Massive baby - what would you do?

[AnxiousMamo]

I’ve just been diagnosed with gestational diabetes after baby was measuring 6lb at 34 weeks. All of the measurements were 85th centile plus, with the stomach measurement being off the scale (!)

My first baby was 8lb 15oz, and this one looks set to be even bigger. First DC I had to be induced which was awful and I ended up with an episiotomy, ventouse and I was unable to urinate afterwards for a week (I needed a catheter). It was pretty traumatic, although I was able to look after DC and be mobile straight after birth which was good.

I have another scan next week when I will be 37 weeks, and they will compare measurements and the consultant will advise me. They have given me two options - induction at 39 weeks or an elective caesarean. Both carry risks. With induction there is the risk it won’t work, I may need intervention again, tears, episiotomy and shoulder dystocia for the baby. With a caesarean there are the usual associated risks. The consultant did they that as I have had a big baby previously, that is a good sign for a vaginal birth.

I am wondering if any others have been in this situation and how it went for you, what did you decide? How was the birth?

Thanks in advance.

An obstetrician once told me that the safest way to give birth is a normal, straightforward vaginal birth. But that can’t be guaranteed. The second safest way is an elective c-section (i.e. not an emergency c-section or other intervention). In your situation I would personally choose the c-section.

My baby measured small, they said I needed an induction, baby was still mobile and on induction morning was head up. They turned her, broke my waters, I laboured on the drip etc and ended up with the c-section anyway (because she was presenting forehead first) by the same very tired doctor that had been on shift 24h earlier. Maybe just go for the section....it's fairly likely to end that way. Labour on a drip and monitors is no fun at all.

First birth - nightmare… long labour, forceps, vonteuse and then emergency c-Sec… Sore underneath and c-sec scar… took a while to recover… Second birth… elected for c-Sec… what a joy… removed all the worry of the unknown after horrid first experience… Very well managed, joyful
experience - totally different from emergency c-sec. Healed fast, intact underneath… I would choose elective c-sec over and over rather than have risk of traumatic birth… Of course had hoped for natural birth - but it didn’t happen - honestly never gave it a second thought and got on with enjoying beautiful babies x

Good luck, good luck btw!!!!!

IMO go for the planned C-Section. It is likely to be a lot more civilised and I wish I could’ve had that.
My DD got stuck and I had forceps and 8 years later I still have lots of issues with “the undercarriage” and it’s unlikely these issues will be resolved.

Difficult birth with ds - episiotomy & ventuse. Long labour.
Dd by contrast was 3hrs start to finish. So easy! Home hours later.

Second births are usually more straightforward even with an induction- I'd personally opt for that over surgery. Also had friends who had GD and babies were expected to be big but they were ok normal sizes!
Good luck whatever you choose.

Please get a c section!

My baby was 10lb2 and was transverse at 40+3. They failed to pick it up previously. They also didn't pick up on his size and every midwife and doctor after he was born, expressed relief I hadn't had a natural birth.

I had an elective c section as I didn't want him turned, nor did I want to wait any longer for him to turn himself.

It was a great experience, really.calm, music playing, I was with my husband and baby arrived safely and happily. I'd absolutely have one again if I was going to have another.

I was almost exactly the same as you except first baby and I had elective c section. Pleased with my choice although recovery harder than expected (hard to move myself across bed or bend for a week after) so have lots of help in place with childcare and you need to be waited on hand and foot- easier to organize this if elective x

What gestation was your first baby induced at? First baby inductions are brutal- particularly if early and baby isn't ready.

If you were willing to wait until baby is ready to come naturally then vaginal would be the best option.

As it's your second, induction is less likely to be as awful this time, but on balance, I'd still opt for c-section.

It does feel a shame there was early intervention first time round. I've had four bigger babies between 8.8lbs and nearly 10lbs. All overdue, but water-births and home/healthy within a few hours.

I don’t regret my elective c section
It was such a positive experience that I’d definitely opt for it again if I choose to have another baby
Inductions have a high percentage of ending up in emergency c sections
Myself and 2 of my friends all ended up being told we had big babies (all around 9lbs) There inductions both ended with emergency c section after days of labour pains. I’m glad I opted to go straight to the elective c section because I had this feeling it would end up in one anyway.

