Scheduled C-Section cause the baby is estimated @ 9 lbs. - *Update* - Page 3 - Mothering Forums

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#61 of 107 Old 07-31-2006, 01:30 PM
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Originally Posted by flapjack
There's a LOT of evidence out there to suggest that the outcome for babies improve at 39 weeks, as opposed to 38.
There is no clinical justification for performing a c-section for macrosomia. The worst case scenario is that baby simply won't come out.
Can you explain that? Do you mean the baby will be overdue? Just curious. I haven't met anyone who had "small baby" but I am curious how it is diagnosed/"treated" in medicine vs. midwifery. Thanks!!!
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#62 of 107 Old 07-31-2006, 01:58 PM
 
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#63 of 107 Old 07-31-2006, 06:50 PM
 
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Originally Posted by CEG
Can you explain that? Do you mean the baby will be overdue? Just curious. I haven't met anyone who had "small baby" but I am curious how it is diagnosed/"treated" in medicine vs. midwifery. Thanks!!!
http://www.perinatal.nhs.uk/reviews/..._sd_11_abs.htm

From the point of view of the actual birth, the biggest risk is shoulder dystocia: which occurs in approximately 1% of births. There's also the possibility that baby's head is too big and simply refuses to engage even late into labour: I've never heard of it happening to anyone standing upright and not using drugs, but that doesn't mean it doesn't.
Over here, we don't have a differentiation between medicine and midwifery: we have midwives to apply the common sense and evidence-based approach that the obstetricians lack, but they're both singing from the same hymn sheet and reading from the same textbook.

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#64 of 107 Old 07-31-2006, 06:53 PM
 
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Originally Posted by kymholly

according to my sil, the friend, "had to really push hard" to get her 9# daughter out.
she had to push hard? well, no wonder, then. none of us pushed hard, did we, ladies? me, i glanced down and there was ds, sliding down my leg and i said 'now how did that get there?'

sorry for the sarcasm. some people get me going...
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#65 of 107 Old 07-31-2006, 07:29 PM
 
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#66 of 107 Old 07-31-2006, 08:15 PM
 
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Originally Posted by josybear
she had to push hard? well, no wonder, then. none of us pushed hard, did we, ladies? me, i glanced down and there was ds, sliding down my leg and i said 'now how did that get there?'

sorry for the sarcasm. some people get me going...
That reminds me of the monty python skit

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#67 of 107 Old 07-31-2006, 08:21 PM
 
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Originally Posted by josybear
she had to push hard? well, no wonder, then. none of us pushed hard, did we, ladies? me, i glanced down and there was ds, sliding down my leg and i said 'now how did that get there?'

sorry for the sarcasm. some people get me going...
...........i really didnt push hard.........i had an epi and couldnt feel a thing.......so i just pretended like i was peeing.....and TADA! a crowning baby.
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#68 of 107 Old 07-31-2006, 08:26 PM - Thread Starter
 
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Quote:
Originally Posted by josybear
she had to push hard? well, no wonder, then. none of us pushed hard, did we, ladies? me, i glanced down and there was ds, sliding down my leg and i said 'now how did that get there?'

sorry for the sarcasm. some people get me going...
Yeah, that comment was almost as shocking as the rest of it. And my sil said it to me with a straight face... like of course, I should be able to understand why *that* shouldn't have to happen again. UGH!
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#69 of 107 Old 07-31-2006, 10:42 PM
 
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Originally Posted by ApplePieBaby
Not just drug users, but if you have high blood pressure or preeclampsia, your placenta just doesn't work as well. Your body sends blood to your vital organs (heart,brain), and that doesnt include your placenta... so baby stops getting enough oxygen & nutrients to grow. I know with me, my less essential organs (liver, kidneys) starting showing signs of losing function too.
This can also happen with diabetes (both types plus GD) and with clotting disorders. The latter is the reason my daughter was stillborn, as far as we could figure out from testing. If you have a high alpha feto protein level without a concurrent neural tube defect, that can be a warning sign of placental malfunction.
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#70 of 107 Old 07-31-2006, 11:54 PM
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Quote:
Originally Posted by flapjack
http://www.perinatal.nhs.uk/reviews/..._sd_11_abs.htm

