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.

You also don't get to choose "no c section" as an outcome, since it might happen anyway!

The only option you can actually choose is an elective c section, and the only one you can really rule out is induction. All the others might happen without choosing them.

Guh.

Trying not to sound judgy to anyone here, and obviously I don't know what size you are. But I think you only really get that 'pouch' if you have quite a lot of belly fat. I don't have one (size 12-14), and nor does my (I think size 16) friend. At least I've never noticed her having one, she's gorgeous!

Echoing that the scar is really not a big deal, it's hidden in your pubic hair.

As for ELCS recovery: it's not nothing, you don't want to be running after and picking up a toddler. I had difficulty getting out of a low sofa while holding my baby. So we made a safe space to briefly put the baby down on the sofa next to me, just literally while I was standing up, and we put a big cushion on the sofa so I wasn't so low. It's that sort of scale of things. For a couple of weeks. And there's no pain if you take your painkillers on schedule.

This is purely anecdotal but I have a group of friends who are doctors, we were at a dinner party and they were all there, I had a c-sec with my 2nd and they were chatting about giving birth and they said if they were given the choice even without complications they would have a section every time. My assumption for this feeling is that because they are doctors they are only ever in attendance when things go wrong but my point is that I would personally always have a c-sec if offered when things may not be quite right as these days it is a pretty safe option and recovery can be really quick. My recovery was much quicker than from my complicated natural birth.

@AnxiousMamo I may be misreading- but are you saying you think you are certain to have a more medicalised birth than you want? Is that just because of the predicted size of the baby, or are there other issues I missed?

@CurlewKate They want to induce me and/or elective section because I have gestational diabetes and the baby is measuring big. Not just in weight but large abdominal circumference in comparison to limbs / head. So that will mean induction + glucose monitoring in labour, at the least. I’m also having a private Group B Strep test as I had this last time, so depending on the result it may also mean antibiotics in labour (IV).

Before I knew about the diabetes and induction I was keen to let nature take its course and have a natural water birth. Now I know the baby is measuring big, it’s reminding me of the birth of my first DC, who was 8lb 15oz and needed ventouse and episiotomy to be delivered.

Ventouse and episiotomy were more likely down to positioning than size. One of mine was 8lb 15oz and was so easy to birth. Another was 7lb and due to awkward positioning and inpatient doctors, ended in emcs 🙄

Generally, they say bigger babies are easier to birth, but the key is all in your position to let your pelvis open up. Medicalised births often have you on your back which are not conducive to natural vaginal births. Remaining upright, squatting or on all fours will help to birth baby no matter how big or small.

They love to fearmonger with the big baby card. Don't let it scare you.

I’m not sure telling her to call ignore doctors and just squat, is a particularly good idea.

At no point did I say to ignore doctors, for goodness sake, don't be ridiculous. I was giving advice that is helpful that is rarely given to women by caregivers.

I've got 3 children. With the first I had GD and needed insulin for my fasting overnight readings and he was born naturally at 40+6 at 7lb15oz, but I had a 3B tear. My second, I didn't have GD (was tested 3 times), I had an elective c-sections at 39+3 and he was 7lb6oz. With my 3rd I had GD again and i needed insulin again for my fasting levels. She was born at 39+3 via c-section again and she was 7lb8oz. My c-sections were fantastic, id do it again tomorrow. No major pain, went to soft play the next week. My last one had a harder recovery as I was sterilised at the same time so I had more pain but still great no problems. The worst part of a c-section in trapped wind!

With the greatest of respect, an 8lb baby isn't THAT big, unless you're tiny, or slender of hip.
My tiny, '4 11'' mother, fired out three of us, all over 9lb. My brother was the smallest at 9lb 4oz. No issues. Obviously a bit painful, but gas and air did the trick.

One of my besties is a gynecologist - and she says a good birth is a live mother, and live baby. It's as simple as that. So, if you want a C section, do it. They wouldn't have it on the table, if they didn't think it was a real possibility,

It just depends. I'm 5'3" and apparently have a small pelvis. I was brought into hospital to be monitored with my first when a scan showed that the placenta had pretty much been used up. Induction was tried twice and didn't work, so it was straight to elective c/s. Baby was 8'7.5 and obs said that I would never have been able to birth them naturally.

2nd was another c/s. This baby was 9'5.5. I still remember the obs' forehead going red with the effort of hauling them out! He said he thought baby would be big but not that big! 3rd, the same, elective c/s and another 2 oz heavier.

They were all born at 38+4... I can't imagine the monsters they'd have been if I'd gone overdue! I didn't have GD either.

Personally I'd go elective c/s. You can plan to have your older child minded. You know when you are going in. I know I don't have the experience of vaginal birth to compare but now I am old and glad I don't have any damage 'down there'!! I imagine trying for a vb and ending up with an emergency c/s must be way worse than having an elective.

And tbh, they are all adults now and it really wouldn't matter if they had had to pull them down my nose lol!

