Midwives - in your experience, what causes "big babies"???

[bobandjess99]

So...I know I should just relax, but I'm anal, lol.

I was just wondering what were the causes of "big baby" that you have encountered in your careers? Cuz I can't figure out why the heck junior is apparently ginormous.

We've ruled out inaccurate dates, diabetes, excess fluid......so, what would you think in this situation, if you have a client with a ginormous baby measuring nearly term at 31 weeks? Honestly, the midwife took a look at me, and truly expected to find twins...and was clearly shocked when her palpation revealed not 2 babies, but one HUGE baby.....

What thoughts would you have at this point?

[CarolynnMarilynn]

There was a study recently published that said women who drink a lot of milk grow big babies. Apparently it isn't the fat in cow's milk, as the results were the same for skim and full-fat milks, but the milk proteins.

[Jane]

Well, hmmm...I know you have ruled out some things, but here's what I would think...
I measured funny, so I'd estimate fetal weight and fluid levels.
If the measurement was accurate, I'd try to feel if it were baby or fluid.
Check dates, when was the first positive pregnancy test - early fundal measurements, ultrasound reports, family history, etc.
Offer ultrasound, talk about when I'd consider an ultrasound to be indicated - when is it an offer and when I'm requesting the information to best care for you.
Consider diabetes screening, including doing the 3 hr. GTT or random blood sugar screens at home with the monitor.
Rh and blood studies? Is she Type O, or Rh negative?
There are quite a few things that lead to polyhydramnios - rule that out and a lot of things look better, with poly you've got lots of maternal or fetal issues that could cause it (and lots of benign things, too).

Most likely, big baby, normal fluid...I'd say dating is off.

[darsmama]

I measured 49 cm at 40 weeks...just as a side note. baby was over 10 pounds

[~Em~]

In my experience, it has a lot to do with genes - my guys were slightly over and slightly under 10lbs each at 38 and 38.5w, but DH was a big baby (over 10lbs), I was 9lbs (at 42w, though) and big babies run in my family (7.5lbs twins and a 15lb singleton, for example). We ruled out all the normal stuff and the doctor chalked it up to genes.

Don't bother washing the 0-3 clothes! They'll make nice gifts for other people's babies though. And I highly recommend the waffle knit blankies - they stretch. Regular-sized receiving blankets you will find to be worthless after about a week - don't bother washing them either.

[MsBlack]

Well, all I can add is that during one of my pregnancies I measured well ahead of dates, more and more ahead of dates from about 22 to 33wks. During part of that time I was beginning to really think I had twins in there, had never been so large. A lot was never figured out exactly (never considered/checked on GD or polyhydramnios--it was a UP/UC), tho I did know that there had been only 1 week that conception could have happened so dates were never an issue.

In any event, round about 33wks, the difference between cms and wks began to subside. By term, my measurement was pretty normal. I did, however, have a baby a full 2lbs bigger than the one before (just shy of 10lbs). Maybe it was the dairy...I sure did eat a lot of ice cream that time! Anyway--my next and final child was 9lbs and 9oz, only 5oz smaller than the last one, but during that pregnancy my cms were never far off the wks.

So, in any event...sometimes it is just a 'who knows?' situation. Your baby who seems so huge now, may simply have been doing more of it's growth earlier than later...and while s/he might still be pretty big at birth, there is no way now to know if this baby will continue to be 'ginormous'.

[bobandjess99]

Originally Posted by Apricot

Well, hmmm...I know you have ruled out some things, but here's what I would think...
I measured funny, so I'd estimate fetal weight and fluid levels.
If the measurement was accurate, I'd try to feel if it were baby or fluid.
Check dates, when was the first positive pregnancy test - early fundal measurements, ultrasound reports, family history, etc.
Offer ultrasound, talk about when I'd consider an ultrasound to be indicated - when is it an offer and when I'm requesting the information to best care for you.
Consider diabetes screening, including doing the 3 hr. GTT or random blood sugar screens at home with the monitor.
Rh and blood studies? Is she Type O, or Rh negative?
There are quite a few things that lead to polyhydramnios - rule that out and a lot of things look better, with poly you've got lots of maternal or fetal issues that could cause it (and lots of benign things, too).

