Having a large baby

[Fairy]

I wonder if anyone else has any experience of our 1st pregnancy.

Our son was induced 10 days after my due date and was born after 8 hours with not that much trouble it seemed at the time! But when he emerged he seemed a lot bigger than we expected and this was where the trouble started!

He weighed 10lbs 5ozs and his head circumference was 38 cms!!!! So he was a big chap, due to his size I lost about 2 pints of blood and fainted straight afterwards. When we were wheeled out of the delivery room it looked like I'd been murdered or in a car crash!

So now I find myself at 34 weeks pregnant with our second and finding the consultant at the hospital to be as much use as a wet potato! All I get is 'well you've done it once second time no problem', now that may be true but it does not instill me with much confidence. I'm being scanned again this Thursday, and I will probably be told again that he is an average size, but I cannot believe that I could go from my first being a whopper to the second being just average.

So what I'm asking in a long winded fashion is, does anyone else out there have any experience of this sort thing? Please?!!!!

Forgot to say, I was 40 weeks plus 6 days with no.1

Well, dh isn't going to forgive me if I don't post this. He was, wait for it....a whopping 13lb 10oz when born (26 inches long). We're talking a natural delivery at home here, too. MIL has got a frame to cope with big babies, but even so......(btw, he was her third, and she has said that she wouldn't have been able to deal with it if it wasn't for the very lovely midwife who delivered him very carefully (newly qualified midwife too). It wasn't, apparently, the head that was so much a problem, but the shoulders!

I myself had shoulder dystocia and they're still huge in proportion to the rest of my frame eg new trouser suit size 8 trousers, size 12 jacket which gapes at the front due to lack of boobs but only just fits across the back. I have a nightmare finding clothes that fit and have often been accused of wearing shoulder pads when its all natural. So I wasn't surprised when DS was big. 36.5 cm head but fortunately no problem with shoulders.

Tigerfeet - can really appreciate your concerns, as shoulder dystocia is a scary thing to have to deal with. It's good that you have an understanding consultant who will talk you thru the options. You will be offered scans which will help to give an indication as to the size of the baby (but only an indication - they can be innacurate), and decisions re: caesarean should be left until later on. As a compromise, you may well be offered induction slightly earlier than you due date (I would be surprised if your consultant was happy for you to go overdue again) - of course induction is not ideal, and an interventionalist procedure, but if it would mean the difference between caesarean or vaginal delivery you may wish to consider this. Of course, inductions do not always work, and a caesarean may then result (don't mean to be the voice of doom, just trying to think of different eventualitites!)
Have you been offered a glucose tolerance test this pregnancy? For ladies who have had previous large babies, these are often routinely offered around 28 weeks of pregnancy, to rule out pregnancy induced diabetes as the cause of a large baby. This should be offered so it can be discounted - ask your midwife.
Ultimately tho' Tigerfeet, if this baby does appear larger than your first, you may well wish to seriously consider a caesarean, although this wouldn't be your ideal. I'm a true advocate of vaginal delivery, but in very few instances, caesarean is the safer option. Think on, and speak to your consultant/midwife when you have a clearer picture nearer the time. Keep us poted.

leese, thank you for your posting. You sound very knowledgeable so assume you work in this field/have professional experience. I go for my first scan next week (I'll be 14 weeks) and hope to have an intial meeting with my consultant then although I did meet him 3 months after ds was born and a section was mentioned then. From speaking to a midwife a couple of weeks ago I was able to put a flag as it were on my file so they are now aware of my history. I will ask about the glucose test then too. Will definitely keep you posted.

Leese and Mears are midwives

Good luck Tigerfeet, and let us know how you get on.

Just a quick follow up. I had my scan a week ago - everything is fine I then spoke to the midwife and I am to be booked in for at least one more scan at 35 weeks, possibly another one before that at 28 weeks and a glucose test. I have to follow this up though so I have made a note in my diary to call the health centre beg. January for the 28 week appointment when, hopefully, I will meet with my consultant.

