big babies induction vs C-section

[Abylite]

I need some advice. I had an U/S today cuz baby is measuring bigger in size for dates. No GDM....just big.Baby is estimated to be 8# 12oz give or take. I’m exactly 38 weeks…. My EDD is 10-22

I had a horrible birth with my 1st DD....7#20z. 24 hour labor, forceps, 4th degree tear and I think my OB is just trying to prevent problems, complications. He's suggesting a possible scheduled C-section if the baby is "too big" and I'm thinking of asking about an induction to try labor. I'm a L and D/peds nursing instructor so believe me, I"m aware of the risks of both.

I see the OB on Tues at 9:30….any advice on what I should do?

Induction and when…and how (cervidil vs Pitocin) or should I just schedule a C-section…I don’t want to go through a Trial of labor and just end up with a C-section anyway….but then again, I am a second time around mom and maybe things will go faster and better this time around… and lots of women deliver big babies...I know the recovery for c-section isn't fun, but I'm willing to do it if necessary.

Please no harrassment...I'm just asking for your stories and advice, pros and cons. Thanks so much in advance. I'm really torn!

[yeahwhat]

My advice would be to wait for labor and see if the baby comes out on its own. A c/s can always be done later if absolutely necessary.

[Marilyn82]

I believe even the ACOG doesn't recommend inducing or giving a cesarean for suspected large baby....there is just no way to tell before giving birth how much your pelvis can move to accommodate baby, or how much baby's bones can move to fit. People have birthed much larger babies without complications. Also, ultrasound is very unreliable for estimating dates, it can be off by quite alot. There is really no accurate way of knowing your baby's exact size...also, babies have growth spurts! It is completely normal to measure ahead sometimes.

I doubt that inducing or sectioning this baby will prevent any of the problems that occured with your last birth, since it doesn't sound like that was caused by baby's size. Every labor and birth is different, and the ease of your birth may have much more to do with other factor's including baby's position, rather than size alone.

I don't know if that is very helful or not, but what I would do in your position is refuse either. I've had a cesarean that I wish I could take back, and I would have rather had a trial of labor first! The recovery is hard, especially if you have another little one...plus my son ended up with transient tachycardia of the newborn which is much more common in cesarean babies, and I didn't get to see him or nurse him for awhile, and he still has lung issues...

I can't think of any pros to inducing early for that reason, sorry But there is a link for induction info that I will try to find, since it tells all the pros and cons of the different methods of induction

[pamamidwife]

Ultrasounds are typically off by as much as 2lbs at this point in the pregnancy.

First time labors/births are "longer" and "more difficult".

Babies only gain about 1/4 lb a week - and then slow after the due date. I'm not sure what inducing early will give you in terms of "a big baby"

Your baby sounds like it will likely be average - and could be less at term than what you're being told right now simply because of the huge inaccuracies with ultrasound.

It sounds like your first baby had a positioning problem - and it wasn't the size issue. In fact, first time moms have a longer labor and if there is an epidural/restriction of movement involved with a malpresentation, you're gonna hit trouble.

Fat squishes. I prefer babies over 8lbs simply because they are less likely to get into weird positions.

Inductions can produce fetal distress in babies. Why risk that over a very small "perceived risk" of repeating your last birth?

For me, there should be a third option: waiting and trusting your body and your baby. Not hassling here, but you did ask this in the birth professionals forum on MDC. We have a bit of a lean. In my mind, you asked this question here (rather than on some sheeple baby site) because you have some doubts about the scenario you're in.

Have you heard of Henci Goer? She's an author that complies research based evidence on various pregnancy and birth topics. She has a great article on "When a Big Baby is Expected" (which may / may not apply simply because I don't see your baby as "big", but VERY normal):
http://www.parentsplace.com/expert/b...234322,00.html


It's hard when you're in the midst of a model of care that works with fear and management - no matter how great the provider is. I hope that no matter who you're birthing with that there is some allowance to make informed choices (and refusals) in terms of what is safe for you and your baby.

Thinking about what impacts a labor like your first is going to be key - there is always risk. Doctors prefer elective cesareans for a multitude of reasons: lower risk to them (no litigation mess), timing (can be scheduled so it doesn't interfere with clinic hours or time off), and a perceived (but inaccurate) view of "managing" the situation rather than allowing it to be spontaneous.

It's not surprising that more and more women are being coerced into elective cesareans with this atmosphere. And when you say "be willing to do it", what does that mean? If your OB keeps making these comments or he says it's necessary? Surely your training and education makes you able to see the dichotomy of what OBs face in terms of there being no benefit for them with vaginal birth.

