My son was large- 9.5 lbs. I am small... His birth went from imperfect to difficult to impossible because my water broke early, his being so large and firmly wedged crookedly in my pelvis in a way where though I was in labor for 24 hours, because of his position, he never stimulated the cervix properly to dilate- I only ever got to 2 cm. I ended up with a c-section, as infection was becoming a concern, the fact that he was so large and crooked, and my personal exhaustion (after all that time, I had contractions every minute and would fall asleep between them!). We tried to avoid it, but things were going from bad to worse pretty fast.

Dr says that for Baby #2 he will do a vbac gladly, but anticipates another "big baby", or at least the possiblility of that, and said that another big baby would have a good chance of ending up with a similar situation as DS and may end up another c-section. He would like to do an u/s at about 38weeks to get a sense of size and position.

What I would like to ask y'all is: If baby #2 looks big at 38 weeks, would you ask to induce to try to avoid a c-section? I would very much like to avoid both, and I know that large babies can be birthed just fine vaginally when labor begins on its own, so this question is tearing at me. I would VERY MUCH like to avoid another c-section, but I am not keen on induction either. But I think I might rather induce if conditions seem to be aligning themselves like they were for DS rather than risk it all and end up with another c-section.

What do you think?

First, ultrasounds that late are very unreliable.

Second, the problem the first time did not seem to be with the size but rather the position of the baby.

Third, inducing (at least medically) increases very much your chance of ending up with a c-section.

I would recommend looking into positions that can help the baby into the right position (perhaps similar to what women with breech or transverse babies do, but you would have to look that up)

I would not do the ultrasound, but that s up to you. I would worry that the OB would then use that to scare me or force me into inducing.

If you truly think that inducing is a good idea, then I would recommend trying natural methods. Perhaps you can do a little nipple stimulation over the last weeks to help your cervix move along.

I would avoid at all costs any other intervention during labour to avoid any cascading into a c-section. Perhaps staying home until you are sure that you are well into labour and progressing (maybe have your DH check you or check yourself).

Your chance of a c-section after induction is a lot higher than going into labor on your own. Not to mention that due dates and weights are *estimates* so baby may not be ready, labor may be difficult to start with an induction and end in failure/c-section and higher mortality all around. I would read Pushed or Born In the USA to start with to see the stats around the facts of induction.

Was baby posterior? Were you induced with your first?

My first son was born via cesarean, and was 9 lbs 6 oz. I also had pre-eclamspia, but basically, his head never descended, and my cervix wouldn't dilate beyond 5cm. He was in a posterior position.

Son #2 was due 17 months later. I was in labor for 3 days, partially because he kept putting his hand up by his cheek, which would tilt him to the side and bring his head up off my cervix... thus stalling labor for a few hours at a time, until we could get him to move his hand. But, once I was fully dilated, he was born in just 15 minutes. And, he was also 9 lbs 6 oz.

Position is everything. Also, my second son was born in a homebirth, so I didn't have any artificial hormones or interventions cluttering my body.

I'm also a small person. A size 2 before having kids (and desperately hope to be again!), but having a large baby was not an issue.

Second, the problem the first time did not seem to be with the size but rather the position of the baby.

:yeah:
Also, read around, VBACs are more likely to be successful if they aren't induced.

uh... Inducing? For a VBAC? You're kidding, right? That's not such a great idea. I would question whether your OB actually intends for you to have one at all, or whether he wants you to be grateful for the c/s that "saves" your baby.

Inducing in and of itself leads to more c/s.
Inducing a VBAC makes it WAY more dangerous than it has to be. ESPECIALLY if pitocin will be involved. Foley catheter, not as much, but most medications used for induction are generally contraindicated for VBAC due to the increased possibility of rupture.
http://vbacfacts.com/vbac/#URSIAL

Inducing for suspected macrosomia is generally a bad idea. Even the ACOG says so, and that's saying a lot.
The ultrasound is the *worst* way to guesstimate how big the baby is. A competent practitioner would do better to estimate with his or her hands, but then, a competent practitioner would generally know better than to induce for a VBAC for a big baby.
http://www.aafp.org/afp/20010115/302.html
http://www.childbirthconnection.org/article.asp?ck=10036&ClickedLink=434&area=27


And anyhow, your problem last time sounds like it had very little to do with size, and very much to do with position and bad management. How much did your OB have you move? How were you laboring?

Work on getting your baby into prime position now.
http://spinningbabies.com/ is a good resource for optimal positioning.

So all that was just to say-- take your time and don't try to head one off with the other. It will just make your life more stressful.

:) Good luck. And don't let the idea of a big baby scare ya. Most moms of big babies say that it's easier to birth the bigger babies-- they help more.

ETA: Also... I would find a new OB or a midwife who is *actually, TRULY* in support of a VBAC-- one that cares enough to be informed.

I'm also a small person. A size 2 before having kids (and desperately hope to be again!), but having a large baby was not an issue.

And it rarely, if ever, is an issue. Small women can have big babies with safe and healthy outcomes. Only CPD (cephalopelvic disproportion) could intervene, and that is extremely rare. http://www.bellybelly.com.au/articles/birth/small-pelvis-big-baby-cpd

Ask the OB flat out, "Do you think I have CPD?" Then get a second opinion.

I would also ask what his induction rate is. "Do you end up having to induce a lot?" "I read somewhere that doctors are inducing labor as high as 85% of the time. Is that about your rate? Higher? Lower?"

If s/he's a habitual inducer, run--don't walk--to another care provider. The induction-happy docs will look for any excuse...

Edited to ask: Has your doc discussed how you will be induced? If the word "Cytotec" is mentioned, and you haven't heard about Cytotec and VBACs, come back and talk to your friends at MDC :-) We'll happily hold another Cytotec conversation again....

Like everyone else here, I would not agree to an induction for a suspected large baby. According to the Coalition for Improving Maternity Services (http://www.motherfriendly.org/) (CIMS) factsheet Problems and Hazards of Induction of Labor (http://www.motherfriendly.org/Downloads/induct-fact-sheet.pdf), "Inducing labor for suspected big baby produces no benefits but increases the likelihood of cesarean section." CIMS gives two peer-reviewed journal articles as references:

1. Gonen, O. et al, Induction of labor versus expectant management in macrosomia, a randomized study. Obstet Gynecol 1997;90(1):125-30.

2. Tey A., Eriksen N.L., and Blanco J.D. A prospective randomized trial of induction versus expectant management in nondiabetic pregnancies with fetal macrosomia. Am J Obstet Gynecol 1995:172(1 Pt 2):293.

I've also read in several different places that induction of labor is especially dangerous for VBACs, as it significantly increases the risk of uterine hyperstimulation, which can lead to uterine rupture. It's certainly something I would think about if my doc continued to push induction!

No, no, no.


Inductions will CAUSE c-sections, not prevent them.

The baby being 'big' does not guarantee that you will need a c-section. Positioning is key. Lying on your back and otherwise doing what you'd have to do will undoubtedly cause malpositioning.


Go into labor naturally. Avoid beds and epidurals.

Inductions often CAUSE csecs, and an induction after a csec raises the risk of a uterine rupture.
I am also on the small side, my water has broken first with all of my labors, and I birthed 3 big babies just fine, the biggest also being 9lbs5oz.
I thinking figuring out baby's positioning after 36 weeks and doing what you can to get him/her into an optimal birthing presentation would be the best thing to do. And ultrasound will probably only cause you worry since it can be so incredibly inaccurate late in pregnancy.
Sounds like you need a patient care provider, a good doula, and the freedom to move into different positions during labor. And food and drink during a long labor.