Measuring large for such a small person!

[activealli]

Hello everyone,

I was wondering if anyone is experiencing anything similar. I am 28 weeks and measuring 3-5 weeks ahead of schedule. I am planning a home water birth, and yes this is my first so I have nothing to reference as far as belly or baby sizes. I had my kasier appt a few days ago and expressed concern over having a large baby. My kaiser midwife, who is pro-home birth (whom I found after going through 3 terrible midwifes and nurse practitioners) wants me to go get an ultrasound, but also is all for me trying at home and transferring if I stall out for long periods of time. I had an ultrasound at 20 weeks and the baby was measuring fine and confirmed our due date and we tracked everything very well, so i dont think its due date confusion.  I wasn't showing at all 6 weeks ago, and now everyone is asking if I am having twins! I have gained 30 pounds, all to the belly. I am very fit, work out every day, eat most vegan, 100% vegetarian, and almost no sweets other than fruit and not spilling sugar in my urine, so I dont have GD. My HB midwife thinks it may be due to baby position. He is balled up under my ribs. I can palpate (and is actually visible to everyone, even through a sweatshirt) a butt under my left ribs and his feet constantly kick my right ribs. My belly looks terribly lopsided and protrudes higher than it should. His rear is practically touching my chest.  At our 20 week ultrasound he preferred to ball up against my hip bones. So maybe the change in position causes change in size?

Long story short... anyone else experiencing or has experienced this? I just dont want my ability to attempt home birth taken away from me and possibly get forced into a precautionary c-section. Husband was supporting my home birth but is terrified of having to have the babies shoulder broken due to shoulder dystocia or getting stuck. I trust my midwives to transfer me if I fail to progress due to large baby but he doesnt want to have to pay cash for the home birth, if it looks like Im going to have to go to the hospital anyways. He would rather just get to the point  I know the ultrasound is not really accurate either, as a fluctuation of 1 pound for a around 2 pound baby is huge.

Sorry for the rant.. Just in a panic and not sure what to do. I feel like Ive lost my confidence to be able to birth this kiddo on my own.

[mareseatoats]

This is all just my opinion, but I feel like midwives are much better equipped to deal with a stuck baby. They'll use different positions, different techniques. I'm sure your midwife would be happy to talk about some of the things she might try -- I know one is basically pinching the top of your hips to widen the pelvis. And like you said, they know when it's important to transfer. The other thing is this: Your body will not grow a baby that is too big for it unless there's some underlying issue. It sounds like that probably isn't the case, so I would trust your body to know what it's doing.

I've been measuring quite far ahead, I'm 5'6" and PP 115lbs, so also pretty small. The baby has also been measuring ahead in his ultrasounds. My daughter was 7lbs10oz, so we're guessing he's going to be bigger than that. I really have a feeling we'll be around the 9lb mark, I don't know why. I was pretty worried about it for a while, but I still feel like, as I said above, my body isn't going to make a baby it can't get out. I also have polyhydrominos (I'm almost positive I didn't spell that right), which is an excess of fluid and is part of the reason I'm measuring big. You may have slightly more fluid than average, and that could add to why you're measuring bigger. I wouldn't get an ultrasound to gage baby's size, it seems like a lot of fear mongering goes along with that, and as you said, they're notoriously wrong.

I hope you start feeling better. I know that the constant "Are you sure it's not twins?" and "You look ready to pop!" comments can get really difficult. I've started just saying, "Yes! Baby and I are very healthy" or something along those lines.

[nald1]

A chiropractor can also help move the baby into a good birthing position.  Mine has even offered to come to the birth ;)

[strawberryprincess]

So, I have the opposite issue...I'm measuring quite small.  With babies #1 and #2, I measured almost exactly on each time, and they were both just shy of 8lbs.  #3, I measured quite small and was totally expecting a small baby.  He was 9lb4oz and 21.5in!  Not small at all!  I'm still not sure where he was the whole time, but I know it had a lot to do with his position.  He was slightly sideways (transverse) until about 36w, then he was in a good up/down position (and I measured right on at 38w or so) but he dropped about a week before he was born, and I measured about 36cm at 40w.  I was very concerned at some points, but I ended up not having a u/s.  my midwives were very relaxed about it, and said he's growing just fine.  Although at my last app, I was about 26w, I only measured 22cm.  I'm not stressing out about it, and really wondering if this one will hit the 10lb mark! LOL!

Also, measuring ahead may be because of extra amniotic fluid.  Also not neccessarily a problem, but could be contributing. 