Most likely, big baby, normal fluid...I'd say dating is off.

OK..here goes...first, the midwife measured the same as what I've been getting, currently 35 at 31 weeks. She double checked my records from dd's pregnancy, and at 31 weeks, i was 30. She palpated, a skill for which she has an excellent reputation (very experienced midwife - direct-entry turned CNM, with hospital, FS birth center and homebirth expereince) and her clinical opinion was that the fluid was normal but that the baby itself is very large. She also said she sometimes sees larger measurements in women at this stage because babe is still up high and floating, but in my case, babe's head is well engaged in pelvis, with body curling up all the way around, and bum under my ribs on right side.
I do have PCOS/history of blood sugar issues, which have been well controlled, have been doing multiple daily sticks and my numbers are good - highest am reading 91, highest 1 hr after meal reading 126, so no problems there. I do very limited dairy as a result of this, also limited carbs, etc...

Dates are spot on, charting for nearly a decade with lmp on march 28(preceded by 3 days of BFN tests - I'm impatient, lol!, so it was definitely a real period), clomid days 1-5, ovulation (severe mittelshmerz and .7 degree temp spike) on cd15 - april ll, started testing on April 19 (8 dpo) got BFN's on april 19 and april 20(again confirming that i was NOT already pregnant and that my lmp was not a "false" period), then got a faint BFP the 21st(10dpo), which darkened over the next couple days. Timing of morning sickness also conincided, as did quickening, which happened during week 20, not super early like you might expect if my dates were behind.
So really, dates are spot on. I'd bet anything.


You ask about blood type. I have not heard about anything relating to blood type causing big baby? could you tell a little more about this? I am B+ and dh is A+.


Thanks for your thoughts!

[bobandjess99]

Originally Posted by MsBlack

Your baby who seems so huge now, may simply have been doing more of it's growth earlier than later...and while s/he might still be pretty big at birth, there is no way now to know if this baby will continue to be 'ginormous'.

I wondered about this, like maybe my baby just did a lot of growing early and is going to plateau or whatever...or maybe for whatever reason, this baby is "destined" to be born at say, 37 or 38 weeks, therefore it is just getting ready to be born a bit earlier than I am expecting.....


*waddles off*

[the_lissa]

At 14 weeks, I was was measuring up at my navel, and went for a u/s to rule out twins.

My baby was 9 lbs, 10 ozs, which is big, but not ridiculous or difficult to birth or anything.

I was surprised because I ate so much healthier with my second pregnancy and he was a pound bigger. My midwife just said second babies and boys are generally bigger.

CRap sorry I misread the title. I'm not a midwife.

[Jane]

Originally Posted by bobandjess99

You ask about blood type. I have not heard about anything relating to blood type causing big baby? could you tell a little more about this? I am B+ and dh is A+.

It's a zebra that I was wondering about - if you were rh negative, you could be throwing up some strange antibody thing. But you are your dh are quite compatible for having babies.
You've got great dating! That's great for a situation like this. You've also got great blood sugar readings - also great to know.

While I trust a midwife with that "pedigree" to have her palpation skills down pat, I am but a newbie. I mentally adjust my weight measurements for the mother's height and another factor - the mother's abdominal fat. Some women carry a layer of fat right over the baby's back, while others don't. It's not neccesarily a weight thing - some obese mamas are all uterus in the front, some women of average weight have belly fat. I usually subtract a pound at term for that. I add a pound for women over 5'9" or so.
And I will admit I don't make estimates at 30 weeks because they are all so skinny at that stage (as they should be). I only really see and feel term babies, so I only feel I can estimate those on the inside.
Although, I am much more relaxed when you say 35 cm at 31. When you said:

if you have a client with a ginormous baby measuring nearly term at 31 weeks?

I was imagining 39 at 31. Lots of people measure 35 at 31 and go on to increase one cm per week and measure 44cm at term and have a nice 9.5# baby. Nine and a half pounds is good sized but not ginormous. More like "cute"!

