Big Baby - Induction or C-Section?

[MrsKT123]

TLDR: My baby is measuring large and they'd like to deliver her by 39 weeks. Would I be better with an induction or elective c-section?

I'm pregnant with my first baby and I found out at my 36 week scan that baby was measuring big (>95% centile). Have been tested for gestational diabetes and all came back normal.

I had another scan earlier this week at 38 weeks and baby has continued to grow and on seeing the midwife today she's said she needs to confirm with the consultant but that given baby's size they'd like to deliver her by 39 weeks.

She's said we can try some sweeps but it's more likely I'll need to be induced. I had an examination this weekend where the registrar had said my cervix was favourable / ripe for induction.

I would have ideally liked a water birth in the birth centre (birth centre is down the corridor from the labour ward if anything went wrong) but with the increased risk of her shoulders getting stuck this isn't advised. I know I could still opt for this but I'm so risk averse I wouldn't want to now.

Therefore, I'm really left between giving birth on the labour ward (whether through induction or going into labour naturally) or a c-section. The midwife wasn't keen on offering the latter.

I'm very concerned around the risks of intervention if I do give birth vaginally, particularly with an induction - whilst they can monitor me wirelessly so I can keep active / upright etc. I worry that the pain will be too much to manage with gas and air and with an epidural there's increased risks of intervention and severe tearing or needing a c-section anyway.

I'm also concerned about the amount of time the induction will take - I have stayed in the hospital for reduced movements and it was awful. It was unbearably hot (I had two fans and this wasn't enough - the other women were all complaining and my husband likened entering the ward to stepping off a plane into the heat). Also the bay I was in was filthy with wrappers, medicine cups, chips etc. on the floor, all marks in the baby bed left in there with me. They were so short staffed I just got left overnight with them not realising I'd not had the necessary tests until the next day (they didn't tell me I needed any to be chasing for these to be done).

I'm therefore also worried if I did require an emergency section / intervention they wouldn't have staff available!

So I wanted to ask on here - based on your experiences and if you were in my position, would you push for an elective c-section? Or is it always better to try for a vaginal birth where possible?

@ohthestruggles down to the individual sorry ! X

Hello @ohthestruggles

Yes I have had 3 sections. All went well. I have heard that they only like to do 3 sections max, but weirdly no obstetrician or midwife ever said that to me. When I was having the pre-op for my third section, they checked my blood type. The nurse said ‘With a third section, we have your matched blood waiting ready to be sent up to theatre. With a fourth section, the blood would be waiting in the theatre’ 😳

Have they said why only two sections might be suitable for you? I never wanted to try a VBAC. DD2 was bigger than DD1 for gestational age...

100% elective csection.

I was induced due to big baby , never dilated past 6cm and had to have an emergency csection , it was horrific waiting for a theatre slot and being told I wasn't any less important but somebody that needed the slot a bit more was bumped ahead of me. They left me with no pain relief and my baby was back to back , I don't think I'll ever willingly get pregnant again.

C section, nothing worse than going through an induced labour to then have to have an emcs, plus you have the risk of getting injured if forceps etc are needed.

Physically I recovered well from an emcs, healed well & was driving just over two weeks after.

Neither at this point. NICE guidelines state that a big baby on its own is no reason to induce labour.

www.nice.org.uk/donotdo/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

Wait to see if you go into labour naturally and you could potentially get your midwife-led water birth. Revisit this decision if you go overdue.

Remember that these pre-natal measurements are notoriously inaccurate. For context, I was told throughout my third trimester that baby was 100-105th percentile and he came out 8lb 15oz. Not small, but roughly the 75th percentile.

@CherryMaple that's interesting! The obstetrician that consented me for my section told me she wouldn't advise anyone to have a more than two sections and the risk of placenta previa/accreta climbs with each one. I knew that but I have heard of people having three sections! Perhaps it was her individual preference and there are clinicians out there who would do three. They all have their own ideas. She wasn't keen on my choice to have a section instead of induction but I ended up spontaneously haemorrhaging before my elective section and needed one anyway!

I wouldn't even listen to NICE guidelines it's your personal opinion and decision.