BTW, my 9lber required a few extra pushes than #2 did, but far fewer than #1. Overall, it was not much more work than the others.  I know lots of moms who birthed 10lbers and had no issues at all.  Big babies do not mean stuck babies.  Conversely, I know a little girl who's collar bone was broken at birth cuz she was stuck, and the dr pulled on her, and she was barely 7lbs. 

[kathrineg]

Well, with a shoulder dystocia they will probably complete the delivery at home instead of transferring. There is the possibility of shoulder damage or nerve damage...that's the case in the hospital too, though.  I know some labor and delivery nurses and they all have a healthy fear of SD because it is difficult to predict and it can cause significant damage to the baby and mother even with the best management. They do drills about how to handle it and they have all seen it multiple times. They know what they're doing. For this reason I trust competent hospital teams to deal with shoulder dystocia about as well as experienced home-birth midwives can. Of course it's hard to know how experienced your midwives are with this unless you ask them. Some of the maneuvers really require more than one attendant, too, so I'd ask the midwife if they will have an assistant. If it gets very, very serious, there are things that can be done for SD in a hospital that can't be done at home. They are pretty horrible and hard on the mother and I wouldn't look them up if I were you. That's down to a fraction of a percent and not something I would personally worry about.

Anyway, I'm rambling, but shoulder injury can happen in either place. Hospitals can't prevent it from happening. The one thing with SD that would make me think hospital instead of at home would be the immediate access to a NICU team for immediate assessment and treatment. Midwives and EMTs can do some things, sure, but it's hard to beat a well-trained NICU team with all the equipment standing right there in the delivery room.

[Gracecody]

I think you should have a heart to heart with your midwife about your fears. It's totally normal to worry about all the what if's, especially if it's your first time. I am also entering that stage of worrying about the birth and this is my third birth. I am also worried about a big baby, but only because my first (boy) weighed 9 lbs 15 oz at birth and this is a boy too.  I feel 100% sure that my body can handle it, it's just a matter of really watching my diet and exercise to make sure the baby and I are both well equipped to handle labor and beyond. Unlike you, I am not so disciplined and have a wicked sweet tooth during this pregnancy...and I know babies love to get good and fat on glucose!

Anyway, I birthed my first baby (the giant boy) flat on my back in the hospital with a CNM (and being coached to push him out ASAP instead of taking a gradual approach and letting him adjust his position) and had some pretty significant tears requiring a lot of stitches and scarring and an extremely painful recovery.  Then I birthed my second, an 8 lbs, 1 oz girl, at home with a midwife on hands and knees and didn't have a single tear or mark.  We also WAITED to push once I was dilated, until I felt ready. In the hospital it was like, okay you're 10 cm! Give us your biggest push! Go!!!

I agree whole-heartedly with a previous poster that having a midwife's knowledge and patience/willingness to try different positions with you will be invaluable. I have talked to my midwife about shoulder dystocia (sp?) as I had a friend who experienced it in homebirth (another of her clients) and she was happy to talk for 15 minutes or more about her experience with it and exactly how she handles it.

[wombatclay]

I can speak to the shoulder dystocia aspect, since I had a "true" SD with dd2.  I was squatting when I delivered her head, the Gaskin manuever and McRoberts didn't work, and after several minutes my OB had to reach in and manual twist/pull to free her shoulder.  We had something of a "best case scenario" however since the birth team was on top of their research (leave umbilical cord alone, put mom of rich oxygen mix, do infant massage on mother's chest, blow room air over baby's face but not the oxygen rich blend).  There were no broken bones though dd2 did have a minor braxial plexus injury (more common than broken collarbone actually) and she had very low APGARS due to the oxygen deprivation.  I ended up with a 4th degree tear and 200+ sutures as well as a minor bladder and uterine prolapse.  So even best case scenarios in a true shoulder dystocia situation are not all that spiffy.  It's considered one of the last "big scary birth things" because you really can't predict it, you have only minutes to resolve it, and it's something that can kill a healthy baby and disable a healthy woman for life during those minutes.  :(  (but it's rare!  really really rare! though that has it's downsides because a provider may never have seen a SD before, and a provider who sees a lot of SDs is probably doing something "wrong")

That said, the research shows that infant size is not an accurate predictor of shoulder dystocia.  You can find the citations here (along with a lot of other research into SD).  And I can add my personal experience to that... my SD child was my "smallest at birth" child and the one who came the earliest (dd1 and ds were 42 week babies, dd2 was 40 weeks and a few days).  The available research also shows no correlation between SD and GD or even pre-existing diabetes (as long as diet/insulin is effective at regulating mom's blood sugar levels).