From the point of view of the actual birth, the biggest risk is shoulder dystocia: which occurs in approximately 1% of births. There's also the possibility that baby's head is too big and simply refuses to engage even late into labour: I've never heard of it happening to anyone standing upright and not using drugs, but that doesn't mean it doesn't.
Over here, we don't have a differentiation between medicine and midwifery: we have midwives to apply the common sense and evidence-based approach that the obstetricians lack, but they're both singing from the same hymn sheet and reading from the same textbook.
Thanks- I misunderstood your post and I thought you were talking about the small for dates baby. Thanks for the explanation though
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#71 of 107 Old 08-01-2006, 04:38 AM
 
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I have a friend whose doctors said she was measuring 42 weeks at 37 weeks, so needed to be induced for huge baby. Ended in C-section of course, and baby was a whopping 6 lbs 8 oz. : But in her case, it turned out to be a good mistake, as they'd totally missed the glaring signs of pre-e, and it finally ended up being diagnosed a week later when she was back in the hospital with heart problems.

On the small baby thing... If a baby is only 2 lbs 11 oz at 36 weeks, YES that baby probably needs to come out. There are cases where the baby can do better on the outside than on the inside, and that's a pretty obvious case to me. My son was a lb bigger than that at 29 weeks! If you leave an IUGR baby in too long, it could end up dying in the womb. On the outside, you can make sure it's getting the nutrients it needs. And no, IUGR is not just found in drug users or malnutritioned women. There are numerous things that could cause placental insuffiency. Obviously, that baby hadn't been getting enough nutrients for a long time. I believe that's the typical weight of a 29-30 weeker (my son was big for his gestational age).

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#72 of 107 Old 08-01-2006, 09:03 AM
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Originally Posted by CEG
ITA. I am not sure what kind of diagnostics they use- I think they usually say there's a placenta problem causing the baby not to grow well. I *think* this is a true concern with babes whose moms are drug abusers (esp cocaine) because it causes abnormal placenta functioning, but of course that's not the norm. I truly believe your average OB sees pregnancy and birth as a problem waiting to happen and the mother's body as a potential threat to the baby instead of the miracle it is.
I'm sorry- I didn't mean to imply that drug users were the only ones who get IUGR. That's just the only example I was pretty confident about.
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#73 of 107 Old 08-01-2006, 10:32 AM
 
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I have a friend whose doctors said she was measuring 42 weeks at 37 weeks, so needed to be induced for huge baby. Ended in C-section of course, and baby was a whopping 6 lbs 8 oz.
Holy crap! I'd better go get indued RIGHT NOW! I'm 35 weeks, measuring 40, this kid is going to be giant!!!

Sorry, couldn't help myself :
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#74 of 107 Old 08-01-2006, 10:37 AM
 
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Originally Posted by CEG
I'm sorry- I didn't mean to imply that drug users were the only ones who get IUGR. That's just the only example I was pretty confident about.
Gotcha.

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#75 of 107 Old 08-01-2006, 10:37 AM
 
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That's insane. I just gave birth, naturally, to a 9lb boy. I've heard alot of stories of mamas giving birth to 10-13lb babies.

Doctors suck..
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#76 of 107 Old 08-01-2006, 09:31 PM
 
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Doctors just love finding excuses to cut you up. My daughter was 10 lbs. 6 oz. and I delivered her naturally. It took me 6 hours to push her out and my midwife just let me go. There was no reason for a C-section. The only intervention I had was a very annoying, extremely uncomfortable episiotomy. Oh and by the way even when I was in labor they told me my daughter was going to be about 8 lbs. They are never right.

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#77 of 107 Old 08-01-2006, 09:34 PM
 
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Just gave birth two weeks ago to my fatty 13 pound girl! At home, unassisted.

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#78 of 107 Old 08-01-2006, 09:43 PM
 
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Originally Posted by mama in the forest
Just gave birth two weeks ago to my fatty 13 pound girl! At home, unassisted.

You go, mama!!



