Fdbk please: Maternal weight gain and baby size update #14

[touka]

This might get kind of long, but I'd really appreciate some experienced feedback regard the recommendations given to a VBAC mom regarding her current PG.

Situation:

1st Pregnancy:

30yr old, slim but tall, very healthy mom, picture perfect PG, gained 33 lbs.

Labor was natural however she was confined to bed with CEFM, became feverish with swollen cervix at 8cms and baby did not appear to be descending. Baby was delivered by C/S weighing 8.4 at 40 weeks.

It appears from speaking with Mom that the baby was asynclitic (Ped remarked on pronounced ridge on baby's forehead) and unable to move through the pelvic outlet (we both think the poor positioning was not given a chance to resolve because she wasn't allowed to move around). The baby DOES have a fairly large (but adorable) head.


2nd pregnancy:

17 mos. post C/S, 6wks along, due early Aug. and preparing for VBAC. Mom is still nursing - at least 4x day although babe will likely wean before new baby arrives

She recently interviewed a care provider who recommended the following:

- gain ONLY 23 lbs in an effort to restrict the growth of the baby (that may sound overly harsh, I don't know how else to phrase it) to mid 7lb range

- beginning at 37 weeks use natural methods to encourage labor (sex, walking etc - no mention of castor oil)

Both of these suggestions made us a bit wary of the CP, but the weight restriction in particular did not sit right.

I would really appreciate some doula/MW/mom's who've BTDT opinions on whether or not this is appropriate advice, whether it would actually make any difference (mainly the weight stuff) and if anyone has some research/references they can throw my way I'd really appreciate it. Mom is feeling a bit overwhelmed with all the information she's getting from a lot of different sources and I'd really like to be able to address her concerns (she asked me about this but I don't know enough to answer properly).

Thanks!!!

[MidwifeErika]

I do not think it is good idea to tell a mom to diet in order to have a small baby. If the baby was asynclitic, then having a pound less of chub wouldn't have helped that first birth. I can understand making sure a mother knows it is really important to eat a great diet and avoid junk food, but setting a weigh gain limit really doesn't set well with me at all.

[spewie]

I gained the least weight with #1 (26lbs) and he was 9'8 resulting in a c/s. Situation similar to your friend's where I was restricted to the bed the whole labor. I gained 36ish pounds with #2&3 and they were 7'14 and 7'8. Both were vbacs

I personally think restricting her diet is a bad idea.

Good luck to her!

[etoilech]

Complete and utter garbage.

Do people even weigh pregnant women anymore? Geesh. No one here does. Weight gain is rarely a sole indicator of anything as far as complications are concerned.

Naturally trying to "encourage" labour at 37 weeks. :

I know you want research, but honestly I am just too shocked that any HCP would think this is a reasonable course of action to come up with anything useful for you. Let me think about this and see what I can find. I'd be more likely to ask the mother to ask her HCP for references saying that this course of action is evidence based.

See... this is why I can't be a doula. I'd suggest finding a new HCP.

[touka]

Originally Posted by hotwings640

I do not think it is good idea to tell a mom to diet in order to have a small baby. If the baby was asynclitic, then having a pound less of chub wouldn't have helped that first birth. I can understand making sure a mother knows it is really important to eat a great diet and avoid junk food, but setting a weigh gain limit really doesn't set well with me at all.

This is exactly what I was thinking. It just makes NO sense to me. Mom is a VERY healthy active woman. Besides running after her son, she goes to the gym regularly (in fact, she just told me to was doing spin classes into her 8th month w/#1) eats no junk food other than a small bowl of ice cream once in a while - no soda, no excessive sweets etc.

Originally Posted by spewie

I gained the least weight with #1 (26lbs) and he was 9'8 resulting in a c/s. Situation similar to your friend's where I was restricted to the bed the whole labor. I gained 36ish pounds with #2&3 and they were 7'14 and 7'8. Both were vbacs

I personally think restricting her diet is a bad idea.

Good luck to her!

Thanks for the anecdotes, it's good to hear how others have dealt with this issue.

[bobandjess99]

1. RUN away from that particular provider.

then....well...eating well in order to restrict oneself to a HEALTHY weight gain is always a good choice....but mom did NOT gain "too much" weight NOR did she have have an overly large baby the first time around, nor, I am assuming, has it been suggested that diabetes was at play here?

mom had a NORMAL size baby that was MALPOSITIONED, and due to her choices, was unable to do anything about trying to change that position.

The best way to have a normal birth this next time around?
Continue to eat and exercise in a healthy manner. Gain a normal amount of weight. Forget ANY mention of trying to induce early...induction, even "natural" is a sure way to become totally stressed out, and is dangerous with a VBAC, and NOT NECESARY at all....againm, her baby was NORMAL sized and right on time. Practice optimal fetal positioning during pregnancy to encourage a better placement of baby. Skip the epidural so that position changes, if necesary, are possible.

[touka]

Originally Posted by etoilech

Complete and utter garbage.

Do people even weigh pregnant women anymore? Geesh. No one here does. Weight gain is rarely a sole indicator of anything as far as complications are concerned.

Naturally trying to "encourage" labour at 37 weeks. :

I know you want research, but honestly I am just too shocked that any HCP would think this is a reasonable course of action to come up with anything useful for you. Let me think about this and see what I can find. I'd be more likely to ask the mother to ask her HCP for references saying that this course of action is evidence based.

See... this is why I can't be a doula. I'd suggest finding a new HCP.

