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VBAC with large baby???

3K views 14 replies 14 participants last post by  readingrunner 
#1 ·
I had a c-section 6 years ago due to a breech baby. Now I am 35 weeks pregnant and am under the care of a midwife with hopes of a VBAC. The wrench thrown in is that at 28 weeks I was diagnosed with gestational diabetes. However I have excellent (and I mean excellent) control of my blood glucose levels with diet and exercise alone. A couple days ago I had an ultrasound to check placement of the baby and was told the baby was already measuring 7 lbs 1oz and in the 93rd percentile. I was shocked as my last baby was born at almost 38 weeks and was only 6lbs 6oz so with the gestational diabetes being so well controlled assumed this baby would be similar. How freaked out should I be? Am I growing a giant baby that is going to lead to complications with my VBAC and what have I done wrong??? I thought I was doing so well. I spoke with my midwife by phone and she is waiting for the report but isn't super excited at this point.
 
#2 ·
A large baby doesn't increase risk factors for vbac birth and ultrasound estimates are not considered a reason for elective cesarean our induction even by ACOG. Even if your baby is as big as the ultrasound says it is there is no reason to think you will have any problem birthing.
 
#3 ·
Totally agree with pp; the ultrasound at this point isn't accurate enough to risk you out of vbac. I vbac'ed a 9.1 pound baby with no issues and only the tiniest of tears. Oh, and you have not done anything wrong! All babies are different. If you have kept your sugar under control then that's the only thing you really CAN control.
 
#4 ·
Try not to let them make you sweat.

Ultrasound estimates of fetal weight are notoriously inaccurate, especially at the extremes. Things like the baby's position and length can throw it off. My son was estimated the day before his birth to be 7lb 11oz; he was born at 9lb 4oz. (A VBA2C, by the way.) Now, they were off by a pretty huge amount, but here's the thing--it was well within the 20% margin of error they claim. One reason the tech was so wrong is that he has short little legs (he was actually my second shortest baby at 19", only 1 inch longer than my preemie). It's entirely possible to err in the other direction with a long baby.

Even if it's right on, or even if they're actually lowballing it, there's no reason to worry. My vaginally-birthed babies have all been at least two pounds heavier than my c-section babies. (My first two were breech, and though I have no way to prove it, I firmly believe that whatever led them to stay that way contributed to them not growing very large.)
 
#14 ·
FIrst of all, gestational diabetes is not real. If you have "controlled" blood sugars, you have nothing wrong with you. There is no other aspect to the (made up) disease beyond out of control blood glucose, which you don't have, so please stop telling yourself that you have gestational diabetes. You are a healthy normal pregnant woman who reacted AS EXPECTED to a glucose tolerance test it sounds like. That is a huge topic and I encourage you to listen to this podcast to learn more - http://www.indiebirth.com/the-truth-about-gestational-diabetes-no-doctor-would-ever-tell-you/

Secondly, your midwife should be able to tell you about your babies position without using an ultrasound. In fact, she should have been teaching YOU to palpate yourself since it is something empowering and completely possible. As far as guessing baby's weight, based on studies that have been done, ultrasounds are on AVERAGE off by between 11-16 oz in either direction. And a midwife or doctor's guess is on average off by 11 oz in either direction. Please stop telling yourself that your baby is measuring 7 lb 1 oz. That is a misnomer. Your baby was ESTIMATED to weigh 7 pounds 1 oz. That means baby could be 5 pounds for all anyone knows. Or could be 8 already. In the end, who cares? If your baby is "big" it not because of your blood sugar, you know that for a fact, so you body will grow the right size baby for you.

I like this article best - http://www.aafp.org/afp/2001/0115/p302.html

But here are the guidelines from ACOG to peruse (not that I think their opinion is worth much) - you may be particularly interested in the very last point :

Summary of Recommendations

The ACOG committee provides the following recommendations for the management of fetal macrosomia:

Recommendations based on good and consistent scientific evidence (Level A):



  • The diagnosis of fetal macrosomia is imprecise. For suspected fetal macrosomia, the accuracy of estimated fetal weight using ultrasound biometry is no better than that obtained with clinical palpation (Leopold's maneuvers).

Recommendations based on limited or inconsistent scientific evidence (Level B):



  • Suspected fetal macrosomia is not an indication for induction of labor, because induction does not improve maternal or fetal outcomes.


  • Labor and vaginal delivery are not contraindicated for women with estimated fetal weights up to 5,000 g in the absence of maternal diabetes.


  • With an estimated fetal weight more than 4,500 g, a prolonged second stage of labor or arrest of descent in the second stage is an indication for cesarean delivery.

Recommendations based primarily on consensus and expert opinion (Level C):



  • Although the diagnosis of fetal macrosomia is imprecise, prophylactic cesarean delivery may be considered for suspected fetal macrosomia with estimated fetal weights of more than 5,000 g in pregnant women without diabetes and more than 4,500 g in pregnant women with diabetes.


  • Suspected fetal macrosomia is not a contraindication to attempted vaginal birth after a previous cesarean delivery.
 
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