My baby was born a lot smaller than everyone predicted

Rather than individual stories of success or failure I’d do some research into the associated risks and try to decide how much risk you feel comfortable taking on. A quick google brings up this as a fairly decent study:

obgyn.onlinelibrary.wiley.com/doi/10.1002/uog.20278

In the macrosomia group (4kg+ weight) there was a significantly higher prevalence of all neonatal complications, with a 10-fold increased risk of shoulder dystocia, a 20-fold increased risk of severe shoulder dystocia, a 30-fold increased risks of OBPI (nerve damage to arm) and birth fractures and a 4-fold increased risk of HIE (a very serious type of infant brain damage that occurs during childbirth when the baby's brain is deprived of blood and oxygen). In the severe-macrosomia group (4.5kg+ weight) there was a significantly higher prevalence of all adverse outcomes, with a 70- to 90-fold increased risk of severe shoulder dystocia, OBPI and birth fractures and a 14-fold increased risk of HIE.

obviously these results are focused on how much the risk increases by - not the actual risk itself (eg if the risk originally is very low it doesn’t matter as much if the is triple/quadruple etc. But for more ‘prevalent’ risks then it really does),

In order of preference

1. spontaneous vaginal delivery (ie not induced)
2. ELCS
3. induction

I think HCPs massively downplay the risks of induction when they are actually big. You know yourself; you had an induction and it did not go well for you.

Not sure how relevant my own births are as I didn't have gestational diabetes, but my two were 9lb4 and 9lb1, both spontaneous vaginal births, first birth included episiotomy and mild shoulder dystocia (but that was because evil midwife insisted I lie on my back which I absolutely didn't want, and which is not best position for opening the pelvis), second birth was on all fours and no issues whatsoever.

Please be aware that induction increases the risk of shoulder dystocia so if you're worried about that you should go for ELCS.

@Mmmmops Thanks, that’s very helpful.

My son measured big and, although they monitored from 20 weeks, I also developed too much amniotic fluid and was then told I had to have a C-section (due to timings and other reasons an induction wasn't appropriate). It was the best thing ever, the morning was so relaxed, we talked to the surgeon as my son was born, it was totally chilled. I have no experience of a vaginal birth or anything like that but wanted to share my story

I’ll start by saying that I am very petite, so my babies weren’t off the charts huge, but bloody big for me.

DC1, 8lbs 6oz induced at 40+10 birth was fairly quick once it got going but baby got stuck at the last hurdle so had episiotomy and ventouse. Ventouse failed once and successful on second try, left dc with a (fairly minor) birth injury though and me with borderline 2nd/3rd degree tear on top of episiotomy.

DC2, 9lbs induced at 40+6, birth was incredibly quick, but again dc got stuck at the last hurdle then heart rate dropped and we were rushed to theatre where they tried literally everything to get baby out, forceps, ventouse, I think the dr had her whole arms up my foof at some point but he wasn’t budging and was going into distress so emergency c-section it was. I’ll say one thing, it’s not fun to recover from forceps and an emcs at the same time!

So yeah if I could go back and chose knowing what I do now I’d chose elective, and if I ever have a dc3 I’ll definitely have an elective.

It's all very dependent on exact circumstances and the individual. My first baby was 8lb4 and not straightforward - long labour with eventual spinal and forceps delivery whilst being prepped for a c section in case the forceps didn't work. My second baby was huge - 10lb7 - but this wasn't known prior to delivery as all bump measurements were normal so had no extra scans. I had him at home after a short labour with only a bit of gas and air at the end. I was really glad I didn't know how big he was as I almost certainly would have opted out of a home birth but in the event it was all very smooth and stress free and I loved being in my own environment.

I didn't have a big baby (6lbs 14oz at 41+6!!) But I did have a failed induction resulting in emergency C section. I wish I'd gone straight for the C section, the recovery wasn't bad at all but everything that preceded it and the fact my daughter was resuscitated at birth left me being diagnosed with PTSD. I very much wanted a vaginal birth but would choose an elective CS over induction should I ever have another baby.

I’d have the section and take all the mystery out of it.

I’ve only heard horrible things about induction.

Elective C Section, no question - especially if the first birth had been tough.

I’d go with the c section. Dd1 was 9 15 (born at 42 weeks), a long and traumatic labour that left me with a prolapse. I was offered a planned section for dd2 and very happy with my decision. Very calm and uneventful and my recovery was much quicker. Dd2 was only 8 10, born at 39 weeks.

not the same situation but there are risks with big babies. They don’t offer c sections without a reason as they are expensive, so I’d take it. They see it as a safer option I think but know that some women prefer to try for a vaginal birth.

DS was 9lb 1oz. I didn’t have any pain relief, not even gas and air, and I had a very straightforward vaginal delivery. No stitches, tears or anything. Good luck with whatever you go for @AnxiousMamo .

I had similar measurements and chose planned c section. Also developed SPD and I had excess water. Midwife doing pre op said it was for the best as she'd never come naturally easily. Wonderful experience with the planned section and luckily had a great recovery.