Something of interest to you may be that 50% of babies with shoulder dysticia are within normal birth weight. As Leese has already said scans can be offered but are not patricularly accurate or helpful. What you might like to ask at the hospital Tigerfeet is if the staff regularly practice a drill for delivery of babies when there appears to be shoulder dystocia. This is a national recommendation.
It is now widelt recognised that babies who are 'stuck' should not just be pulled on with gust but that there are various manoevres that should be tried that can increase the diameter of the pelvis or help the baby rotate.
It is called the HELPERR pmnemonic (? spelling) and is part of a drill that should be used where there is shoulder dystocia. It is probably a bit much to explain it all here but the consultant and midwives in the labour ward should be aware of it.
Shoulder dystocia is also more common with forceps deliveries. Second babies are less likely to be delivered by forceps but that can happen.
Second babies are not always bigger by the way. I was with a friend of mine in labour whose first baby was 10lb 13oz delivered by forceps after an 18hr labour. Her second baby was 8lb 7 oz who slipped out after a 5 hour labour.
Hope you feel more reassured after speaking to your consultant. Let us know how you get on.

SueW - all fours is a good position because the pelvis diameters are at their largest. Babies do tend to deliver more easily. Infact one of the manoevres with shoulder dystocia is to change the woman's position to all fours if possible. Not always easy if she has an epidural.

When, during labour, is it suspected that there could be shoulder dystocia? With DS my second stage lasted for approx. 5 hours with my contractions stopping halfway through that time so it was onto a drip but I do remember pushing in what I imagine to be a conventional position, one leg on my husband's hip and one on the midwife's. I also remember prior to this the midwife encouraging me to walk around and generally stay upright as much as poss. as DS was still quite high up. Would/could SD have been predicted at this point and my position changed (only using TENS machine) or is it once the head has been delivered?

Tigerfeet - shoulder dystocia is something that can only be diagnosed retrospectively if you like. Basically, when the head delivers, and then you have trouble freeing the shoulders to deliver. Sometimes this is just 'difficulty with the shouldes' , but if, as Mears illustrates, some other manouvres have to be brought into play to help delivery, this is then classified as 'shoulder dystocia'. Fairly often labour will progress as normal (not necessarily any longer than usual), but the head will often deliver slowly, then just sit on the perineum - as the shoulders are too tightly wedged to rotate as they should, so the head does not turn to the side.

Tigerfeet - the conventional position you describe is one that is now recognised as being potentially harmful to both mother and midwife. For the woman it increases the risk of symphisis pubis dysfunction causing damage to the pelvis. For the midwife it can lead to back problems and is therefore not recommended under manual handling guidelines. Since you were only using tens for pain relief you would have been better out of bed on your feet. The position you describe also limits the diameters of the pelvic because the coccyx at and sacrum at the base of the spine cannot move (back as it is pressed against the bed) to give the baby more space.
When shoulder dystocia is diagnosed after the delivery of the head in this position, the woman should lie further back should be told to bring her knees right up as far as she can (The McRobert's Manoever - the first 'L' of the HELPERR drill) to allow the sacrum to move back. She will need assistance to do that and often that is all that is needed. Much better not to be in that position in the first place.

Just popping back in again to keep all informed of progress. I am now 28 weeks and had my first growth scan on Thursday. They took a measurement of the head and abdomen. I was then told that the head isn't really an accurate measure due to the moulding of the skull (and with ds1 although he was large his head was fairly small) but that they rely more on the measure of the abdomen as the growth/size of liver can give an indication of the size of the baby (did I explain that right)? Anyway, I'm pretty much in the middle of all the charts and my tummy is only measuring 1cm more for my dates. I go for a glucose test in 2 weeks and then arrange another growth scan in 6 weeks. Other than that all things seem to be progressing well and no need to worry/think about the birth just yet.

In fact, everywhere I go I have to explain why I'm having these procedures done as there is nothing in my notes relating to birth no.1 and I obviously look and feel pretty healthy. Out of interest, is it general procedure to essentially start afresh with new notes with each pregnancy(hence why I have to explain why I am having growth scans etc) or is it a local thing ie. only my local hospital/community does this? It's just that I get the impression that if I hadn't mentioned my previous history at my booking in then this pregnancy wouldn't have been more closely monitored. Also, the onus is definitely on me to make appointments for scans, glucose tests, meetings with the consultant etc.

If you are booked at the same hospital then you notes should contain everything about your first pregnancy. If you are attending a different hospital they will not have your history. The consultant usually writes to the previous hospital for information if there have been problems. In our area, appointments are made for the women that need them for scans and gucose tolerance tests etc.
Glad to hear things are going well.

