41 +2 with big baby not engaged - advice needed please

[numummy2b]

Hi all, I'm hoping people might have some advice for me as I'm feeling very emotional and unsure how to proceed.

I am 41 +2 with my first bubby which is expected to be nearly 10lbs (based on scans). I have had 1 sweep and tried every natural induction method possibe (pineapple/ras leaf tea/reflexology / acupuncture/ walking).

I now have a consultant appt on Thursday and need to work out my options. I initially planned a natural birth with an epidural, however am now terrified and am wanting to request an elect caesarean. I am fearful my concultant will push for induction which I feel is doomed to fail given baby is not engaged, cervix is not favourable and baby is so large.

Do you think a consultant would support me in this request for an elective?

Hi there,

I was in your position in December. Uncannily similar in fact, down to spending hundreds on acupuncture. I never even had a Braxton Hicks.

I asked outright for an elective, and was given it. I said my mother had had an induction with me and it had been very difficult for her(this was true). Also, based on me being short and husband tall, she just laughed and said 'well, that was never really going to work, was it?'

Also, she said that if head not engaged at all at this stage with first baby then they do have to ask themselves 'why?' Maybe cord is too short for baby to engage, maybe head is too big. In these cases, it is no good to be induced.

I'm not being as articulate as I want to be, but basically just say what you want, don't feel pushed into having an induction. Outright request an ELCS. I went straight from my birth plan of natural birth, to ELCS, with very little discussion of induction in between.

It is good that you're seeing the consultant, as no-one but a consultant can sign off on an ELCS. Which hospital are you at?

Good luck!

Your message is very reassuring thank you! I have searched the Internet and come up with so much varied guidance I'm almost on information overload.

How many weeks were you when you had the caesarean? I'm at St georges and although they seem great with all the care I've received so far they do seem very guided by 'standard practice and procedure' which no longer feels right for me.

I just seem to crumble and become emotional when talking to midwives about my concerns I think knowing someone else has been where I am will help my confidence in my request.

Firstly scans can be 1 lb either way or more sometimes. If the baby is big natural delivery is still ok but it depends on position. Both my dds were big and back to back neither fully engaged. Try positioning to swing baby back to front rocking on all 4s and side stepping up and down stairs if poss. My 2nd this worked but due to past c-section was forced to lay on my back for ages and baby went back to back. I say positioning, sit on a chair upright, side in bed and don't slouch, lots of walking. HTH
C-section is not an easier option and remember it is major surgery.

PS 1 week over with first is not unusual unless you can pinpoint the conception date through IVF etc.

Thanks for your ideas

Your point about the scans is one of the reasons I fear the consultant may refuse my request. But what if baby is that big? To be honest I am not keen for the operation, the idea of it is intimidating but seems to be the lesser of evils as my worst case would be baby in distress leading to em caesarean.

In terms of conception I was tracking with predictor kits so very certain of those dates although the hosp still go by scan date- 1day difference.

I am honestly trying to reposition baby and feel a bit of a failure for not being able to. Have looked at spinning babies to try get ideas and am constantly active. I know it is unlikely baby can't fit but I just keep wondering what if this is the rare case and baby has no way of getting outt or communicating distress.

Baby was born at 41 + 1, the decision was taken at 41 weeks and I was booked in for the next day. The baby was never going to be huge (she was 7 1/2 lbs), but in relation to size of my pelvis she was big. I knew exactly when I ovulated so was sure to the day about due date. I spent hours on birth ball trying to get baby to engage!

Agree, and I know you feel the same, that yes cs is major surgery. However if, realistically, the chances of a successful induction are slim, then it is better (IMHO) to go straight for elcs.

Please just speak your mind when you see the consultant. If he suggests something you are not happy with, say 'What are the alternatives?'

I was at Royal Free Hampstead.

Again, really good luck.

I had an elective section at term for my 10lb 2oz baby whose head never engaged and was very happy with the whole experience (had some minor complications, wound infection, slow start to breastfeeding but nothing too bad). I was told they would not try and induce such a big baby so other option was to wait for spontaneous labour and have a go at vaginal delivery.