Choosing to go naturally just because NICE guidelines say you DONT HAVE TO be induced or have a section is a bit silly to me because they wouldn't offer the other options to you if there wasn't a significant risk.

For me personally, why would you choose to put yourself through an extremely painful labour, risking tears, shoulder dystocia, EMCS when you could just have a nice planned operation that is carried out every single day. Yes I know c section has its risks and recovery is hard, but it's just as hard as recovering from a third degree tear/episiotomy just without all the PTSD from a traumatic horrible birth.

You could always go naturally and have a perfectly fine labour, I just don't think it's worth the risk. I don't think you should take the NICE guidelines into consideration, you've got to go to with your gut.

For some reason there is still stigma around having a C Section just because it's not "natural" when in reality for some women it is the safest option and that's just that 😀. Good luck OP and hope you make come to a decision that's right for you x

@jozipozi31

But it's a big decision as then you're C sections later too for more babies. I wouldn't risk VBAC. I know someone whose baby died and she had to have a full hysterectomy to save her life.

So C section is a choice for life.

This is massively irresponsible and wrong. You know one person whose VBAC went wrong, someone else will know someone whose CS went wrong, or any other bloody scenario - there is always risk and sad stories about any possible option.

You do not need CS for subsequent babies. The risk of rupture is there but very small. There are other risks for CS. You're scaremongering. I say this as someone who delivered a 9lb5 baby through VBAC.

Thank you so much everyone for sharing your experiences and insights - this really helped me to consider all aspects!

Since I posted my anxiety over this birth has reached new heights due to the lack of clarity / consensus from the consultants I've spoken to! I'm 39 weeks +1 now and have no idea on what will happen with the birth.

On review of my file, it was decided by another consultant I shouldn't have an early induction as they said baby is only just on the 95th centile and as I don't have any other risk factors I was told I was back to low risk and could give birth in the birth centre.

I then went in for the scheduled monitoring and to discuss my birth plan with a consultant as asked to by my midwife, for one of the nurses to discover just now at 39 weeks that they'd missed the blood test results I had weeks ago that showed my haemoglobin levels were low! I've had a lot of issues with my care so far but this really was the cherry on top!

This means the birth centre now won't accept me with the current levels. The consultant prescribed me iron tablets and said to come back at 40 + 3 for a test to see if they've improved to acceptable levels whilst at the same time saying I could be induced at 40 weeks and start sweeps now. He said he couldn't sign off on what the best options were for the birth as it was up to the consultant on the day.

So I am left with no clue on whether it's preferential to give birth with low haemoglobin levels or to continue to let the baby grow! I'm hopefully speaking with my midwife today.

From what I've read having low haemoglobin doubles your chances of haemorrhaging and requiring a blood transfusion, making a c-section more risky, but there doesn't seem to be any stats around as to what that risk is in the first place.

[quote mrssunshinexxx]@jozipozi31 Jesus this scared me that's so sad. Did her scar rupture?[/quote]
Yes her uterus ruptured through the scar, under the pressure of contractions.

I only mentioned as something to bear in mind when choosing a C section - that it may mean one decides against future labour/vaginal deliveries.

Sorry you don't quite know where you are, OP 🤦‍♀️💐

Is there a specific/senior consultant you could ask to have a chat with? It sounds like you're being given lots of bits of information and no real clarity. Maybe ask to talk to someone with a lot of experience? Sometimes (/quite often) you need to speak up and insist. I find the voices of pregnant women are not often totally listened to. Very much depends on much and who is around you.

Insist on talking to someone. It's not right or fair for you to be left uncertain like this. Yes there's a big element of the unknown in labours/births, but there are also some clear indicators. You need to find out from a doc about the haemoglobin issue. Xx

@jozipozi31

Sorry you don't quite know where you are, OP 🤦‍♀️💐

Is there a specific/senior consultant you could ask to have a chat with? It sounds like you're being given lots of bits of information and no real clarity. Maybe ask to talk to someone with a lot of experience? Sometimes (/quite often) you need to speak up and insist. I find the voices of pregnant women are not often totally listened to. Very much depends on much and who is around you.

Insist on talking to someone. It's not right or fair for you to be left uncertain like this. Yes there's a big element of the unknown in labours/births, but there are also some clear indicators. You need to find out from a doc about the haemoglobin issue. Xx

I agree with this.

