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.

My second baby also measured off the chart, born 9lbs and I am very small. I didnt have GD but did have a lot of fluid. I chose to resist induction or c section and see if I went into labour naturally. I did have two sweeps which may have helped. Baby was born at 40+3, fairly quick labour, no pain relief, no problems or tears (and I did tear with the first one!). The midwife was great, I had monitoring but she helped me move around as much as I liked. I read that induction carries risks of shoulder dystocia and haemorrhage, same as a big baby, so concluded its no better to be induced. It was consultants who wanted loads of interventions rather than the midwives who were much more laid back about big babies!

Elective caesarean is definitely the safest option, as a PP has said. My sister (who is a paediatrician) tells me that it is very common for female paediatricians and gynaecologists to have elective caesareans even without a huge baby! Go with the people in the know! Good luck x

My first birth sounded similar to yours. Induced, lots of issues (ended up being rushed to theatre but got her out with forceps). She was 1.5 weeks early and 8lb 3. It was not a pleasant experience!!

Second I knew was big. Ended up having a completely natural birth, no pain relief. Small tear I think. He was 10lb 2. It was a MUCH better birth than with my first. It was the contractions which were the killer....I don't think his size had any impact. He was born within 1.5 hours of arriving at hospital, and within 5 hours of contractions starting.

@Tulipblank Did you have an induction? It seems like (anecdotally) most people who have inductions end up having issues with instruments or tearing, as was the case with the birth of my first DC. I will definitely be induced again this time if I go for a vaginal birth.

Are they looking after you properly wrt gestational diabetes?
Have you been given a CGM and having your BG /urine checked regularly?
Our services here are excellent for pregnant women with diabetes but I know it's not always the case.
(I'm T1 but I wasn't T1 when I had my children- I have had 2 CS and recovered very quickly )

@HumourReplacementTherapy So sorry, I’m not sure what those acronyms mean. Basically I am seeing my midwife as usual, and the diabetes team are monitoring my readings via an app. Any issues and I can call them or they will call me. I have to do a blood test every morning before I eat and after each meal. I can control it with diet, but I have had a few high fasting readings first thing in the morning so they are keeping an eye on it. They have told me I will need to be monitored during labour and baby and I will need to stay in for at least 24 hours afterwards.

Another thing to add in general is that it feels like a huge decision, however, really, you are choosing about a very small amount of your child's life and your own medical history.

Try and neutralise the decision if you can - make it small and practical, and focus on the outcomes that really matter.

For me, this is a healthy baby, and health consequences that I can manage.

I’d go for the elective c-section.

I never understand why an induction is pushed if they think the baby is going to be big enough to possibly get stuck in the birth canal and you end up needing a rushed emergency c-section.

I was told all my 3 would be a normal size ie 8lb ish despite my bump being HUGE! First born was lying at an angle, 3 day labour, induction, hours of pushing but no progression, one look from consultant and they had me under a GA (epidural wasn't working any more) and C Section. Baby was 10lb 5.5oz. Baby 2, 'obviously' smaller (not really!) so no problem with going for 'normal' birth - fast labour, pushing for ages with no progress, suggested forceps but DH was an angel and persuaded them not to as we had discussed this and decided the potential injury to baby was too great. Emergency CS - baby was firmly stuck by the shoulders and would have had to break both to get them out. Had to be shoved back up into uterus (yes, literally!) 10lb 6oz. Baby 3 - slightly smaller bump but really pressured to have elective. Put it off as long as I could but went in on due date - baby was nowhere near engaged and wouldn't have come naturally without loss of life to one or both of us. 10lb 7oz!

Its been well over 20 years now and it took a long time to get over the feeling of not having given birth 'properly', but as I went through 2 full labours it was probably easier to deal with than it could have been.

Everyone is different - you have to do what is right for you. I'm realistic enough to appreciate what I've got, even if it wasn't the textbook calm and natural birth I wanted and that my babies were healthy (Big!) and have grown into happy and very healthy adults.

It baffles me too. I really think it’s an ideological decision rather than a common sense one. Can’t be seen to recommend elective sections willy nilly so let’s attempt an induction even though an emergency section is the most likely outcome 🤷‍♀️ It’s like traumatising women doesn’t really matter.

I knew someone who begged for an elective section for her (clearly quite massive) baby. Refused. End result was a an 11lb baby and myriad of birth injuries: torn cervix, vaginal canal, perineum…

I do think it's important to remember that having a big baby is not necessarily a problem. It can be, of course. But lots of women have big babies vaginally without issues, so if you want to do that, ask questions. Make sure you know exactly why they want to intervene. Particularly if they are offering induction- they obviously think the baby will "fit" so what is their reason for not letting it happen naturally. Obviously, whatever you choose is the right choice for you!