[courtenay_e]

Hmmmm. Yes, i was thinking that 4cm isn't THAT huge...

[NavelgazingMidwife]

I've wanted to answer this for a couple of days, but haven't had the time... and even now am dashing out to prenatals this morning. Forgive the not incredibly in-depth answers.

Two things that I find cause big babies are dairy and beef. Dairy because it is ingesting pure glucose. There isn't enough protein in milk to even consider it a protein food. If I have a client that is having growth issues, has a history of large babies, shoulder dystocia, etc. I *highly* encourage her to not eat/drink ANY dairy *at all* for at least the last 6 weeks of pregnancy. I have seen it make worlds of difference between pregnancies. One (successful!) VBAC mom had a baby two POUNDS lighter than her first. The OP's glucoses seem quite high to me, especially with a history of PCOS. I would encourage her to really consider stopping all dairy now. But that's just me.

The other issue comes with beef. If women eat beef, I ask that they eat organic beef because regular, store-bought beef (and store-bought dairy) contain growth hormones that I believe contribute to the over-growth of the fetus. Not helpful at all!

I've been in birth for 25 years and I've watched babies get larger and larger and larger - and I keep hearing women say, "The baby will get as big as he needs to get if I eat right, " but I wonder just how big that's going to be. The pelvis really isn't going to be able to accommodate all that this diet we eat is able to sustain! Something has to give and I believe it is a combination of things.

We need to move our butts more and eat less. Myself included!

I hope this helps.

Barbara E. Herrera, LM, CPM
San Diego, CA

[meowee]

One of my midwives swore that grains and fruit juices grew big babies. She encouraged her patients to grow "small" babies i.e. less than 8 pounds. I know it's taboo to suggest that a woman should strictly control something like that, but she was a great midwife. And my 2 easiest births were with babies under 8 pounds. All my others were closer to 9 pounds and they were all pretty tough.

[Reha]

My son was 6.6, and while he was born at home, it was a long and challenging birth.

From my own experience attending births (not many...only about 40 so far), it is the 'big' babies (9lb and up) whose births, including pushing phases, are fast...even in primips. I attended one HBAC with a baby who was almost 2 lbs bigger than her sister, born by cesarean.

I think it is important to keep in mind, re. shoulder dystocia, that it occurs a little over half the time with babies UNDER 8.13.

[NavelgazingMidwife]

Originally Posted by Lennon

I think it is important to keep in mind, re. shoulder dystocia, that it occurs a little over half the time with babies UNDER 8.13.

In my 25 years of birth work, the shoulder dystocias I have seen - and in the shoulder dystocias I've had to help be born (6) - they have all been over 10 pounds, the largest being 11 pounds, 11 ounces. I have yet to seen these hypothetical under 4000 gram shoulder dystocias. I don't hear about them, either.

Barbara E. Herrera, LM, CPM
San Diego

[Defenestrator]

I think that if we had a full picture of shoulder dystocias in front of us, a lot of the lighter babies who were experiencing sd would be with instrumental deliveries (forceps, vacuum, etc.).

My worst sd yet was with a baby who was just over 9 lbs, with an average-sized mom. She had been posterior up until pushing, though, and had rotated in a way that made her shoulders very straight and unyielding. Besides her, the SDs that I have been part of in homebirth have all been pretty big babies, including a 12 lb boy.

I noticed recently that over half of the babies in my practice are "macrosomic" by the standard OB definition. I do feel that diet impacts baby size and agree with Barb that milk might be part of the equation (though I usually tell my moms it is ok to eat cheese). I see the biggest babies in my practice amongst ovo-lacto vegetarians (not quite sure what to make of that).

[cathicog]

Originally Posted by NavelgazingMidwife

In my 25 years of birth work, the shoulder dystocias I have seen - and in the shoulder dystocias I've had to help be born (6) - they have all been over 10 pounds, the largest being 11 pounds, 11 ounces. I have yet to seen these hypothetical under 4000 gram shoulder dystocias. I don't hear about them, either.