I came out of my consultant appointment about my induction confused as anything. I went away, went home and called the hospital and spoke to one of the specialist midwives and she got a different consultant to call me and help make decisions. Don't sit in limbo.

leave the decision op, let the specialists guide you

Birthing a big baby is not always bad. Our 2nd was above the 97th centile, I had a natural unassisted delivery with him only 14 mins pushing (shoulders needed a lot of effort), he was 10lb 12oz.
Since him I've had another big singleton naturally and then breech twins via elcs. Our current baby is also above the 97th centile on growth so they want to bring her at 39wk. After having a full induction with our eldest which ended with fetal distress and an assisted delivery I swore to never have another. I opted for an elcs this time instead of induction, I've got 4 days to go now.

Good luck whatever you choose

@Chelyanne

Birthing a big baby is not always bad. Our 2nd was above the 97th centile, I had a natural unassisted delivery with him only 14 mins pushing (shoulders needed a lot of effort), he was 10lb 12oz. Since him I've had another big singleton naturally and then breech twins via elcs. Our current baby is also above the 97th centile on growth so they want to bring her at 39wk. After having a full induction with our eldest which ended with fetal distress and an assisted delivery I swore to never have another. I opted for an elcs this time instead of induction, I've got 4 days to go now.

Good luck whatever you choose

Thank you and good luck for your elcs! :)

My assigned consultant didn't get back to my midwife so come Friday I was still no clearer on what would happen. I'm actually under a pilot scheme where you are assigned a midwife / consultant throughout your pregnancy in an effort to make the care better...hmm...

I was told on Friday when I called having heard nothing to go to the MAU on Saturday for bloods and to see if could see one of the on call consultants when they weren't on on the labour ward to discuss my options as my midwife is now off work until Wednesday and I'm due Tuesday.

I had my bloods yesterday but no consultants available so I was told to come back today (Sunday) and finally got to speak to a wonderful consultant who reviewed my file and laid out all of the options and answered all my questions - I can't tell you how much better I feel!

In possibly good news, it seems my haemoglobin levels have gone up a lot and are back to normal which they were very surprised at given the short amount of time I've been on the iron tablets - I'm booked back in for a re-test but I think that as my 28 week tests were also normal, I wouldn't be surprised if the ones they took in the middle are inaccurate / weren't even mine (Long story short - my bloods were taken when was admitted to the labour ward overnight, they forgot to take them when I was admitted and only realised the next day going round no one had done this, so they took them when they were also doing others on the ward. No one checked these results / followed up as they apparently should have).

The plan now is that I'm booked in for an elcs at 41 weeks, with the view that if I went into labour naturally before this I would have a vaginal birth - so no induction!

Again told conflicting things about the birth centre - today was told it was a no given baby's predicted size again and tbh by this stage I'm ok with that as don't want the stress of the back and forth of it all. They also have wireless monitors on the delivery suite so could still move around it would only really be the pool I wouldn't have. I think now I'd actually feel more reassured with the constant monitoring you have on the delivery suite.

@jozipozi31

Sorry you don't quite know where you are, OP 🤦‍♀️💐

Is there a specific/senior consultant you could ask to have a chat with? It sounds like you're being given lots of bits of information and no real clarity. Maybe ask to talk to someone with a lot of experience? Sometimes (/quite often) you need to speak up and insist. I find the voices of pregnant women are not often totally listened to. Very much depends on much and who is around you.

Insist on talking to someone. It's not right or fair for you to be left uncertain like this. Yes there's a big element of the unknown in labours/births, but there are also some clear indicators. You need to find out from a doc about the haemoglobin issue. Xx

Thank you so much - finally got my answers today!!

Oddly I've never been one to shy away from speaking up but I think I found it more of a challenge in this case as I could see everyone was so stretched and trying their best, especially when I was in MAU and told the consultants couldn't see me as they were on the labour ward dealing with an emergency etc. so didn't want to seem unreasonable.

I will definitely be giving them feedback on my experiences though as there have been so many areas that they can improve on, mostly on communication, which will hopefully help other women in the future! xx