I had a vbac with my daughter who was 9 lbs. Everyone looked at me like I was : It was a great birth....
All I have to say is thank goodness I didn't stay with my OB and I switched to a midwife halfway through my pg. He would NEVER have been cooperative about a big baby, especially 10 days past my EDD.
My midwives were awesome

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#79 of 107 Old 08-01-2006, 10:38 PM
 
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Originally Posted by josybear
she had to push hard? well, no wonder, then. none of us pushed hard, did we, ladies? me, i glanced down and there was ds, sliding down my leg and i said 'now how did that get there?'

sorry for the sarcasm. some people get me going...
ha ha ha laughup
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#80 of 107 Old 08-01-2006, 11:20 PM
 
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It is criminal to intentionally deliver a baby that early with no cause. If they are so worried about it why not just wait till the poor kid is ready to come out and then section her? Unreal.

Oh forgot to mention. My DS was estimated to be over 9 pounds at 37 weeks. When my induction failed and I was sectioned, he weighed a WHOPPING 7.12
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#81 of 107 Old 08-02-2006, 04:50 PM
 
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I delivered my 9lb 8oz son vaginally. I would never let them section me just for a "large" baby.

Any misspellings or grammatical errors in the above statement are intentional;
they are placed there for the amusement of those who like to point them out.
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#82 of 107 Old 08-04-2006, 03:11 AM
 
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Quote:
Originally Posted by lizziejackie

Here's another good one off another chat site:

Q: What was your c/s for?
A: They tried inducing me at 36 weeks because of a small baby (2lb. 11oz.) and she couldn't handle labor, she was in distress so they did a C/S.

Do they REALLY think a baby that timy would do better on the outside than inside??
Are you serious?

A baby estimated at under 3 pounds at 36 weeks is NOT thriving in the womb. Period. For whatever reason, something is not going as it should for a baby to be THAT small at 36 weeks.

IUGR is a very serious, potentially life threatening complication of pregnancy that simply cannot be ignored just so mom can have her magical birth experience...unless a live baby is secondary to her birth plan.

So, my answer to you is YES, a baby that tiny at 36 weeks most assuredly is safer OUTSIDE the womb vs. inside, even if it means sectioning mom to get baby out. No doctor in their right mind would allow a pg to continue under those conditions unless he or she was just itching to have a dead/damaged baby and a lawsuit on their hands.

Perhaps before *assuming* that everyone who is ever induced or has a section must either be an idiot or have been under the care of an idiot, it would serve you well to actually do some research on what might very well be a valid medical reason for serious intervention.
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#83 of 107 Old 08-04-2006, 03:21 AM
 
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Are IUGR babies prone to stillbirth?
I was IUGR... full term. No 26'000 ultrasounds during pregnancy back then to diagnose stuff like that.

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#84 of 107 Old 08-04-2006, 09:45 AM
 
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My OB doesn't do medically unnecessary c-sections. In fact, the hospital doesn't allow them. I was very overdue and vaginally delivered a 10 pound 6 ounce boy with no tearing, thanks to my OB's amazing perineal massaging.

Although, I do know of women who had issues with the size of their pelvis and ability to deliver. I just don't think that a "large" (and I use that term loosely, because I really don't consider an 8 pounder large) baby should automatically require a section.
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#85 of 107 Old 08-04-2006, 11:40 AM
 
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Originally Posted by littleteapot
Are IUGR babies prone to stillbirth?
From this website, I got this quote:

Quote:
Severe IUGR may result in stillbirth. It may also lead to long-term growth problems in babies and children.
A 2 lb 11 oz 36 weeker sounds like severe IUGR to me. Remember that in IUGR, baby is not getting enough nutrients via the placenta/umbilical cord (for whatever reason). Thus it could die in utero if the lack of nutrients gets bad enough, while on the outside, baby can get all the nutrients it needs (via IV if necessary, or via breastmilk if oral feeds are possible).

Yes, many IUGR babies are able to go full term and just be a bit small (like 5 lbs), but the above baby does not sound like one of those cases of IUGR. That is VERY small for that gestation. It's obvious that the baby was not getting the nutrients it needed for growth in the womb.

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#86 of 107 Old 08-05-2006, 11:42 AM
 
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I think sometimes the problem is that people do not really understand or ask enough questions. They come away telling people their baby is too small so they are inducing. Makes no sense in that light, but it would seem the doc knows there is IUGR and all those complications.....perhaps the doc didn't communicate well, or the patient wasn't listening/understanding/asking questions. I have a friend who had a c-section because she had a herpes outbreak when her water broke. She tells people she had it because the docs thought the baby was too big. People roll their eyes cause her baby was 7#10oz but obviously her herpes status is none of their business.

