What would you do?

[babyblabber]

hi all, would love some advice. am 5 months pregnant with baby number 2 and really confused about what i want for the birth.

I was induced with DS 12 days overdue and needed nearly every intervention bar forceps so the whole thing took 2 full days. DS was 11lbs much to everyone's surprise as i am only 5ft 3 and although a little overweight, have quite narrow shoulders, small feet etc. i was tested but didn't have diabetes and will be tested at 28 weeks this time.

I suffered badly from physio issues after DS as my bump had gotten so big and had to wear support belts around my stomach and hips for months even to walk to the next room. have also realised since getting pregnant again that my pelvic floor is very weak.

I'm quite worried about having another big baby and even my doc admits that once they get over 8.5lbs, the scans are very inaccurate. i'm worried about the baby getting stuck, about shoulder dystocia, about my vagina being badly damaged etc. Doctor's attitude is i've done it once i can do it again but he brushes me off if i say maybe i just got lucky last time or what if this baby is even bigger? at first he said he would take me in early (even though i swore after the last time that i wouldn't be induced again, i do think it'd be better than c-section and anyway, there is no way he would agree to section me) but now he's saying he won't intervene and will see where i am at 40-41 weeks. i know a girl who's 1st baby was 10lbs 12 and so was induced 9 days early for no.2 who was still 10lbs!

i have already decided that i do not want forceps again and if it comes to this i will not consent and want a c-section. i'm happy to discuss this with him before labour although i know it will be a battle!

but i really think i should be brought in at around 38/39 weeks and am wondering should i push for this? what would you do? should i just let nature take it's course, i would far rather go into labour myself than be induced but i could go well overdue again and am petrified of having a 12/13lb baby then.

I would push for some growth scans and see what they say (I know they can be inaccurate but they might give some idea) if you really want to be induced early I would push for it - can you get your MW on board? I sort of know where your coming from my DS was an early induction (for GD) and eventually needed forceps.
The one thing I will say about your forceps refusal is that if the baby is too far down the birth canal forceps are actually better than a section as with a section they have to then be pushed back up the birth canal from the bottom and pulled from the top so you would still end up with an episiotomy (this nearly happened with my DS, luckily the forceps worked!

babybladder I am feeling quite similar to you at the moment.

My back story is:
Dd1 - episiotomy, ventouse, 8lb 5oz, painful sex for a year after & not brilliant pelvic floor.

Ds1 - water birth 9lb 12 oz. Notes state shoulder dystocia but ds was born without episiotomy with midwives releasing his shoulders. It was shocking & traumatic, 2nd degree tear, quite alot of stitches but a much quicker birth than dd1

So now I am 33 wks with ds2. Ref to consultant at my request who basically read through ds's birth notes & said he'd describe it as difficult shoulder not dystocia. That he's sure I could deliver bigger !!

I am 5ft 4, has small hips, size 4 feet.

Anyway. His plan is to do growth scans at 32, 34,36 weeks. Note trajectory of growth & induce ms early if ds2 looks like a whopper.

I feel so mixed. I do not want to be induced, will not consent to forceps, don't want another episiotomy & know all these are more likely when induced.

I'm considering just insisting on an elcs but know it also carries it's own risks. Arghh.

I just feel like we may have been lucky last time. Not sure I want to take the risks. Just don't know what to do.

Hi

I had a similar experience with my 1st baby with shoulder dystocia and forceps in theatre. She was 9ib 3 so not as big as your ds and I think it was partly as I was 11 days overdue.

I'm now 36 weeks with number 2 and had gtt which was negative too. Next step for me is consultant appointment where they'll do physical exam to see how big baby is. Apparently they'll feel how big baby is as growth scan is not reliable for big babies! I saw the consultant who was clear I should not be fobbed off with a scan and make sure a senior doctor saw me. if baby is big I'll be booked for a cs. But dr did say thatv2nd time round your body is more likely to be able to give birth naturally.

I understand how you feel about being confused and i'm not sure whether or not to push for a cs. But if you're not happy with the proposed treatment and sounds like you don't feel like your dr is listening - can your mw help at all? Mine has been really supportive and said I need to be happy with what's been proposed.

Oh, I fit right in here!!

My history is DD was an induction for prolonged rupture of membranes and no labour, looong labour, epidural, third degree tear and now I'm 32 weeks pg with twins. DD was only 7lb 5.5, but big enough to do me a lot of damage!!! With twins, I will be induced at 38 weeks (said I never want to be induced again) in my hospital, I have to have another epidural, have to be monitored, have to have syntocinon up after twin one born. So all in all, sounds like a good possibility of more perineal damage to me...

OP, did you watch Britain's Biggest Babies recently?! About women having 11-12lb babies and why etc. They were being brought in early and induced if required. One lady had an ELCS at 38 weeks and the baby was still 10lb8 or something. Big anyway for that gestation. A friend has recently been monitored for a big first baby- she's 5'2 and her baby was 9lb 2, and had sweeps etc at 38 weeks whcih did trigger labour.

