a 10 lb 3 oz baby and a 9 lb 8 oz baby, both vaginally, both late, both without drugs. You can do it!

GL!

Liz

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