Induction for big baby?

[FolkSongSweet]

My baby is measuring 90th centile or above for head, femurs and abdominal circumference. I don’t have any medical issues and baby is doing well. My first child was born naturally at 42 weeks on the 75th centile, at just under 4kg (8lb 12oz). It was an easy and very fast labour though I did have a second degree tear.

I saw the doctor today and he’s recommending an induction at 39 weeks because of the baby’s size (estimated to be 9lbs at 40 weeks). I really don’t want to agree to this but not sure if I’m being stupid.

Does anyone have any experience? Did you agree to an induction in these circumstances and was the baby as big as they thought?

I had an induction at 39 weeks because they said baby would be around 10lbs but he was 8lb3oz. Have you been having regular growth scans? I got told they have a 25% margin for error (not sure what the point of them is really)

My fundal height is average so haven’t had growth scans. Went for a private scan at 35+3 which said that the baby was 7lbs 13oz. Then the hospital scanned be at 36+4 and said the baby was 7lbs 1oz, so even that is conflicting! They really don’t seem reliable but I guess taking the average of those two scans the baby will probably still be 8.5/9lbs at 40 weeks.

Growth scans are notoriously inaccurate, the consultant midwife I spoke to said 50/50. You'd need regular growth scans to see if the measurements are reasonably consistent which would give you some confidence that they're accurate.

I am basing this on my own experience but I don't see the issue with a 9 pound baby. Both my babies were over 9 pounds (DC1 was 9lb4, born at 41+4, and DC2 was 9lb1, born at 40+1). Of course there are exceptions but second births tend to be quicker and easier, so if your first birth was already quick and easy, your second one probably will be too.

Women have birthed babies much bigger than 9 pounds with no complications. Check the Nice guidelines but I didn't think a big baby was in itself a reason for induction, unless there are other factors (gestational diabetes or other issues).

I had an 8lb 13 oz first baby, followed by a 9lb second baby.
The second baby was a far easier birth, TBH.
Maybe consider telling them you don't want induction unless you are overdue?
(All with the exception of if you have a tiny frame, of course - I'm 5' 5", so you need to consider that too.)

Found it.

"If your baby is larger than expected, you should not normally be offered induction for this reason alone."
www.nice.org.uk/guidance/cg70/ifp/chapter/Why-you-might-be-offered-induction

evidencebasedbirth.com/evidence-for-induction-or-c-section-for-big-baby/
(This article is very helpful so I'm sharing it even though I don't like the website because they refer to "pregnant people" and "birthing people", fuck off!)

These estimates are often wrong, as PP have said. I measured spot on at every scan and appointment. Baby was born three days overdue at 10 lb 11 Oz. Nobody had a clue. He came out without any issues and no lasting damage to me either.

Thanks so much for the replies, and the link @NameChange30 - really helpful. I’m 5’7 so not small. I feel like I can do it. The consultant today told me that outcomes were better for inductions at 39 weeks for big babies but seems like I should challenge this.

Most definitely. Another link for you (last one, promise! )
www.aims.org.uk/information/item/making-decisions

You could ask about the risks of induction, ask if they have data for the number of inductions ending in further interventions / complications versus spontaneous labour with big babies ending in the same...

I had a big baby (9lb 2oz) and was induced, but that was due to the fact I had sudden severe pre-eclampsia at 40+2. He was also in a back-to-back position me and going absolutely nowhere fast so he was brought out with forceps in the end - no-one had mentioned he was going to be big at any of my scans etc.

Mine were all induced for dates:

My 1st was 7lb 6oz at 41 weeks (3 pessaries and ARM) - 32 hours in total

2nd 10lb 6oz at 42+3
1 pessary - 10 hours in total

3rd 9lb 2oz at 40 (avoiding big baby again)
3 pessaries and ARM - 32 hours in total

4th 9lb 10oz at 42 weeks
2 pessaries - 11 hours in total

So I wouldn't bother being induced early for dates!!! My later biggest babies were far easier labours!

I'm tiny 5' and they completed missed that I was having a HUGE baby despite looking like I was carrying twins by fundal height I consistently measured small!

So the consultant I spoke to mentioned a study called the ARRIVE study. I’ve just looked at it and not sure it’s even relevant - it looked at first births (I’ve already had a large baby, without issues or interventions), showed a small reduction in c section rates in the induction group but increased rates of perineal damage and no other notable benefits really. Quite confused as to why they’re pushing this now. I’m 33 so not ancient, have a healthy bmi, have gained the recommended weight in pregnancy and am fit and well. It seems bizarre.