Barbara E. Herrera, LM, CPM
San Diego

: Interesting you mentioned the hormones in beef. I helped a lady a couple years ago, with her birth, and the baby weighed, no joke: 12 lbs!!!! I knew it would be a good size baby, cuz all her others were no less than 9.5, but whooeee...sure took me by surprise(the previous baby was 11.2)...so this pg, I shared with her about the hormones in beef(and chicken for that matter) and about eating more raw fruits and veggies, and more water(no soda or sweet tea). So far she is doing much better on the size, and is checking her own glucose, which is staying wnl...so I am hoping for a 10 lb girl, and so is she...the 12 lber did have a mild distocia, which I used the corkscrew manuever to help him out...the hospitals here would have cut mom open and never said a word...he had no problems getting started...and is a real sweet boy....I don't want to have to deal w/ another 12 lb baby, kwim?

[sevenkids]

Originally Posted by NavelgazingMidwife

In my 25 years of birth work, the shoulder dystocias I have seen - and in the shoulder dystocias I've had to help be born (6) - they have all been over 10 pounds, the largest being 11 pounds, 11 ounces. I have yet to seen these hypothetical under 4000 gram shoulder dystocias. I don't hear about them, either.

Barbara E. Herrera, LM, CPM
San Diego

Yeah, I haven't seen any of those either. Every S/D I've attended has been well over 9 pounds. Two of the WORST were with moms pushing in a squat.

I'm not crazy about growing huge babies, even though I had some pretty big ones myself. My third and fifth babies were big, but I really worked on having smaller babies with my 6th and 7th. Neither was a S/D, but the recovery was very hard on me.

So, what grows big babies....besides genetics....

Simple carbs, fruit juices, dairy and beef/poultry.
Simple carbs turn into glucose rapidly, and glucose crosses the placenta easily and grows fat babies. Stick to whole grains, sprouted grains preferably, like Ezekiel bread. If it's white, it ain't right.

Fruit juices, pure sugar. It takes about 4-5 apples to make one glass of juice. I don't know of many people who can sit and eat 4-5 apples in one sitting. Eat the fruit, drink water.

Cow's milk is intended for baby cows who grow and gain weight very rapidly. Just like babies on cow's milk formula tend to put on weight faster, babies of moms who drink lots of milk grow bigger babies. Use only organic milk/cheese so at least you're not getting all the growth hormones and use sparingly.

Same with supermarket beef and poultry, they're fed growth hormones to make them ready for slaughter quicker and eating the meat will grow big babies. If one can afford organic, stick to that and again eat beef sparingly.

Get out and walk every day, burn some of that extra glucose with excercise.

[pamamidwife]

With shoulder dystocias occurring at less than a half percent, I'm wondering how many births you've attended, Barb. It seems you should also be seeing a fair share of uterine ruptures, too.

I think the bigger issue with shoulder dystocia is pushing positions. In the hospital is where you're going to see those smaller babies with shoulder dystocia. Pushing on the tailbone, in a semi-reclined position, these all contribute to a decreased pelvic outlet. Forced pushing also complicates things, as it impacts how a baby rotates through the pelvis.

I know alot of sticky shoulders get termed SD, but I also know that it's a pretty rare thing. I'm glad I don't have your bad luck, Barb - I have seen one SD in eight years of ten years of attending births...and that was a primary of mine. I hope that, based on statistics, I never see one again.

[momileigh]

About milk (Barbara):

8 grams of protein in 1 cup of milk seems decent to me. If I'm drinking 3 cups of milk a day and eating 2 servings of yogurt and cheese, that's over or about half my protein right there depending on your recommendation for grams. Add a Luna bar and a couple servings of eggs and/or meat and you're good. Exactly how many grams of protein per serving does something have to be to be considered a good source of protein? And why do you say it is pure glucose? Last time I checked milk has a very decent glycemic index and milk-drinkers were found to be slimmer than non-milk-drinkers.

Maybe I'm biased because I love milk, I drink it constantly (half a gallon a day), and my kids were both under 8 pounds.

The women I see packing on the pounds are the ones who eat lots of processed grains. Organic beef and organic milk are practically superfoods as far as I'm concerned.