There's also your other child to consider. Caring for your first child will be drastically more difficult with a primary cesarean, along with a new baby.

If you're looking for someone to validate and cheer these two choices, you may be looking in the wrong place. However, I honestly think you are not on board with either of these choices - and that is why you came here.

Forget what I said before, my third choice would be to birth outside a system of fear.

[Abylite]

Thank you everyone for your stories and honest replies. Wow! I truly appreciate MDC. I had a midwife with me first and she gave me lots of confidence....things didn't go as planned, and I was just glad baby and I were both fine. That was in RI.

Now we moved to CA, no midwives are covered by my insurance, so I have what I thought was a good OB. I liked him up until he suggested I have an u/s to check the size of the baby since I am "huge"!!! And pretty much said because of the forceps, smallish baby last time, and the 4th degree tear, I MIGHT want to consider induction or C-section to "avoid" problems. And everyone is right....something is just not sitting with me since I'm so not into medical intervention unless absolutely necessary. I'm finding it hard to trust my body and this baby.

I know the risks of both...and because maybe I haven't released the trauma of my first experience, I really am scared to death! But reading your posts made me realize to wait a bit and not let him talk me into anything. I'm hoping this baby decides to come out soon, on his own, and that our experience is a good one! Thanks....on Tuesday I think I will tell him I'd like to see what happens for the next 2 weeks. I may even check out accupuncture....I'm taking EPO, walking alot, etc.

[Abylite]

Oh, I forgot to add that I really did have a "natural" birth...no epidural, etc. I did have some IV stadol 2x which did nothing. I moved around as much as I could, but after 22 hours of labor and 3 hours of pushing, honestly, all I wanted to do was lay in bed. Supposedly she was in a good position, face down, etc. I believe my uterus just gave out and became too tired to push anymore so they eased her out with forceps. Water had broken at 2:30 in the am the night before and I delivered her at 6:08 am. Thanks again for sharing!

[MidwifeErika]

I just want to share with you that size of baby doesn't mean much in the way of tears or complications. One mother could have a nasty tear with a 5lb baby and go on to birth a 10lb baby without even a skid mark. Position of baby, instruments used, position of mom, etc, etc, etc all have a large impact.

[georgia]

All the homebirth midwives I know encourage mamas to grow their babies as big as the babies need to be Your body and your baby know what they're doing

[1stimestar]

Two points for you to consider. One, the difficult part of babies to come through the birth canal are the head and then the shoulders. When babies gain weight at this late point, they are putting on brown fat, fat in their bellies, thighs, butts. Those are the parts that just slide out. Like has been said, fat squishes. Babies don't gain weight in their heads and shoulders.

Two: If you agree to an induction, your body will not get the full benefit of relaxins which loosen the ligaments holding your pelvis tight. So if it IS a big baby, you really want a loose pelvis, making waiting even more important. Being induced will mean that your pelvis will not be able to open the way it is supposed to.

Good luck.

[mama to 2 girls]

I just wanted to share that my cousin had a very long (24 hr.) labor with her first child that included 4 hrs. of pushing that ended in an episiotomy and vacuum extraction...all for a 7 1/2 lb. baby!! She did have an epidural......

She just had a 9 1/2lb. baby boy(second child) 5 mos. ago, NO TEARS, and only pushed for 15 mins!!

So it can be done! Trust your body, it usually knows what it's doing!

[Paige, CPM]

What wonderful replies, I 100% agree with everyone who has replied!!!

As a midwife I have to say trust your body!!!

Can you get a doc with a low c/s rate? Can you ask around? I know it is late but it is something to seriously seriously consider. Call up your local homebirth midwives, they will know who really trusts in womens bodies and has low intervention rates and will save you a lot of time researching.

Your doc is on the interventive side...I bet a high c/s rate. This means if he already has it in his mind your baby is big then he might be nervous and continue to make inappropriate suggestions. He does not trust your body. Not only do you not want to be fighting this prenatally, but imagine being up against this attitude during labor!

You must trust in yourself...births are never the same the second time around. Read Ina May's Guide to Childbirth...she says "Your body is not a Lemon."

And throw out the "lets see what happens in the next couple of weeks", that stinks of 'lets see how my body works, hopefully it will...'. I wanna hear 'Who cares when I give birth...my baby knows best and will come when it is ready.'

You go girl!!! You are going to do it really well, I have the feeling...and so do you and that is why you are here, like Pam said. Remember us, we are professionals and sisiters and the truth has been spoken...there are more of us here trusting in your body than the one doctor who does not.