@HollaHolla I think we are much more used to hearing about ‘big babies’ these days. 8lb 15oz is 4kg which classifies it as macrosomic - by medical definition that is a big baby.

@BeckiP85 Do they think your tear with DC1 was down to the weight or the fact that baby may have been so disproportionate due to GD? Because I am wondering whether or that can also play a role in a tear and/or episiotomy - this baby may ‘only’ be around 9lb, but because the stomach is so disproportionate that could lead to tearing or reopening my episiotomy scar or needing to be cut again!

I'm 14m PP and back to pre-baby weight. I only had a pouch before I lost weight. My scar was quite purple at first but now it's really fading and I barely notice it.

c section all day long. There’s literally no question.

I haven’t got a C-section ‘apron’. It’s not a-given. Just as piles, stretch marks and incontinence is not a-given.

I had an elected section for this reason, ds was measuring big and I was worried about the risk of shoulder dystocia and need for intervention. I had a really positive experience with my section it went smoothly and I'd do it again. I'd say that when you get home you need more support lined up and planned out .

I’m pretty convinced that what people describe as a “c section pouch” is simply an area of sagging abdominal skin that would be left over after pregnancy whether they’d had a c section or not.

He had a big head and just sort of exploded out of me, no pushing involved. I don’t think it was GD related though, all 3 have big heads, they get it from their father!

I’ve got my follow up appointment and scan early next week, but did meet with my midwife.

At the bare minimum, with GD and baby’s measurements, they would recommend that I be induced at 39 weeks (due to increased still birth risk), have a blood test every hour throughout labour and have the baby’s heartbeat continuously monitored. They have a mobile monitor which can be used to monitor the heartbeat so you aren’t stuck in one position. She said the consultant will more than likely want me on the high risk labour ward, but I can fight to be on the consultant led unit which has a birthing pool and the options of different positions. If I have a natural birth I do not want to be lying down. I’ve also got a private Group B Strep test coming up as the NHS won’t test me - even though I had it in my last pregnancy and had antibiotics in labour. So that will also dictate whether or not it’s recommended I have antibiotics again or not.

The midwife also suggested we could start sweeps from 37 weeks, to try to avoid the induction process (but they would still recommend the other interventions). She also said if I turn up for the induction at 39 weeks and my body is showing no signs of readiness (my last DC was induced at 42 weeks!) I can still opt for the elective section.

Obviously I don’t have to agree to any of this and can just tell them I don’t want any of it, but that doesn’t seem a good idea.

DC1: I felt I was big throughout and the midwife just said it was probably water. Born vaginally at 41 weeks but it was a long labour, I had the drip ( no epidural) episiotomy, forceps and then ended in shoulder dystocia. It was awful. Was kept in a week as we both had an infection. It was incredibly traumatic and I ended up with a prolapse. Birthweight was 9lbs 8 and luckily no issues with the baby.
DC2: Was afraid of the same thing happening again. Sent for extra scans but the hospital lost the data. Had a conversation with consultant at 38 weeks and they gave me my options: sweep to see if things went naturally and if there was any sign that the labour was going the same way I could have a c section ( would be classed as emergency) or book in for C section. I had the sweep and nothing happened so had an elective C section 2 days later on due date at 40 weeks. Baby did not want to come out and the surgeon found it difficult ( she said after I made the correct choice). Baby born weighing 9lbs 12.
No gestational diabetes either time. I just make big babies.

I 100% preferred the C section. It was amazing. I healed quickly and having a simple birth really did ‘fix’ the previous mental trauma after my first child.

Not sure if my story is helpful, but DC2 and DC3 weren't identified as being large babies in utero (even with scans close to my due dates).

DC2 was 10lb9 and an absolutely easy breezy birth. DC3 was 11lb8 and a reasonably easy birth, but with swiftly resolved shoulder dystocia (no instruments used, just pressing on my belly). I did have 2nd degree years with all three of my births (including DC1 who was normal sized). I should add that I'm quite slim, so it's astonishing to me that my babies weren't identified as whoppers while I was pregnant!

I think the moral of my story is that sizing scans can be very unreliable!

My babies were significantly bigger then this and my neighbour had GD and was induced early and then baby was small and they had got it all wrong and so I don't think you need to do either if you dont want to...its not an exact science.

But if its between being induced and an elective c-section I would have the C-section everytime.

Sounds like a helpful appointment.

Personally I would advise against sweeps as I don't think they do anything other than increase the infection risk.

If I were you I would go in at 39 weeks and ask them to check bishop's score, and if it's high enough to indicate the possibility of a successful induction, I would consent to an induction on the consultant-led labour ward with mobile monitoring. But as midwife said if your bishop's score is low at 39 weeks I would just go straight to ELCS.

Anyway good luck with your tests and other upcoming appointments.

My first was 8 pounds 15 and a bit of a nightmare with an episiotomy

Second 8 pounds 13, out 4 hours after arriving at hospital, no bother other than stupid stuck placenta

Third 10 pounds 1 born at home, no pain relief, came about 12 hours after contractions started and was perfect.

I think go with whatever your gut is telling you.