efw - how accurate is it? if too big, is induction necessary? - Mothering Forums
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#1 of 17 Old 01-06-2004, 05:21 AM - Thread Starter
 
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I just had an u/s done yesterday and the efw was 4 kg. My gynae is strongly encouraging me to induce or have a c-section. According to his ve, my cervix is slightly sore but not effaced yet.

I had two u/s done during early pgy. Edd is either 6/1 (which my doc prefers) or 10/1 (which I prefer).

My gynae says the longer I wait the bigger my bb will be and the harder to get it out. He also says that as a Asian woman, a bigger baby will usually get suck and cause all sorts of complications. (he named shoulder dystocia as one of them) I'm not a petite Asian woman. I'm 1.7m and about 80 kg at the moment. My usualy weight is about 70kg.

This is my second baby. My first was born buttocks first with the help of an epidural. I didn't have an epi done and had a small tear that required one stitch.

Personally, my preference is to wait for this baby to decide to come out naturally. I feel I will be able to birth my baby irregardless of weight.

What do the rest of you think? I'd really appreciate some feedback.

Thanks!

Frond
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#2 of 17 Old 01-06-2004, 07:39 AM
 
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Your instincts are correct. EFW at term can be off by over a pound (500 g), not to mention that the vast majority of women can handle a baby of 4 kg without difficulty. The ease with which you delivered your first (a breech! almost unheard of these days in the US) and your size would lead me to believe that this is a non-issue. Here is an article by Henci Goer on this subject. In it she covers the research on the subject which shows that induction does not lower the incidence of shoulder dystocia, c/sec or birth injury for women with babies suspected of being over 4 kg. In addition ACOG (the American College of OB's and Gyn's) themselves released a study last summer showing that this practice actually increase c/sec when compared with waiting for labor with no benefit in fetal outcome.
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#3 of 17 Old 01-06-2004, 10:28 AM
 
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frond,

Welcome to MDC! I saw your post last night while nursing and ran back in this morning to respond because I've been thinking of you.

Mom2six said mostly what I was going to - I would just add some encouragement. Trust your body! Trust your baby! You birthed a breech baby, your instincts tell you you can do it this time, your baby will know when it is the right time to be born.

I don't have time to look up links now, but there are so many increased likelihoods of more complications when you induce labor before your body is ready, cervix is ripe, etc. And I hope you will be able to have someone with you who can support moving around and changing positions in labor as much as you want to. This will be the greatest possible aid in getting the baby out -- standing, squatting, walking, getting on your hands and knees -- whatever you feel you need to position the baby, especially if it is large (and I agree that EFW is often not accurate). This might be a reason to consider alternatives to an epidural, such as warm water in a shower, massage, etc - so you have freedom of movement.

You can do this!!! Keep us posted please!

mamabutterfly

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#4 of 17 Old 01-06-2004, 11:33 AM
 
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Ultrasounds rely on length to estimate mass - so if the length measurement is off even a bit, you can get weight estimates that are way off (the error gets multiplied by three.)

My dad is a pediatrician, and once attended a C-birth of twins which was scheduled because one baby was "so big" and one was "so little" - they were estimated to be over a pound different in weight. (It was the alleged difference rather than the particular weight that caused concern.)

In fact: one ounce difference. Even comparing two babies in the same place at the same time with ultrasound can be tricky!

Especially if you have a disagreement with your ob on dates - hold firm. You can do this. If complications arise, you will be able to have a C-birth if you need one. No need to put the cart before the horse!

Can't give up actin' tough, it's all that I'm made of. Can't scrape together quite enough to ride the bus to the outskirts of the fact that I need love. ~ Neko Case

 
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#5 of 17 Old 01-06-2004, 12:34 PM - Thread Starter
 
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Ladies,

Thank you so very much... I guess I do know what I want to do but am the type of person who needs to know that there are others who think/feel the same way.

Mom2six (wow!) thanks for the url... I've read Henci Goer's book and found the article very encouraging.

From what I've read and understand, positioning is everything. My situation is slightly complicated in that I'm going to be delivering at a goverment run hospital which has rather strict std operating procedures... *sigh* I won't be changing hospitals due to financial constraints (with this one I don't have to pay cash at all) To get around the situation, I've engaged a doula who will be assisting me at home up to the point when we decide I really want/need to get the hospital. So postitioning up to that point will be easy as there won't be any 'medical' people around to say otherwise.

