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 son was 9lb 6oz (I am slight in build and only 5ft 2in tall!).

I went in to labour but despite many hours of contractions and drip, I ended up with an emergency c-section.

Had I had another baby, I would definitely have gone for elective section.

@AnxiousMamo I would highly recommend following the naked birth coach on instagram. She has lots of free and informative resources regarding "big" babies.

I was told my son would be a larger baby and they recommended a c section which I declined. They then recommended that I was induced which I also declined. I went into spontaneous labour at 39+3 and he was born vaginally weighing 6lb 5oz. This is my experience, however scans are notoriously inaccurate at predicting weight, especially in the third trimester.

That's another thing to add to my pros and cons list - I'm 5'9" with broad hips. Hopefully this means my "big" baby has a bit more room.

Hmm, 98th percentile for me, 94th for the baby. Maybe not so bad then!

@Soverymuchfruit I have seen the website, thank you, it is very helpful and informative. I have been following the GD diet strictly!

@shams05 My consultant is female, and to be honest she was quite good. She didn’t try to persuade either way. She simply gave me the facts of induced vaginal and elective c-section, pros/cons and told me to go away and think about it. She’s seeing me again after my 37 week scan and will be able to advise more. The only thing she did say is, having previously had a big baby, it tends to be easier a second time round.

I do understand what people are saying about scans being inaccurate, however, with my last pregnancy they did accurately predict that my baby would be macrosomic. This baby has also been measuring larger throughout, but it was on the recent 34 week scan that it became apparent just how large they are. Due to my last baby being big, and having gestational diabetes, and then recent scan measurements, I think it’s safe to assume that this baby is likely to also be on the bigger side.

Mine were 9lb 11 a week early and 10lb both birn vaginally. First one i had 3rd degree tear but gine eith second one. Depends on uour pelvis i guess

Typos sorry, fine with second birth

What does your gut tell you OP? I remember the feeling of overwhelm at that stage, especially following a complicated and long first delivery. Had I been offered an elective c section I would have taken it for my second, in hindsight this is what we should have argued for after the trauma of the first. Mentally there's much to be said for feeling like you have the choice and an element of control.

FWIW, I had 3 CS for various reasons, and recovery was absolutely fine. Much easier than for several friends who had vaginal births. I'f go ELCS.

My large baby wasn’t identified (I was measuring normally and no GD) he was born at 10lb9 and I delivered vaginally. Second degree tear. I also had a 24 hour and then 7 day catheter. However, you are more likely to need a catheter with a section, it’s needed because of the “trauma” to your bladder. In my case (and probably yours) a large head squashed it and in the case of a c section it has to be moved out of the way by the surgeons hands. Afterwards everyone (HCP / MW) would say “oh so you had a c section” and I was like “uh no” and it would be followed up by “why did you need a catheter then?” I discovered it’s because it’s far more usual with a section and it took everything in my power not to sarcastically reply “why do you think?! Because my bladder is working perfectly…?” Nevertheless I was still healed by 3 weeks PP. I live rurally so being able to drive is a necessity and the recovery from a section would have been too much, especially with a toddler too. For that reason I wouldn’t have chosen a section had I been given the option.

this is mad!
How common is this?
I was told by my hospital that I could get an ultrasound at 39 weeks to try to predict weight, but actually a very experienced midwife would be more accurate estimating with her hands.

Caesar. No question. Wouldn’t think twice.

Just to add to the stories of scans being incredibly wrong. I had weekly scans at one point for my "small baby".

She was born at 40plus1 at 8lb 3oz.

Not sure what weight they would have considered to be a big baby!

A planned cs would have an easier recovery than a traumatic delivery. You’ve recovered from the latter. I’d say not to go through that again. Enjoy the birth. It’s a recovery afterwards but you’ll be up and about in no time. Also no damage to what has healed from your first birth.

Btw, as a counterpoint to the messages about inaccurate scans. You said that your baby has an unusually large stomach, which makes sense as it's associated with GD. My understanding is that the relative size measurements are much more accurate than the total size ones, that is, they might get your baby's weight wrong but they are very likely to be correct about that large abdomen. And when I was reading up on it (I really was in exactly the same situation), I understood that it's large abdomen relative to head size, that gives you the risk of shoulder dystocia. And that's the outcome that potentially seriously injures both you and baby.

My baby did indeed come out at a lower percentile than estimated -- 90th rather than 99th. Maybe they were a bit out. But also, I got a better handle on the GD once I knew about it, so maybe I just stopped over-feeding the baby. Anyway I've never regretted my ELCS for an instant.

Anyway, I suggest you ask about this point about relative proportions and shoulder dystocia, at your next appointment?