Believe me, I'm with you on all of this! Mom was definitely taken aback by what was being said because she was expecting a less controlling (my word) reaction because she's a CNM. Additionally, we both viewed one of this CPs birth videos and I was really turned off by how it was handled.

This was ONLY an interview and I'm fairly certain that she will end up going with a different practice that she really liked during an earlier info session. This CNM was recommended by her doula, whom she really likes, so she decided to do the interview.

I'm planning to read through my MWery books and check out the med searches online but I really like hearing the first person experienced stories too.

[touka]

Originally Posted by bobandjess99

1. RUN away from that particular provider.

then....well...eating well in order to restrict oneself to a HEALTHY weight gain is always a good choice....but mom did NOT gain "too much" weight NOR did she have have an overly large baby the first time around, nor, I am assuming, has it been suggested that diabetes was at play here?

mom had a NORMAL size baby that was MALPOSITIONED, and due to her choices, was unable to do anything about trying to change that position.

The best way to have a normal birth this next time around?
Continue to eat and exercise in a healthy manner. Gain a normal amount of weight. Forget ANY mention of trying to induce early...induction, even "natural" is a sure way to become totally stressed out, and is dangerous with a VBAC, and NOT NECESARY at all....againm, her baby was NORMAL sized and right on time. Practice optimal fetal positioning during pregnancy to encourage a better placement of baby. Skip the epidural so that position changes, if necesary, are possible.

I agree with all but the bold stuff. Yes, she chose to be in hospital, but the CEFM kept her tied to bed. She DID NOT have an epidural.

I'm encouraging her to go with her gut, which would omit this CP from consideration and most likely have her choosing another practice that she does really like (and has a better success rate). We were both really flabbergasted by these suggestions.

[KariM]

I'm a BTDT mama, I guess.

My DS was born 9lb 10oz (ended up a c-section due to doc's impatience, among other things). I gained 23 pounds that pregnancy.

My DD was born 7lb 12oz - HBAC. I gained 25 pounds that pregnancy.

I'm curious to see how this little dude/dudette turns out. I'm currently at 24 weeks and have only gained 5 pounds.

BTW - I've been overweight/obese for all three pregnancies.

[MsBlack]

This advice sounds both ignorant and dangerous to me. I hope this CNM is at least able to back up this advice with some studies, or something.

Yeah, run!

[touka]

KariM Thanks for your stats. This mama is very thin and I really feel, based on anecdotal evidence only though, that she may be prone to gaining more weight because she needs to add the extra weight/fat that someone like you or I already have available. Given her history of healthy eating/living, I'm inclined to say her body gained exactly as much as she needed to keep both mom and baby healthy.

MsBlack I couldn't agree with you more and I have far from the experience and learning that you and other MWs do. And, something that occured to me last night (should have been the first thing I thought of): bones are bones. Restricting the baby's growth during the pregancy isn't necessarily going to change his bone structure!

Uh, everything about this just feels wrong and I'm glad I'm not the only one who thinks so.

[KariM]

touka, I guess the point I meant to make was that I birthed a 9lb 10oz baby boy while only gaining 23 pounds. Keeping weight gain low doesn't necessarily correlate to a smaller baby. Yes, maybe he was big because my body had extra weight to share, or maybe he was big because his genetic structure made him big - he's still big today and his father and uncles are big as well.

But I also had a 25 pound weight gain and had a much smaller baby.

My personal experiences showed me that weight gain during pregnancy doesn't affect the sizes of *my* children and I don't see that it would with other women as well.

[touka]

KariM Sorry, I didn't mean to make it seem like your weight/gain had anything to do with the baby sizes! I think we're actually thinking the same thing - in normal circumstances, weight or weight gain doesn't matter. Her gaining "extra" weight didn't make for a big baby and you NOT gaining as much didn't make for a small one. I just didn't explain my logic very well up above.

[touka]

Talked with Mom this morning and she happily informed me that she is going with her first choice. Thrilled with this (and expected it) and she seems much more relaxed.

She spoke with another client of the CP and found that that Mom had experienced the same weight/size focus (and this was 20 years ago) too. Seems to be a crusade with this particular CP. Scary!

Thanks for all of the reponses!

[mwherbs]

the studies on diet restriction in order to prevent a baby from being macrosomic have not proven to work-- the difference in the size of babies with mom on a diet or not was 1 oz . restricting weight gain is insane- sounds like a throw-back to the 1950's -- my advice is to RUN away from this provider
now eating health foods - and mom does not gain alot is just her own body but deliberate dieting to the degree of not allowing for gain,,,, sounds almost like an eating disorder to me--
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[danotoyou2]

I think 23 lbs is a bit extreme, BUT I will say that a MW whom I adore gave me advice for my VBAC. She said to watch my diet carefuly, so as not to have an overly large baby. First was 9.6, so I was really careful in my diet... still gained the same amount of weight as the first pregnancy, and STILL had a 9.6 baby. But, I felt a lot better, and had I been eating junk food and lots of carbs, I may have ended up with an even bigger baby. As it was, the baby was the right size because I ate healthy (which is the focus of her diet).

[mwherbs]

the studies just don't support changing a baby's size via maternal diet-- genetic play quite a role- now women who start out under weight and have low weight gain in pregnancy are at risk for pre-term labor--- I do agree that eating healthy foods more veggies and less grains, less to no simple sugars, no hydrogenated oils, decent amount of protein mom is going to feel better and be healthier -- she may or may not gain as much weight