I would not be in the slightest bit happy being brushed off, you are genuinely concerned having had a big baby that you don't want forceps, shoulder dystocia etc etc for this birth and this baby. I think you should be monitored and have the option of earlier induction if it is thought baby will be big. It is hard though- I totally understand the never wanting to be induced again, and I have booked an ELCS for 37+6 because I can't face it especially for twins but am worried about what to do if I go into labour before that.

If I were you I think I would ask at your next appointment and if you're not happy with the plan then, grit your teeth and be brave and ask for a different consultant and second opinion. You are allowed that!!! They have said to me 'oh, just because you've had a third degree tear doesn't mean you'll tear again' but it also doesn't mean I won't, plus I'll also have interventions like epidural which could make tearing/instrumental more likely...

I thought you could ask for an ELCS if you thought you wanted that though- Isn't this what the new NICE guidelines say too? The other thing to consider though is if you think you will have other pregnancies though- if you don't think this will be your last baby, maybe early induction over ELCS as there are more risks with susequent CS of adhesions etc. but oh, we'll see at 41 weeks would not reassure me (nb- I am a worrier!)

Good luck!

thanks for the replies girls. doc said he'd be able to tell at 34 weeks roughly how big baby will be. am doing my best to eat healthy and avoid junk and too much fruit (ate it by the bucketload last time and it's quite high in sugar which i don't think helped). i'm not mad on the idea of a section with a toddler at home but then i'd rather that than more damage or something to go wrong with baby. also really want to avoid the physio issues i had the last time so don't want my bump to get as big!

DreamingofPeace, just to let you know a friend of mine also had an 11lb baby after induction. she recently had twins at 37.5 weeks after another induction but she said it was totally different. first twin arrived after 3 pushes only 3 hours after she got the gel and doc didn't even wait for second twin to turn, he literally reached in and pulled her out feet first! they were 7.5lbs and 6.5lbs.

to be honest i put a lot of hope in that story, that if i am induced it defo won't take 2 days again! or if it was looking like it might i could me more vocal this time and ask for a secion at some stage.

babyblabber Your diet shouldn't affect the size of your baby (this was discussed on another thread this week by a GP I trust) :)

I consented to induction first time round at 40+15 (DD not large or anything) and ended up with the cascade of intervention resulting in forceps, 3a tear and various issues immediately post birth.

I am now 34+6 with DC2, this baby is over the 90th centile and is predicted to be around 9 1/2 - 10 1/2lb at term. Of course, growth scans can be notoriously out (I think one site says 30% - that's a couple of lb!) and there are hundreds of stories on here of women who were predicted to have large babies who actually turned out to be average sized babies at birth.

It will be a cold day in Hell before I consent to induction for this baby. As far as I am concerned, it will take as long as it takes, and if I go past 42w and expectant management shows an issue with baby or the placenta then I will agree to EMCS. That's it.

For me personally I feel the risk of intervention and further damage from induction are too great - regardless of whether that is before or after 40w.

So in your shoes, I would do nothing. No induction, no ELCS - just wait for baby to be born. But that's me, and not you.

NICE Guidelines say that you should have the request for ELCS agreed if all other avenues (eg counselling) have failed and if your Consultant doesn't agree they should refer you to someone who will - however they're not rules and if a hospital doesn't want to follow the guidelines then they don't have to.

thanks flisspass, my doc also said my diet would have no effect, i just grow big babies. i'm just doing it because i think maybe if i was borderline diabetic last time i know tropical fruit is one thing mums with gestational diabetes should avoid and i was eating a massive bowl every day from about 5 months. am still eating fruit, just not half a pineapple in one sitting!

i would love to just let nature take it's course but am so worried about baby being even bigger than 11lbs. even if all goes well at the birth, my stomach muscles were so badly separated that i couldn't stand upright last time until i got the support belts, could only walk a few feet at a time at first and i was weeks before i could even make it to the end of the road. i just can't imagine being like that when i have a toddler and a newborn to look after.

will see what he estimates the size at (taken with a pinch of salt as he said DS would be 8.5-9lbs!) and take it from there. why oh why can't i have normal size babies and not have to think about this?!!!!

I've actually just come off the phone to my Supervisor of Midwives who was inviting me to another growth scan, which I have declined - what's it going to tell us other than the baby is expected to be larger than average? To quote someone off here from last week - "it's not going to make the baby smaller"!.

By her own admission, they're very difficult to get an accurate measurement from and so I don't see the point unless baby suddenly shoots up several centiles on the next fundal height measurement.

Don't forget as well, that having an ELCS could still render you pretty much immobile for the first few weeks. Some people recover really quickly but others don't and it's not without risks or possible complications. It's major surgery so even if you do take that option it could still be weeks before you make it to the end of the road, and you'll still have a toddler and newborn to deal with. You don't need me to tell you that though!