Once I get to the hospital, things will change. I can only pray that by the time I arrive the baby will be ready to literally 'pop' out.

The alternative is if I'm brave enuh to have an 'accidental' birth at home... honestly, I don't know if I am *that* brave.

I will trust my body and God. And I will keep you guys posted!

Thanks again!
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#6 of 17 Old 01-06-2004, 12:59 PM
 
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As long as you don't end up in the lithotomy (flat on your back with feet in stirrups) you would be amazed the size of baby you can push out.
And being small has nothing to do with it. I birthed an 8 lbs. 12 ounce (not sure how many kg that is) baby the first time and a 9 lb. 1 oz. baby the second time and it was almost effortless when I was pushing on my side rather than my back.
For the record, I'm 5 feet tall and used to weigh around 105 pounds. This is one instance where your doctor does not know best.
Hope that is helpful to you. Good luck.
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#7 of 17 Old 01-06-2004, 01:22 PM
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I don't know why they even bother with efw. Does anybody know? Of all the women I know who have given birth the efw has always been higher than the eventual birth weight. It just scares mothers unneccessarily. My son was estimated at 10lbs.+ but was 8 lbs. 4oz. at birth. My best friend with the same OB was told 10lbs.+ even though her first two children were only 5-6 pounders (full term and perfectly healthy). Her baby was 7 lbs. something at birth. I can see using it to make sure the baby is getting bigger but why even take a stab at the weight if it's so inaccurate?! Grumble grumble.

I wouldn't pay any attention to it. You obviously know what you are doing so just carry on!
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#8 of 17 Old 01-06-2004, 02:45 PM
 
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I'm sorry I don't know the conversion to kg off hand, but I had 2 friends induced b/c of 'huge' babies (estimated 9-10 lbs). Both ended up having c-sections and the babies ended up being 7 1/2 lbs and 8 1/2 lbs. Those efw's always seem to be wrong. If you already managed to birth a breech baby, I'm sure you can handle this baby, even if large.

Michelle -mom to Katlyn 4/00 , Jake 3/02, and Seth 5/04
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#9 of 17 Old 01-06-2004, 03:19 PM
 
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"My situation is slightly complicated in that I'm going to be delivering at a goverment run hospital which has rather strict std operating procedures... "

Have you discussed different positions with your doc? Perhaps some logic will help (that in an upright position, pelvic volume increases by up to 30% -- common sense, eh?)

I haven't given birth in a hospital, so I don't really know what you're up against. However, I'm assuming they won't physically force you into a lithotomy position (or force surgery on you when the baby is not clearly in distress) perhaps you can just ignore them and refuse to get on the bed? Or -- maybe there is a waiver you can sign?

You can birth this baby. I wouldn't worry at all about the size. I'll wish you good luck, but I think you only need it with respect to dealing with the doctors!
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#10 of 17 Old 01-08-2004, 01:51 AM
 
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As a mother that has been through this exact thing, and fallen for it ONCE, I would tell you they are full of C*rap. I have had two big babies, the first by c-section without labor after being scared into it by tales of baby too big to be born and shoulder dystocia. I so regret it now. My daughter weighed 11 pounds 5 ounces and had a 16 inch head (of course, she never went through labor) and at the time I thought I had made the best decision. But I so regret missing out on her first day of life because I was in pain or a narcotic pain relief fog. I couldnt' keep my eyes open to hold her, look at her, or nurse her. I'll never get those moments back.

I figured it out by my next birth, and had a homebirth and my son weighed 12 pounds 1.6 ounces and also had a 16 inch head. Was my cesarean necessary? Clearly now.

This is something that OBs use all the time. THey fear a big baby. The best thing to do is stay unmedicated and refuse an induction or a c-section. A study last year came out that had the data that inductions for big babies had not bearing at all, no advantage for babies or mothers, they just caused more cesareans.