For my own comfort level and given my own experiences, I refuse to schedule a c/s "just because" I am now higher risk for complications.  But I did choose a hospital birth for ds and now for this babe too because I wasn't comfortable with the answers about SD I got from the various homebirth midwives I interviewed.  Just "measuring big" is no reason to be labled high risk, though an ultrasound to rule out anything odd might be a good idea (for instance, a uterine fibroid that was previously small/unremarked upon might have decided to "grow up", explaining the sudden increase in size) especially if you're planning a homebirth where special circumstances might require more pre-planning.  And if SD is a real concern of yours (or your partner!) then perhaps find a copy of Simkin's Labor Progress Handbook, check the information on the page I linked, read up on the Gaskin Maneuver (which is more successful than not at freeing a trapped shoulder, though as I found it's not a sure thing), review the Spinning Babies info on resolving SD (here), and ask every possible question of the midwife who will be attending your birth... has she seen SD before?  How did she/would she resolve it?  What are her transfer protocols? (you can't transfer for a SD, you literally have only minutes, but some midwives will transfer if the pushing stage goes past a few hours with little progress... a sign that maybe things aren't fitting properly and a SD could be more likely).

Again... just "measuring big" shouldn't be the deciding factor in making you high risk or risking you out of a homebirth.  Especially with a first babe when your body is still figuring out what the heck it's doing with all these hormones, the new blood volume, the crazy bone separation, etc.  But measuring big, especially when it happens "all of a sudden" can be a warning sign that something isn't working right and it's worth taking the time (and possibly the interventions like an additional u/s or 3 hour GTT) to double check that everything is fine.

[bignerpie]

Originally Posted by nald1 

A chiropractor can also help move the baby into a good birthing position.  Mine has even offered to come to the birth ;)

Seconded. I am completely convinced of the sheer awesomeness of chiropractors. But I believe you are on the SPD thread and going to see one soon, anyway? If you are lined up, it is so much easier for the baby to get into position, no matter what size s/he is!

I'd also look into Spinning Babies. Here's a link a page on their website that talks about CPD- http://www.spinningbabies.com/baby-positions/cpd . It seems like very often, it is a positioning issue rather than size, even if the baby is very big.

[~~Sarah~~]

Hey.

woah.

Slow down horsey.

Why are we talking about shoulder dystocia? Which by-the-way, happens as often (which is rare) with "small" babes as it does with "large" ones.

Let's not get ahead of ourselves.

One can measure big for many different reasons. Positional reasons are positional reasons - is that what your midwife told you? At 28 weeks the position of the baby has nothing to do with the position s/he may be in at birth or during labor. You could have a large amount of fluid. Baby may have just gone through a growth "spurt". Or any of a combination of the above or others. Also, some people just measure larger than others. Measuring the uterus is not really an exact science. Most people measure within 2 - 3cm (in either direction) of their week of gestation. That alone (a 6cm variation) is huge.

Is your care provider *really* supportive of home birth? Then why are they discussing stalling in labor at 28 weeks?

[activealli]

Well, I wont have to worry about shoulder dystocia now. Home birth cancelled, I will need to be in the hospital. There is a blockage with the babies intestines causing the fluid to back up. I have over 2x the normal amount of amniotic fluid. Baby will need to go to surgery as soon as he is born. Now there is a 30% chance he also has down syndrome because there is a high prevalence between the blockage and downs. Just spent the entire afternoon in the hospital because I was 1.5 cm dilated and having contractions after the scheduled ultrasound, even though I never felt it or showing signs. I wish it had just been big baby at this point. They are hoping to keep the baby in at least another 3-4 weeks. I have to go see many many specialists this week. Please keep me in your thoughts.

[kathrineg]

I'm so sorry to hear that. You're in my thoughts. 

[bignerpie]

[mareseatoats]

I'm so sorry to hear that. You and your little one will be in our thoughts . Be gentle with yourself and please keep us updated when you can.

[scsigrl]

Thinking of you and your little one. :hug:

[LadyJennifer]

Sorry, I tried to edit my reply and it posted twice....

[LadyJennifer]

ETA, just read update. So sorry! You and little one will be in my prayers! :(

[Gracecody]

I am so sorry to hear this. Keeping you and your sweet little one in my thoughts and prayers. I am sorry you have to go through this and wishing for the very best.

[Ms. B. Sprout]

I'll be thinking about you and your baby in the days and weeks to come. Big hugs to you.

[wombatclay]

(((hugs)))

I'm so sorry you're facing this challenge (though glad it was discovered early enough to give you a little time to prepare).  Wishing you full term pregnancy, a wonderful child who recovers quickly and completely from the challenges they face, and the support of your family, friends, and community.

(((hugs))) 

[Dlynn918]

Much love to you and your beautiful baby!!! Stay strong and vent as much as you need to here. We are all here for you!!!!