If you want a section tell your consultant that you would like the delivery method that is safest for your baby - for a first baby this is an elective section. The caesarean risks are predominantly for the mother but if you are generally healthy the risks of elective section are tiny and up to you if you are prepared to take them.

Issues to bear in mind though are how many children you plan to have - with repeat sections the surgical risks (to you) increase, as I only planned to have 2 children my consultant felt elective section was reasonable decision. After the birth I was told by her that if I had managed a vaginal delivery I would have had a very high likelihood of pelvic floor injury.

Good luck.

Thanks to you both so much I do feel better and much more calm knowing I'm not being totally unreasonable (despite my midwife looking quite disapproving of the idea). Congratulations on your bubbies and successful births!

Hopefully I'll be able to keep it together and convey everything fairly logically to the consultant as I want him to understand I've considered all risks/benefits and not seeking an 'easy option' (DP has instructions to step in only if I'm crying).

Future children is my key concern, I'm 31 and planned on 3 in fairly quick succession (if we're that lucky) - maybe there will be a way to consider a VBAC later - but I think in this circumstance it really is the best option. The horror stories of pelvic injury and the repurcussions do also put me off trying to birth big baby...

Fingers crossed for Thursday

Numummy2b, I can understand why your are feeling fearful and pressurised but just wanted to say that sometimes it is more scaremongering by the hospital than a real problem as it is always difficult to know what will happen.

Scans to determine the size of a big baby can be out by up to 20% so for a 10lb baby could be 8lb or 12lb, so not really very accurate at all.

I was told with my first baby that it was a very large baby and I may need to be induced or need a section, I was tested for gestational diabetes which came back clear. I decided that as there was no specific cause for my big baby I was making the right size baby for my body and trusted that I would be able to deliver him. My ds did not engage until I was in labour and I had a normal delivery, apart from episiotomy of a 9lb15oz baby.

My second baby was even bigger at 10lb7 but arrived after a very rapid labour of 2.5 hours with a tiny tear that did not require sutures.

Sometimes it is worth trusting in your body and letting nature take it's course, I can completely understand your reasoning and it is so hard when we cannot see what the outcome will be and we just want our baby safely in our arms. Good luck with your decision.

Hi numummy2b - hope you are managing to relax a litle and not getting too stressed.

Thouht I'd add my twopeneth worth!

I had dd last year by EMCS at 40+13 after being induced at 40+12. They knew she was going to be big (don't think they thought she would be quite the 10lb 1oz she was mind!). She never engaged even 12 days over due and was alternating between breech and back to back. I didn't have hardly any BX's either. I never got the 'needing to pee/waddling thing' that happens when the baby drops at the end.

Whe she came out she had a ring of bruises round her head whre she was stuck in my pelvis. She was so high theycoud't even get the forceps on her head! To be fair, had I known there was no way she was going to fit I would have requested a ELCS. The CS was ok, the emergency part was proper scary.

I will NOT be attempting a VBAC for any future chldren lol!

So, my opinion, for what it's worth is ask for the ELCS. I know lots of MNetters are all for attempting labour, and I can see their point, but you shold be supported to make the right decision for you.

Good luck - can't wait to hear from you when yo have your little one there with you xx

Thansk everyone for your guidence and experience!

green beannie - thanks for your message it does help to get the perspective that maybe it is meant to be this way for my body and baby, but for some reason I just can't shake the feeling that baby just can't fit. I will definately listen to the consultant though and try to be guided by him.

Happycamper - sounds exactly like me (except have had some BH), baby changes position so many times a day must be dizzy! I'm sorry she had bruises how horrid for you, but am very pleased you have a gorgeous little girl! Can't wait to hold my bubby in my arms! I'll update you on how we get on.

Leonie - glad you had such positive experiences! My bubbies head was over 37cm at the last scan(99th percentile) 2 weeks ago - her Dads family all have big heads so I blame him

xx

How did you get on? Hope all went well today.