And you do have normal sized babies - normal for you. What's normal for anyone else is totally irrelevant.

Can I just ask you all if your fundal height was bigger than it should be too?

My DS was 9lb 11 measuring right for dates, am currently nearly 30 weeks with DS2 but measuring 2 weeks ahead.

littlemissnormal Yes, my fundal height is 3cm bigger than they would expect.

The SoM also confirmed on the phone yesterday that that can be down to how baby is lying, if there's a lot of fluid, or even if baby is just long (DD was 8lb 2oz but incredibly skinny and had legs longer than Mr Tickle's arms, just like her Dad!) and can also be affected by the person taking the measurement. Inaccuracies are more likely if you have someone different taking your measurements at each appointment.

what the hell is fundal height?!!!! have never heard of this. am in ireland if that makes a difference but didn't think it would.

am exactly 24 weeks today (in fact 23+5 really as i know the day i ovulated) and had a scan this morning. doc kept saying, oh yes, perfect size for 24 weeks but i could see at the bottom of the screen it said 24w+4d. does that mean baby is bigger than average already?!!!

i actually read my notes last night from when i was pregnant with DS and so i know what his estimated weight was at 28, 33 and 35 weeks. all were above average. am going to compare this baby's weights when i get to those milestones so at least i might have an idea if this baby is going to be even bigger and think about my options then.

also thinking of asking for a sweep at 37/38 weeks rather than induction for what they're worth (don't know anyone they worked for!). would love to experience going into labour naturally and have a 9lb-er!

babybladder fundal height is the measurement they do from the top of your womb to you pelvic bone.

littlemiss I always measured less that my dates. The fundal measurement IMO is a crock of shit at judging baby size.

I am seeing consultant tomorrow & am going to ask about a elcs for dc3. See how he reacts, the worry is doing my head in.

Also meant to say babybladder the consultant & midwives said to me that babies lay the vast majority of weight on after 28 wks. After 28 weeks is when growth curves change, some babies growth curves are steeper that others after this date.

oh that's interesting bunsouttheoven, will be watching closely to see what happens between 28 to 33 and 33 to 35 then.

ok my new plan is if the baby is looking the same or smaller than DS, which would be ideal, is to let nature take it's course.

if it's looking bigger and i'm still worried, am thinking of asking for a sweep at 38 week, another at 39 and for doc to calculate my bishop's score (which determines whether an induction would be successful). if it's low, indicating induction won't work, another sweep and bishop's score at 40 weeks and if bishop's score is still too high then i'll ask to come in at 40+5 and do the same and if it's still too high for induction i might ask to be booked for a section at 41 weeks.

re forceps have done some research over the last few days and i know at what point i'll refuse them (or at least discuss it with doc) and i know when they would be the best option.

feel much less panicked now that i have a clear plan and more in control.

I saw the junior consultant today?Discussed our worries & that I am feeling that I would like an elcs. He discussed my notes & explained the risks of cs. Now I am having another growth scan at 36 weeks (in 3wks time) & talk to the head consultant then. He will look at the scan & consider my request. I got the impression that they would probably do an elcs if I listened to all the risks etc & still feel the same. He said elcs now happen from 39 wks unless medical complications occur before.

I feel a bit relieved so I suppose for me that is a sign that I am comfortable with my decision for a cs.

God, this having babies business is stressful

just an update. good news is i don't have diabetes so that's one thing ruled out. bad news is my stomach muscles had already separated so am probably going to be fairly incapacitated again after i have this baby.

am 28 weeks now and had a scan yesterday. average size for baby at 28 weeks (according to 5 websites, 1 irish, 2 english and 2 american) is 1kg, DS was 1.2kg at this time and this baby is 1.5kg!!!!

doctor said it's on the big side of average but still within normal range and still won't discuss interventions but i'm not so sure. it's 50% bigger than average! am kind of freaking but will wait and see what size it is at around 33 weeks but at the moment am thinking it could be 14lbs at this rate!!! should say, i'm in ireland so the system is different here. am a private patient so just see my consultant, no midwives (except during labour) and not easy to change consultant, although i think his views are that of the hospital where he works which are very proud of their low section rate.

i put it as my status update on facebook about the baby's size and a girl i know who is training to be an obstetric consultant messaged me and said she presumed i was getting a section. my dad is also friends with a consultant at another hospital so might give one or both of them a ring at some stage to discuss and then have a very frank discussion with my doctor.

one thing i forgot to mention is that i've been doing a lot of research on the internet and most of the websites which encourage vaginal labour for large babies advocate active mums and no lying down as this can reduce the amount your pelvis can open by up to 30%.

i have no interest in giving birth without an epidural and as we don't have light epidurals here that means i will be lying down for the birth.