Another update! Am now coming up for 37 weeks and no closer to making a decision on the birth. Have had 2 growth scans, both of which put the baby smack in the middle of the charts so it wouldn't appear to be the whopper no. 1 was. We finally saw a consultant last week who, disappointingly was unaware of my history. There is plainly no system for bringing together previous records with new ones so once again I had to explain my entire history to someone else. I really hoped he would be able to advise me but due to the fact he only had 30 seconds to think about it left me feeling even more confused. He also contradicted himself by saying that if I was his daughter he would probably say to let nature take its course bearing in mind that it is unlikely to happen again and that no. 1 has probably paved the way for no.2. But, when we told him that the ob. who delivered ds said immediately after the birth to book a section next time, and then repeated that advice 4 days later (when still having bladder issues), the consultant switched and said how well-respected etc, this guy was so perhaps I should err on the side of a section instead. Plus there is always the slight risk that it could happen again, that diagnosis doesn't happen until the head is delivered and then you only have around a 2 minute window to deliver the baby. Mmmm not something I really fancy contemplating. Help - can't decide and really need some more advice. We're having one more growth scan next week and then it's decision time.

Tigerfeet, I'm seeing my consultant re: mode of delivery next week (@ 38 wks) because of previous c-section..but I too worry about size - dd was 8lb 4oz..and I've had growth scans this time (for another reason) & this dd is bang on 50th centile...but a good friend whose dd1 was 6lb 13oz and very dinky (also had growth scan @ 30-odd weeks) has just had dd2 - a whopping 9lb 10oz, who unsurprisingly got stuck! so it really is unpredictable when you mentioned bladder problems, I started to shudder - a friend in Australia had to self-catheterise for weeks at home following her ds1's birth and NO ONE wants that! sorry to not be much help re: advice, but much sympathy heading your way

TigerFeet, I have had 2 elective c-sections and can honestly say that I felt great after both of them, I had spinal blocks each time and was up and in the bath 6 hours after surgery, and feeling absolutely fine. If I were in your position (which I know that I'm not) I would book the c-section and put my mind at ease for the remainder of the pregnancy. It is major surgery, but in my opinion it is very easy to recover from, I was back at the gym within 6 weeks both times

A quick question for you midwives out there following my earlier posting. I've been trying to do a little research and keep coming across the term 'expectant management' in studies investigating births of possible large babies, preventing shoulder dystocia and whether to choose early induction, planned section or expectant mgt. What exactly does expectant mgt. mean/involve?

Tigerfeet ... I am very interested in your progress here. When and if I get pg again (am trying hard ) it is likely that I will have another large baby (I had to have a c/s with DS after no progression in 3 days). My doctor here in NZ said that if you have had one large baby you are more likely to have another one ... so it would be more unlikely for me to manage a VBAC ... but I would be monitored and it would be a last minute decision type thing.
I would love to give you advice on what to do ... but all I know is that had I managed to give birth to DS (eventually) he and I would have both been quite damaged ... I am relieved that modern medicine was able to give me a c/s and therefore an 'undamaged' baby and only a scar on my tummy that no-one can see.
BTW ... what is shoulder dyst-wotsit?

It's where the shoulders get stuck and unfortunately is one of those things that you don't find out about until after the head is delivered.

And what happens? Is there always damage, like the paralisys that your son had, or can the baby be delivered without too much harm?

Hi Tigerfeet - expectant management just means "wait and see" basically. It may be that you will go into labour, make good progress and the baby will deliver well. If however, you go well past your dates and it looks like it will be difficult to get you into labour then the option of a caesarean might be best.
It might be that your labour goes OK but that the second stage lasts longer than expected. If that happenend it is more likely you would be offerred a C/S than a forceps because of what happened before.
So with expectant management you are letting nature take it's course but being prepared to step in if complications arise.
The decision is ultimately yours. There is no evidence to say categorically that shoulder dystocia first time should mean a C/S next time. However it is important to avoid positions for delivery such as propped up in bed on your sacrum. Hands and knees, lying on your left side or standing give the baby much more room. Propped up in bed reduces the space in your pelvis. Good luck with yur decision.

Ghosty - a first big baby does not mean that the second will be bigger. I delivered a friend of mine's second baby weighing 8lb 9oz whose first baby was 10lb 13oz (forceps). Again expectant management is an option.

Defintely there is not certainty of paralysis. I was an example of shoulder dystocia with no side effects and my Mum went on to deliver two more babies of similar weight vaginally.