That said, docs are more afraid of getting sued for breaking a baby's arm, clavicle, or injuring the brachial plexus-paralyzing an arm during shoulder dystocia than they are getting sued for an unneccessary section. If you give mom a perfectly healthy baby they are soooo in love and grateful-blind and sliced open but grateful-so they don't sue. If you hand over a baby with a birth injury they are POed. I attended my oldest sister's birth when she was 18. She had a 10#5oz baby (no GD) and the shoulders got stuck. She went totally natural and moved around in labor. They "allowed" her to push on her hands and knees. Head was out and shoulders would not budge.........the doc was on his knees trying different angles, tried getting to baby's arms, moved her to side lying and repositioned her legs, suprapubic pressure finally after 2.5 min (I guess the cord in compressed in the birth canal so baby isn't getting oxygen in this time. His heart rate was really low) he rolled my sister on her back and took the sissors cut an episiotomy-didn't work so he took the sissors and placed on inside her rectum and the other at the base of the epis and cut in!!!!!!! Horrifying! But the baby delivered without any injury to him. My sister on the other hand had no distinction in her rectum and vagina.....one gaping hole-keep in mind she only had a local so she felt almost all of this. It took an hour and a half to repair her vagina, and they gave her antibiotics. The doc came in and tried to explain how you cannot predict this, and it is all about a woman's tissue and women have 10# babies without these problems She says her perineum is firm with scar tissue but she says sex isnt painful. I was 16 when I saw all of this and was trying to process what happened for a long time. Was it necessary? How could I ever have a baby after seeing this? Well, my sister swore no more vag. deliveries, but at age 28 she went all natural again. She went into labor at 37 weeks (she agreed to be induced at 38 for "big baby"). I was happy she went on her own and all natural, but as she pushed out her 7#3oz girl her scar tissue ripped back open!!!!!! Another hour and a half repair. She swears the docs saved her baby and is glad they hurt her not him. I wonder if there aren't more maneuvers they could try before literally cutting her a new one. I had all but one of my babies at home (had a congenital anomaly so I went to the hosp). My sister's case is rare, but I imagine it only takes one like that to change a doc's protocol.

That said, why don't they go over the risks of each. I think most women are blind to the risks of c-sections. Why can't a woman sign something saying I understand the risk of shoulder dystocia but I wish to have a trial of labor? I suppose many women would be too afraid to sign...........
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#87 of 107 Old 08-06-2006, 01:47 PM
 
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I dunno. This is literally like the first case where I have heard of the mom actually being in the hands and knees position and the baby still getting stuck. I dont really see how cutting her up like that could have possibly helped though. The baby gets caught on the pelvic bones, not the skin. (usually they get stuck against the symphysis) I can see how a regular episiotomy might be helpful in getting the baby out quickly once the shoulders are unstuck, but IMO all that extra cutting was really unneccessary. I dont know why the baby finally came out, but I doubt it had anything to do with having her rectum chopped up

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#88 of 107 Old 08-06-2006, 02:00 PM
 
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Oh, and here is a little article about it-it says having a cesarean or induction for expected macrosomia does NOT lessen the incidence of shoulder dystocia.

Evidence is lacking to support labor induction or elective cesarean delivery in women without diabetes who are at term when a fetus is suspected of having macrosomia.14 In two studies of 313 women without diabetes, induction for suspected fetal macrosomia did not lower the rates of shoulder dystocia or cesarean delivery, nor did it improve the rates of maternal or neonatal morbidity.15 [strength of recommendation (SOR) evidence level A, meta-analysis] While labor induction in women with gestational diabetes who require insulin may reduce the risk of macrosomia and shoulder dystocia, the risk of maternal or neonatal injury is not modified. Not enough evidence is available to routinely support elective delivery in this population.16,17 [SOR evidence level B, systematic review including a single randomized trial]


In women without diabetes, labor induction for suspected fetal macrosomia does not lower the rates of shoulder dystocia or cesarean delivery.