I would look at your first baby's heed measurement, was that also large??

They may be concerned about the 2nd degree tear tbh but I'm not sure that size has much to do with that - usually more baby position and maternal predisposition?? Something worth reading up on.

I didn't tear or have stitches tbh.

If I were you I wouldn't agree on early induction if they are just basing it on baby weight alone.

You can refuse, you could just say I'll consider it at 40 weeks and then say consider at 41 weeks etc.

I had very severe SPD with number 3 hence keen to be induced at 40 weeks - shouldn't have bothered!!!

Yes @RandomMess first baby’s head was huge 🤣. He was 75th centile weight but his head was 95th centile. Had I known that in advance I’d probably have been terrified, but my 36 week scan suggested he’d be 50th centile all over so I already know how inaccurate they can be.

They think this baby also has a 95th centile head but an 85-90th centile body. Doesn’t seem much different to me. They thought I had gestational diabetes but have ruled that out now, though I wonder if that suspicion is influencing their thinking somehow?!

I wanted a natural birth without interventions and I guess I’m struggling with whether it’s somehow selfish of me to continue to pursue that against their recommendation or not. 🤷🏼‍♀️

If you managed ok with huge head first time then go for it and just hope you don't tear again?

I suppose the risk is a 3rd degree tear and then ongoing issues but perhaps a more likely outcome is not tearing as its not your first???

Yes they were panicking after I delivered DD2 with her being so huge and obsessively checking her blood sugar levels having ignored my concerns that I was carrying a HUGE baby!! Strangers would ask when I was due then always go "Oh, is it twins?" I would just say no I'm short... but they weren't far off being right. Huge placentas and super thick umbilical cord. Felt cheated having this 3 month old baby within a couple of weeks 😂

I'm 5'3"

First baby 7lb 12oz at 40 weeks, induced for pre eclampsia

Second 9lb 7oz at 41 weeks, waters went and augmented labour

Third 11lb 3oz at 41 weeks, natural labour and delivery but did have to change positions from squatting to standing with one leg on the bed to help shoulders out. I was lucky to have had a very skilled midwife, nobody had mentioned the fact that he was big.

It's not selfish to want to avoid unnecessary interventions. They can have negative outcomes for mother and baby. There is nothing selfish about following your own instinct when it comes to giving birth. I really hate this narrative that we are somehow "selfish" for wanting to avoid a stressful traumatic birth, as if we have to prove ourselves by agreeing to all sorts whether it's necessary or not!

(Sorry I'll stop ranting now )

Just to comment on what a PP suggested - the risk they worry about with a "big" baby is shoulder dystocia, not the size of the baby's head causing a tear.

Growth scans are unreliable. I was fold DD1 would no more than 8lbs, she was 10lbs 14oz. I was induced, (failed). I had a horrific Labour that ended in an emergency c section. I would try and avoid an induction tbh.

Use your 'BRAIN'

B - benefits
R - risks
A - alternatives
I - intuition
N - (do) nothing

Do your own research, ask questions and make your own decisions. Do not let them bully you into something you don't feel comfortable with.

I had my growth scan a couple of months ago. They said he’d be about 8lbs but had a 95th percentile head so wanted to induce me on my die date if he wasn’t here. They induced me, he still wouldn’t budge. Ended up with a csection. He was 10lb 13oz and his head was off the charts. My first baby had a head off the charts and got stuck but was eventually born vaginally with a lot if complications. He was only 8lb. Thank GOD I didn’t try push the second one out.

Thanks - yes, I guess growth scans can be wrong both ways! I’m thinking of asking for another scan at 39 weeks to help me make up my mind. Tbh I feel like even the fact they are questioning this is making me lose confidence in my ability to give birth, even though I’ve done it before. Trying to relax and not think about it but it’s hard ☹️

I was induced on my due date due to a predicted large baby and he was 10lb 2oz. Ultimately my decision was based on a desire to reduce as far as possible the risk of shoulder dystocia.

My body definitely wasn’t ready to birth the baby and it was four days from arriving at hospital to having him with plenty of interventions but ultimately I consider the birth to have been positive and had a good experience.

First baby though so as you say it is different.