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Childbirth

Share experiences and get support around labour, birth and recovery.

Is it procedure to induce a large baby?

24 replies

biggest · 26/07/2010 20:12

I am having a scan on Thursday when I will be at 39+6. Last scan I had a couple of weeks ago showed baby measuring large and I had a (negative) GTT last week. I really don't want to be scanned again this week - what can they say? Baby is bigger now?!
The doctor I am seeing is a registrar, and while she has been fine throughout (been monitored because of high bp in first pg) she is obsessed with medicalised births, her experience is with women with pre-eclampsia. I just know she is going to suggest induction.....
I just need to know where I stand regarding normal practice, I am assuming that a big baby is not a complication in itself if it is a normal pregnancy?

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Flisspaps · 26/07/2010 20:40

Firstly - if you don't want to be scanned, then don't be. They can't make you do it. However it won't do any harm to go and see - it might turn out baby isn't as big as they first thought.

Induction also brings its own complications, so if you don't feel comfortable with that route then say so, providing you and baby are well then I don't see why you'd do it, lots of women give birth to large babies without being induced.

thisisyesterday · 26/07/2010 20:43

if you don't want to be scanned then decline it.
they can offer and you can refuse

growth scans are notoriously unreliable, up to 20% margin of error either way... so i would not trust anything it showed anyway even if you do have one

how big is big? did they give you an estimated weight last timke? is it your first baby?

a big baby is not a problem in itself IMO.

makeupmummy · 26/07/2010 20:47

I would get scanned if I were you: I had a big baby(11lbs 4oz), was induced, not fun and he was pretty stuck! No-one knew he was big beforehand, and I was v pro a natural, active birth, but did not happen, ended in ventouse after bit kerfuffle, luckily all well. If I had known how big he was I may well have made different decisions, though obviously people have big babies fine all the time! I am not sure induction is the way tho as I did read somewhere that big babies sometimes don't (can't?) engage properly. Anyway, my view is really that I would have liked to know and make informed choices.

Tillyscoutsmum · 26/07/2010 20:49

Both my dc's were quite large. I was scanned at 38 weeks with dc2 and they estimated he was around 8.5-9 lbs at 38 weeks. At no point was there a suggestion that I would be induced. I actually had awful SPD and was a little bit worried about being allowed to go to 42 weeks.

As it was, DS arrived bang on 40 weeks and was a "healthy" 10lb 5oz. There were no complications.

Habbibu · 26/07/2010 20:58

My dd was 10lb 11oz. I was under the care of a consultant who was in charge of the obs ultrasound (due to a previous loss, not because dd was big) - he said that growth scans are great for predicting the weight of average babies, but pretty rubbish for very big or very small. He wasn't big on intervention - not even a fan of membrane sweeps. As it was, dd got slightly stuck - shoulder dystocia, which is a risk with larger babies - but he and mw delivered her with no instruments, just a change of position to open up my pelvis.

It can be useful to know that a baby is big, just so the delivery team can be aware of the risk of shoulder dystocia, but other than that, I don't think induction is generally the norm, and brings its own risks.

ds was 9lb 1, so big too, but he came flying out...

biggest · 26/07/2010 21:24

Thanks all. It is my second baby, DS was 7lb 4 and induced, ended in forceps and was pretty brutal!
This baby was appearing 8lb 15 at 38 weeks, with abdominal measurements off the scale. I really do not want to be induced and am considering asking to see a different consultant on Thursday who is a bit more open to letting things take their own course. As far as I can see the scan in Thursday will just make me more anxious about forceps again rather than be in any way reassuring.
(Admit I am crossing my legs at 11lb-er makeupmummy!)

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biggest · 26/07/2010 21:24

And for the big baby mums, would you have risked a MLU birth or gone for labour ward?

OP posts:
Habbibu · 26/07/2010 21:30

Well, I wanted a MLU birth, but eventually went for labour ward just because we had had previous shoulder dystocia - cons recommended this, but did say he wouldn't stand in my way if I desperately wanted MLU.

thisisyesterday · 26/07/2010 21:35

mine were 9lb 1, 9lb 5 and 9lb 11
had first in hospital and second 2 at home

friend had her 11lb 12oz girl at home!

Tangle · 26/07/2010 22:03

NICE Guidelines on induction state as the conclusion to Section 4.10 (pp 61-62):

"In the absence of any other indications, induction of labour should not be carried out simply because a healthcare professional suspects a baby is large for gestational age (macrosomic)."

One of the concerns given includes the inaccuracy of trying to estimate weight prior to birth (8 studies showed the chance of predicting a large - >4kg - baby using sonography estimates to be anywhere between 15% and 79%).

Two randomised control trials indicated no statistical difference in foetal or maternal outcome whether labour with spontaneous or induced. Other (non-RCT) studies have suggested an increase in CS rate if labour is induced.

Assuming there are no other risk factors then I would be asking a LOT of questions about the research behind a recommendation to induce purely on the basis of a large weight estimate given this is contrary to NICE guidance - and quite a few questions on how they can have confidence in their weight estimate to start with! If you don't have confidence in what your registrar is telling you then you should definitely ask for a 2nd opinion.

I'm not sure what I would do if it were me. I do know an extremely experienced MW who's view re. SD was that, if it happens to you, where you are is a lot less relevant than how skilled your HCP's are at resolving it - pretty well everything (apart from a couple of very rare surgical procedures) that can be done to resolve SD can be done in any location, including at home. She had an argument, you were at more risk in a CLU with a MW that was used to pushing a panic button for anything that deviated from normal than you were at home with a MW that was used to having to deal with whatever problems occurred, as speed of action is critical.