I had a similar situation with my first (and only) though measurements were even bigger, and medical advice what that shoulder distocia was a big risk. Had a lovely elective section. What is glorious isn't the hour you spend in the operating theatre I mean I had a ball but maybe it isn't your thing but the whole afternoon you can then spend cuddling your baby, when you're happy and rested and not in pain or dealing with complications or anything. The way they come out is such a small part of the story of your lives together, as long as you're both unharmed by the process. (Which does not sound a given if you opt for the induction).

Yes you then need to heal, but you want to spend those weeks cuddling on the sofa, anyway. As long as you have someone else to help with your older child.

I've had 5 massive babies when you take into consideration their gestational age. Diagnosed with GD for last 3, fairly confident I've had it with all.

36w5 8lb4oz Natural, induced after waters broke.
37w2 8lb2oz Natural
38w2 9lb1oz Natural, induced.
38w6 10lb Natural, induced.
35w1 6lb12oz Emergency c section.

My 2 biggest were induced and we're by far my easiest labour and deliveries.

@phoenixrosehere In my case, it was to have DS early, before he reached DD’s proportions. 😂
I had no trouble birthing a 7lb 12 oz baby, whereas I did with a 9lb 10oz one.

I think that’s also the logic behind the OP’s offer of an induction, but she has the added complication of GD. A c-section might be safest for her.

Sounds not dissimilar to my story. I would strongly recommend a C-section. I have done both - as in, first baby was a traumatic vaginal, second baby was an “ok” vaginal but still ended up with further reconstructive surgery as perineum didn’t recover well after minor stitching. Third was a C-section and absolutely lovely by comparison. Planned sections are fab IMHO.

Thanks very much, this is so helpful. It's really kind of you to write such a useful message.

DD was measuring large (no GD, just a big baby) and I went in for an induction but then the doctors suggested a section so I went for that. So glad I did, she was 10lb 13oz, 98th centile for height and head size, and totally stuck in my pelvis. Would have ended in a section either way. Recovery was fine.

That said: it made it harder to breastfeed and I did end up with bad PND which could have been related. But all in all, no regrets.

Are your consultant and midwives advising the same thing? I can imagine a male consultant saying vaginal would be easier with a second baby.
I'm sorry I have no experience in regards to c sections and larger babies as mine were all tiny, the only thing I can say is those growth scans were never accurate or even near accurate for me in all 4 of my pregnancies where baby's growth was monitored.

Yes, induction with first. Natural with second. Induction was pretty rubbish.

@thecatsthecats this sounds quite flippant tbh, and minimising the experiences of women with significant birth trauma (mental or physical). My first birth was a awful, required me to have years of therapy, and has left with permanent injuries that effect me every day so no, I wouldn’t consider that “minor”

Btw have you found this wonderful site? Put together by those with experience of the condition, tons of evidence- and experience-based advice, support and recipes!
https://www.gestationaldiabetes.co.uk/

Well, I didn't mean it to be from that angle.

More in the sense that there's a lot of conflicting information and anecdotes, and no guarantees that whatever choice you make will be based on the "right" information.

There's no amount of research you can do that will make it the "right" choice, so for me, it's a case of making the decision on as narrow a set of criteria as possible, and trying not to worry about the rest.

Women shouldn't have to feel the responsibility for getting that decision right by making a series of deep, complex and ultimately unknowable medical calls, and that at the end of the day, there are no medals for having given birth a particular way.

Not that having had a traumatic birth is minor or unimportant - only to avoid winding yourself up trying to "beat the system" and prevent one.

@thecatsthecats yes, that makes more sense. But by your logic, OP should go for an elective C. She’s already had a vaginal birth with complications previously, and an elective c section has a more predictable set of risks than a vaginal.

I would add which is what I thought @thecatsthecats was saying that the benefit of an "ideal natural" birth (uncomplicated vaginal) over a well-managed calm "medicalised" birth is not that big. Really what matters is that mother and baby are both unharmed by the process. And so, the advantage of either over a traumatic birth (for mother or baby) is huge!

And what's a well-managed calm medicalised birth? An ELCS is one, unless you're very very very very unlucky. There might be other form of this too, I don't know. But it seems that an induction of a very large baby, quite likely doesn't fit this description.

If that's the conclusion she reaches, sure.

The whole reason that I'm on this thread is because I'm in a very similar situation and am not yet decided!

I'm hoping things will be clearer nearer the birth for me. This thread is providing useful context and information.

@Soverymuchfruit - yes, thank you, that's what I currently think re: inductions. There are some local factors too that skew me towards an ELCS (badly mismanaged vaginal births resulting in disability appear to be a regular news feature...), but they won't be relevant to everyone.