[Abylite]

Thanks everyone for giving me more confidence this weekend. I was really "convinced" that I'm not cut out for this and that I may as well induce or have a C-section. I haven't really thought of switching so late in the game....and don't know if I will....but on Tues I will say....I want to wait and see what happens. This birth will be totally different than my first, etc.

Again, Thank you everyone for your replies!

[mothercat]

I'm popping into this rather late but wanted to add something I have learned from the ICAN (Intl. Cesarean Awareness Network) list.

Waiting is always the better idea unless there is a very specific problem with your or the baby's health that makes induction or C/sec absolutely necessary.

Failed inductions are a leading cause of C/sec. An induction doesn't really fail. It is your body doing what it was meant to do. If your body and your baby aren't ready to birth at 38 weeks, no amount of Pit or prostaglandins will be able to drag you through that process. Then the message of the "baby is too big to fit" will be reinforced. Having a C/sec. to "fix" that problem will only further reinforce that your body can't birth. Which isn't true!!

I used to work with an OB named Ron Cyr. He was Canadian trained and preferred a wait and see approach to most situations. He wrote a series of research reviews for OB/Gyn (2002/2003 I think)and one of them was on the fallacy of inducing for macrosomia. The hospital librarian may be able to find this for you. He pulls out all the best evidence and says "don't do it"

The other thing to consider is that they baby may not have found just the perfect position for tucking up and finding her/his way through the pelvis. I have seen babies still switching positions until the day before labor starts.
Forcing the baby through the pelvis by artificial means before it has found this really good position can make for a much longer and harder labor.

Good birth vibes being sent your way.

[ldsapmom]

Just wanted to add: My first was an induction because my OB said, "He's getting too big." Not knowing better, and trusting my care provider implicitly ("She wouldn't induce unless it were truly medically necessary."), I underwent a horrible induction. I pushed for three hours, and she pulled him out with a vacuum. I had a 4th degree tear/episiotomy. He was big, 9 pounds, 8 ounces, but I am sure laying on my back like a dead cockroach, didn't help open my pelvis at all.

My second baby, I went with midwives. The whole time I was worried about a repeat scenario. At the end, I told my midwife, "If I go over, I think I am going to stop eating." She said, "His HEAD is not getting any bigger, her is just putting on fat." That hit me like a thunderclap. Why hadn't anyone ever said that to me? It made so much sense.

I waited to go into labor on my own. From first contraction, and not great pain, but, "Oh, that's different," to baby was 8 hours. And, he was posterior-born and had been asynclitic, so my pushing phase was a bit long for a second-timer -- 90 minutes -- but I pushed him out myself, and he was 9 pounds, 9 ounces. I am still amazed at how my body handled it all. If I could get him out vaginally in a less-than-optimal position, and he was big, I am sure I could have birthed my first free from scare-tactics and intervention if I had the confidence and trust to do that.

That was my loss, though -- I didn't trust myself at all, I didn't even think to bring myself into the equation -- I simply believed my doctor, and I believed she would not do anything that wasn't in my and my baby's best interest. With my second, I started building that trust in myself and my intuition. My third birth was amazing, even shorter, another OP baby, but he rotated during a lunge and was born in the next contraction.

According to Henci Goer, ultrasound is off by +/- 5 days in the first trimester, +/- 8 days in the second trimester, and +/- 22 days in the third trimester. Something to think about.

[Zoo Loo Naturals]

A personal empowering story from me:

I have 5 kiddos. My first was a c-section, long labor, long pushing, ended with the surgery. He was 7lb. 12 oz. 2 other babies came after naturally and quickly, vaginally. They were in the 7lb. range. Then my 2 homebirth babies. First was 10lb. 14oz. and his brother was 10lbs. 12oz.

I was very happy with my big babies. The births of my big babies was far more pleasant than my c-section.

[Mindi22]

Abylite -
In addition to what's already been posted, I just wanted to encourage you to have a doula at your birth. A doula will be there with you in the birthing room 100% of the time, and help you to make choices and have options that will give you the natural birth that it sounds like you want to have. Plus, having someone "on your side" during labor and delivery is essential, especially if (like it sounds) your OB is on the intervention-heavy side of the spectrum.

[Abylite]

It's sad to read about everyone that was coerced into having inductions and C-sections based on size...I really appreciate the stories and the empowering ones too!

[Defenestrator]

The article that is mentioned by mothercat is the top result on this google search. (for some reason going to the page through google helps you bypass a login that you need if I link to it directly)

[Abylite]

Thanks for the link!

[BirthFree]

Also, for what it is worth, my 9.12oz baby was the easiest to push out and I had 7.11 and 8.8 prior. You may very well be amazed how much easier things can be when your pelvic bones have already spread once before. I know I was.