That said, all of this came out because we wanted a HB for DD1 and our CMW was very supportive. We wound up with a HB even though we knew she was of above average weight (9lb 12) and breech (we did go out of our way to find very experienced IMs to support us). For me, hospital isn't an environment that I find conducive to birth so I felt HB to be "safer", although trying to do an objective analysis is nigh on impossible. Given that's my starting point, I'd probably start by planning another HB - but that decision is always going to be shaped by previous experience.

Habbibu · 26/07/2010 22:21

Think I agree with that MW, Tangle. ime, anyway. I didn't know anything about SD happening until I was having a couple of stitches, and lovely MW was handing over to next shift! DH says she just calmly reached in and got dd's hand and arm out - she and cons were great team, but cons had already put me in MacR position, presumably precautionary. They were both so calm and chilled (plus cons had been brilliant with us in the past), that it all was resolved without me even knowing.

Tillyscoutsmum · 27/07/2010 09:00

I had my 10lb 5oz in a MLU. I had my first dc on a ward (due to other complications). She was a bit smaller (9lb 12oz) but my experience in the MLU was much much better

biggest · 27/07/2010 21:23

And did you have epis or tear with such a big baby? I am scaring myself by reading too much online about SD

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StarlightMcKenzie · 27/07/2010 21:28

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Baileysismyfriend · 27/07/2010 21:31

Personally I would go for the scans. My DS was 11lbs 9oz and his birth was difficult and resulted in an EMCS. We had no clue he was so big and it would have been much easier all round to know.

I will definitely be having growth scans with the next one.

Habbibu · 27/07/2010 21:40

Small tear with dd (10lb 11) - didn't notice, 4 stitches, no probs. tiny tiny tear with ds (9lb 1) - 1 stitch, no probs.

As I said, it does no harm to know baby is big, so that team are prepared to, say, suggest position changes, etc, but don't see any reason for induction.

Tillyscoutsmum · 28/07/2010 08:24

I tore with both mine (9lb 12oz and 10lb 5oz). I didn't notice the tearing at the time (honestly !). The stitching up after isn't pleasant but I know lots of people who have had much smaller babies and still tore.

Try not to worry (easier said than done, I know). Ime, Starlight is right. If the baby is in the right position and you are upright, then the extra weight can actually help the cervix dilate quicker and it could be easier than a smaller baby. Its all about gravity . My second stage with DS (the 10lb+) was 6 minutes and 2 pushes. They weren't even real pushes - the midwifes reckon I almost "breathed" him out I found a birthing stool amazing

BettyButterknife · 28/07/2010 10:09

Friend of mine had a 10lb first baby, laboured naturally but didn't have a great time of it. Second pregnancy, she was under consultant care and they recommended a C-section due to size of baby after several growth scans.

Turns out her DD was only 8lb 4oz - friend a bit miffed that the scans were so inaccurate, and that her subsequent recovery from c-section took so long.

I had a scan last week at 40+8 and asked if they could estimate size. Sonographer said they are 'wildly inaccurate' at this stage, and that the best way is to have regular growth scans throughout pregnancy so that they can build up a picture rather than relying on one instance.

japhrimel · 28/07/2010 10:31

If you don't want the scan and feel it will only make you more stressed, don't have it. They're so inaccurate, it's not like it'll give you good information anyway. All they can say is "this baby looks bigger than average"!

And start quoting NICE Guidance at any doctor who suggests induction merely based on their inaccurate scans of baby being big.

I've been doing some reading up on naturally birthing big babies ever since my MIL informed me that big babies run in DH's family and it seems that positioning is even more important. Going for an induction may mean you are restricted in movement and positioning, which could actually cause more issues, such as increasing the risk of shoulder dystocia or meaning you need a CS as you're trying to birth a very heavy baby uphill lying on your back! Knowing about the McRoberts Maneuver might be good in case it's needed: en.wikipedia.org/wiki/McRoberts_maneuver

childrenchildreneverywhere · 28/07/2010 10:33

Have a look at www.bigbaby.org.uk - lots of info and research.

makeupmummy · 28/07/2010 14:14

it was not fun! I should say that he was two weeks o/d and waters broke with meconium, hence induction. Agree with what others say that induction restricted movement etc. He also was back to back, discovered at last minute too. I think that what i would say is that I would never have a baby there again!! It was labour ward staffed by midwives, got doc when apparent all going pearshaped. Despite my complete aversion to surgery, I think would opt for cs if ever did it again(but won't!). But loads of others have bigger babies fine - if baby IS big, who knows? Not an exact science, and not wanting to be voice of doom - my big boy is gorgeous. Good luck

biggest · 29/07/2010 12:16

Just an update from the scan I had today - baby still big (surprise!) measuring about 9lb 10 today although I know about margin of error so I am lopping 10% off that weight for starters!
Spoke to 2 docs, one was keen I go straight to labour ward, other was more relaxed about me trying water in birthing centre first. Basically up to midwife at the time...
I refused a sweep today, would rather see how next couple of days go (40 weeks tomorrow), and didn't feel pushed towards induction at all.
Here's hoping for good news this weekend!

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makeupmummy · 29/07/2010 12:27

will keep fingers crossed! Come on, baby!

mrsfred · 29/07/2010 12:38

Good luck!

I was scanned every three weeks with DD1 because they thought she was going to be big. Even in labour the midwife said she expected the baby to be large ... DD1 was 7lb 6 and a half!

Turned out she just had a big head

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