@Soverymuchfruit this is interesting. So you meet large abdomen relative to small head? That ratio?

mean, I mean

Yes. As I understand it, if the body is large relative to the head, there's a much bigger risk that the body gets stuck when the head is already delivered. This is shoulder dystocia and is dangerous. It is also associated with gestational diabetes that has gone undiagnosed because the baby has had too much sugar. And if you're looking at shapes on a screen, you might not translate that into weights quite right, but you really can see if the abdomen is unusually big relative to the head. So if they say big abdomen, believe them and take that seriously.

But the OP should definitely talk this through with her specialist, I'm just describing my understanding from a couple of years ago, I might have got some of it wrong!

@Soverymuchfruit Wow, thank you so much for this information. I am off to do more research now. Interestingly, I’ve just had another look at my babies measurements - the head circumference is 70th centile whilst abdomen is greater than 95th centile (off the scale)! Limbs are all 85th. Those measurements definitely fit with GD and also suggest a greater risk of shoulder dystocia.

I am still torn and in two minds. I’ve spoken to some people in my personal life and their opinions are really mixed too - some think I should try induction and vaginal whilst others are telling me that I should have the elective caesarean and recovery and pain is really not that terrible.

In your position (as I probably will be in 8 weeks time) I would try for a vaginal birth and prepare for it as thoroughly as I could.
My personal reasons would be:

• benefits to the baby of the microbiome
• easier recovery making breastfeeding start easier
• I don’t want a scar on my stomach my whole life
• I’ve done it before and I can do it again

Everyone will have their own personal list like this, it’s individual choice. Good luck.

Not the same situation but I had a big baby and a bad tear first time round and was offered a c-section to prevent further damage. I stressed for ages about the risks of a c-section and the disadvantages to the baby of being born by c-section.

The c-section was a beautiful experience with a far easier recovery than my vaginal birth and DC2 is generally healthier than DC1 (much less prone to minor illnesses).

@Nubnut I don’t fancy the scar either nor the recovery afterwards (though lots of people have told me it’s fine)! I’m just worried about risk to the baby and further damage to myself, tearing along the episiotomy for example, and I’m not sure how I calm these concerns. I would be devastated if anything happened to the baby, or if I ended up damaging myself further or worse down below, or if it ended in an emergency c-section anyway. If I could have the natural, water birth that I envisioned it wouldn’t even be a question. As it stands, I’ll be hooked up to an induction and glucose drip, as well as being monitored throughout. It will be very medically managed. I also had Group B Strep last pregnancy, and I am paying for a private test this time around, so there’s also the possibility I will also be hooked up to a third (!) IV of antibiotics. I really wish I was not in this position having to choose between two births I do not want.

@CaptainJackSparrow85 Thank you, I’ve heard that lots of people have had positive elective caesareans, which is very reassuring if I decide to have one.

I don’t want a scar on my stomach my whole life

I know you don’t really mean “stomach” but most c section scars are so low down, below the public hair line, they’re basically invisible. Mine is so thin and fine I really do struggle to find it 🤣

@Jellycats4life A few people have told me about the c-section ‘pouch’ though! Which is a silly (and vain) reason not to have a section if that’s what is best for me and baby.

I was coerced with our first into an induction for a “big baby” because they diagnosed me with GD (32 weeks) but it was diet-controlled, sugars had remained normal during testing, urine normal throughout pregnancy, as well as checks on my placenta at 38 weeks showing no issues. They wanted to induce me at 36 weeks but I refused because there was no evidence beyond baby “looking big”. Before my GD diagnosis, the consultant was speaking of induction at 20 weeks because they (only them) thought there was IUGR, but we got a second opinion from a fetal specialist in IUGR that said there was no evidence supporting this and baby was healthy. At 24 weeks, same consultant said baby was looking big. GTT at 28 weeks, I passed. Several appointments over two weeks 36-38 telling me I was hurting my baby by not inducing and quoting stillbirth stats (outdated ones that had no relevance to my pregnancy). 38 weeks, baby looked to be close to 8lbs via ultrasound was their reason for induction. Induced at 39 despite me asking for my bishop score beforehand because I didn’t want to proceed if it was low which means a higher chance in induction failing. Told they had to induce me first. The pessary was painful going in that I was in tears. As expected, it failed, 3 cm in three days, horrendous care from the consultants, emer cs, and a blue baby that was not disclosed until after we reported them. Son was a whopping 6lb 14oz.

Hospital couldn’t explain to us why induction was pushed after looking through everything and concluded it had been absolutely unnecessary. No apology from any of those consultants. Do recall someone being pushed into retirement though.