Similarly, prophylactic cesarean delivery is not recommended as a means of preventing morbidity in pregnancies in which fetal macrosomia is suspected.9 [SOR evidence level C, expert opinion based on cost-effectiveness analysis] Analytic decision models have estimated that 2,345 cesarean deliveries, at a cost of nearly $5 million annually, would be needed to prevent one permanent brachial plexus injury in a patient without diabetes who had a fetus suspected of weighing more than 4,000 g. In the subgroup of women with diabetes, the frequency of shoulder dystocia, brachial plexus palsy, and cesarean delivery was higher, leading the authors to conclude that a policy of elective cesarean delivery in this group potentially may have greater merit.9 [SOR evidence level C, expert opinion based on cost-effectiveness analysis]

And this is what it says about treatment in the case of SD:
H Call for help.
This refers to activating the pre-arranged protocol or requesting the appropriate personnel to respond with necessary equipment to the labor and delivery unit.
E Evaluate for episiotomy.
Episiotomy should be considered throughout the management of shoulder dystocia but is necessary only to make more room if rotation maneuvers are required. Shoulder dystocia is a bony impaction, so episiotomy alone will not release the shoulder. Because most cases of shoulder dystocia can be relieved with the McRoberts maneuver and suprapubic pressure, many women can be spared a surgical incision.
L Legs (the McRoberts maneuver)
This procedure involves flexing and abducting the maternal hips, positioning the maternal thighs up onto the maternal abdomen. This position flattens the sacral promontory and results in cephalad rotation of the pubic symphysis. Nurses and family members present at the delivery can provide assistance for this maneuver.
P Suprapubic pressure
The hand of an assistant should be placed suprapubically over the fetal anterior shoulder, applying pressure in a cardiopulmonary resuscitation style with a downward and lateral motion on the posterior aspect of the fetal shoulder. This maneuver should be attempted while continuing downward traction.
E Enter maneuvers (internal rotation)
These maneuvers attempt to manipulate the fetus to rotate the anterior shoulder into an oblique plane and under the maternal symphysis (see Figure 2). These maneuvers can be difficult to perform when the anterior shoulder is wedged beneath the symphysis. At times, it is necessary to push the fetus up into the pelvis slightly to accomplish the maneuvers.
R Remove the posterior arm.
Removing the posterior arm from the birth canal also shortens the bisacromial diameter, allowing the fetus to drop into the sacral hollow, freeing the impaction. The elbow then should be flexed and the forearm delivered in a sweeping motion over the fetal anterior chest wall. Grasping and pulling directly on the fetal arm may fracture the humerus.
R Roll the patient.
The patient rolls from her existing position to the all-fours position. Often, the shoulder will dislodge during the act of turning, so that this movement alone may be sufficient to dislodge the impaction. In addition, once the position change is completed, gravitational forces may aid in the disimpaction of the fetal shoulders.

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#89 of 107 Old 08-07-2006, 12:35 AM
 
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I It makes me so sad to think that as women, we are being encouraged to be afraid of, and not to trust, something as natural as childbirth. When did it become such an unnatural event? (I know, I know, when it made it more convenient for the doctors to have births fit their golf schedule...) I actually had someone in medical school tell me that she enjoyed her rounds observing c-sections, because you know what to expect!!?? My ds was 9.9lbs and though one OB told me, while I was in labor, that I would probably not be able to have him vaginally, my own OB checked me sometime later, and said, "He's big, but I know you can do this!" I LOVED my OB - he would get annoyed when the hospital would suggest additional u/s once I was overdue - he was really all about just letting things take their course.
It is so frustrating that so many women fall for the c-section thing - I know so many who have - I would switch OBs or hospitals or whatever it took...

Erika, mama to Sawyer 6/04 joy.gifand Gracie 7/10energy.gif  :, dw Amy:

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#90 of 107 Old 08-07-2006, 12:42 AM
 
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that makes me so sad to hear. The worst part is that most of those babies come out much smaller than they were "estimated" to be. My little 8lb 10oz-er was easier on me than his 7lb, 14oz sister...

I wish that women would stop accepting their doctor's word as law in these situations and stand up for their bodies...

Kristen, Loving my family heartbeat.gif Sweet DH, C 11, A 9, B 7, G 4, H 1, C newbie!
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