Get on the ICAN (international cesarean awareness list) if you want more info about cesareans and why this is just a bogus reason. Your body will grow a baby that will fit through you. Concentrate on gestating and getting your baby in the best position for labor. Anyway, the ICAN list, go to ican-online.org for info on that. You would hear from sooooo many women told this exact thing, and then we go on to birth even bigger babies the next time. By the way, I am only 5 foot 3.

If you are interested in my birth story, do an archive search for "pablo felix" and you should find it.

Good luck, please dont' make the same mistake I did and have an unnecessary cesarean.
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#11 of 17 Old 01-09-2004, 05:42 AM
 
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well i'm horrible at converting metric to english, but my sister had a 10 lb baby (her second child) naturally, vaginally, and didn't even tear.

just go with the flow. your body can accomodate the birth of any baby you can grow. really.
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#12 of 17 Old 01-09-2004, 03:10 PM
 
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He frond, welcome to MDC! I just met with my ob tuesday. I had an u/s Monday to determine my baby's size due to an anomaly in the umbilical cord. For me there was concern that he would not get as much nourishment as needed and wouldn't grow. Well ,at 32 weeks the baby's weight is 4.5 pounds. Perfectly healthy. My ob said that after this she wouldn't recommend another u/s in the third trimester because the standard deviation of an ultra sound in measuring weight is plus or minus 20%. She also said that this is known, common knowledge and the American College of Obstetrics and Gyencologists (hardly an overly natural, non-invasive leaning bunch) recommend that doctors do not rely on ultrasound to determine fetal weight because the deviation is just too darn great. So, trust your instincts. You know what childbirth is like. If you feel that you are capable of delivering this baby as you'd prefer, go for it. For him to make a general statement about pelvic size and Asian women to justify this is not right. It doesn't sound like he's even considered your body frame or the fact that you have already delievered a breech baby vaginally. If you can do that, (!) it sounds to me like you can deliever this baby, even if she/he does turn out to be a little bit on the large size.
Christen
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#13 of 17 Old 01-19-2004, 12:34 AM - Thread Starter
 
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Hi there,

Just to let you know that I delivered a healthy happy baby gal on Sat morning (10/1). She weighs 3.93kg and is 50cm long. She's been a great nurser from birth and I'm on the start of my tandem nursing adventures... such fun!!

Delivery was Heaven & Hell - two parts.

*heaven*
My doula and hubby were a great support to me at home while I laboured. I felt peaceful, calm and in control. Its something that I had wanted to experience and am happy to have done so. It was so empowering for me to realise that I could cope with the feelings that my body was producing. I always thought I was a wimp when it came to pain...
*hell*
Then, we checked into the hospital (without my doula)... *SIGH* having to deal with all the procedures and their requirments quite frankly scared me. As a result my labour slowed down. I've gotta say that labouring on your back/side while lying on a bed and labouring in any other position is just *so* different. On the bed, I felt so helpless and lost. That resulted in a major mental/emotional breakdown while in the ward. I think I was easily the noisest patient there. Medical interventions snowballed (what's unusual) and I landed up having both an epidural & a long episiotomy.

One thing I have to say, I appreciate my husband more than ever before. He was a rock of strength during the entire 20+ hours that I laboured. I couldn't have done without his support. And for those of you who are considering a doula... get one! She was a great help for me both before and during labour.

Joanna
happy mummy to Khai 26mos and Shiyr 10 days old
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#14 of 17 Old 01-19-2004, 03:20 AM
 
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Yay! Thanks for the birth story. I know what you mean about dealing with hospital policy and things slipping out of your control and snowballing away from you. Very glad that your "too big" baby was just fine and is nursing happily. Healing vibes and congrats to you!

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#15 of 17 Old 01-19-2004, 12:32 PM
 
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thanks for the update, frond - i've been thinking of you! congratulations on your new baby girl.


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#16 of 17 Old 01-19-2004, 01:03 PM
 
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Congratulations on your successful V-birth!

alittle offtopicT
...but two and two tenths English pounds is equivalent to one metric kilogram.

2.2 lbs = 1kg.
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#17 of 17 Old 01-19-2004, 07:50 PM
 
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I'm so sorry about the "hell" part. But at least it's satisfying to know that you were right about the weight not being a problem, eh?

Congratulations on avoiding a c-sec, and also on your healthy little sweetie.
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