Vaginal or C Section for LGA baby

[SuzyQMamaOf2]

I didn’t have a particularly traumatic birth with my first baby but I did have a 35 hour labour resulting in very deep 2nd degree tear and an episiotomy which resulted in delayed breastfeeding and skin to skin (while healthcare professionals were trying to decide the best way to stitch my unique internal tear). Afterward my midwife said I was unlikely to experience the same problem in a subsequent delivery. I wish I would have asked for more information, but I didn’t. I’m assuming the episiotomy had rectified the problem but I’m not sure?? I also had an agonising and long recovery period in the proceeding months. At the time I thought it was normal, but now realise it was perhaps a more difficult birth & recovery than my friends had who said they were up and running around without pain in the weeks after giving birth vaginally. That was definitely not my experience.

Fast forward to today. I’m currently 32 weeks pregnant with a little boy. Im 5’4 slim build and DH is a slender 6’. I’ve only gained 13lbs since I got pregnant but started off much heavier with this pregnancy as I didn’t lose much after DD was born in lockdown. At week 28 I had a midwife appointment and my fundal height was low (under 10 centile) and baby was transverse, so I was sent for a growth scan. At 29 weeks I was scanned, and to our surprise, they found baby to be very big!!! He was in the 90-97 centile. According to what I’ve read a big baby lying transverse (or side to side) can pull your fungus downward. Diabetic test negative and at 32 week growth scan, baby’s even bigger at above 97 centile.

When I went to see the consultant, she said that baby’s femur length was very long (off the chart at above 97 centile), baby’s abdominal circumference was around the 80 centile & head circumference 50 centile. Baby’s estimated foetal weight at 32 weeks was already 2426g or 5 lbs 5.6 oz. She said as far as we can estimate, baby’s weight is probably around there but because he’s probably tall, his physique could be slender and cause no problems at birth. She said there was no reason I couldn’t try for a ‘natural’ birth. I asked her about other options and was told about inductions, sweeps and c section.

Before this, my hope was for a water birth in a MLU, all natural like I did with my DD, but I began feeling a lot of anxiety after the first growth scan saying baby was big. After my last baby got stuck I’m very hesitant to try for another vaginal birth with a potentially big baby and I believe that I will be panicking and thinking he’s stuck or there’s something wrong the whole time. I have heard too many horror stories about tearing with induction so I’m definitely not going that route. So that basically leaves me want to elect for a planned c section.

Ive done a lot of research regarding big babies and I’ve found that there are increased risks for a vaginal delivery with a suspected big baby. Even my doctor knowing baby might be big increases my chances of having a forceps, vacuum or emergency c section. An elective c section does sound less risky to me than a vaginal delivery especially considering my DD was a normal weight and got stuck. I’d much rather have a planned c section than end up with an emergency c section, another tear, or even worse have baby get his shoulders stuck.

I just want to make the best decision for me and my baby and I know statistically most people would be fine with a vaginal delivery, but I feel I’ve lost faith in my ability to birth this baby safely the natural way. Am I crazy for giving up my ideal all natural water birth for a surgical procedure?

sorry this is so long and thank you if you made it until the end ☺️

My first was estimated to be a big baby. I wanted a vaginal delivery, but they wouldn't let me go more than a week past due date before the induced me due to baby's size. I was induced and 36 hours into labour I wasn't progressing fast enough, baby was in distress so I had to have an emergency c-section. He was 10lb 2oz when born and I'm glad he was a section. With my second who was also estimated to be big, I elected to have a C-section. It was fine. The recovery with both was ok and easier than what some of my friends endured after a vaginal delivery.

Id 100% go for the safest option which sounds like it's the ELCS. I wouldn't want to risk the potential birth injuries which are more likely to result from forceps. Id personally rather have an elcs than an emergency one.

Thank you for your comment JKRDW. It’s really encouraging to hear your story.

That’s how I feel too LearnedAxolotl.

I had a similar experience to you with my first baby, including type of tear and post-birth recovery except that I tore before I had the chance to have the episiotomy. Very distressing experience.

First baby I gave birth to on my back. Second baby I gave birth to on my side. The labour and birth were both faster and easier than the first. Still had a second degree tear along the scar, but only external. Baby was 8lb 10oz. Recovery was much easier and less painful than after 1st.

3rd baby was born in a birthing pool, after a much shorter labour. I was upright. No tearing, no stitches. Baby was 11lb. Recovery was entirely different - suddenly I understood how mothers can get pregnant again before the 6w check!

Predicting birth weight from growth scans can be very inaccurate. I was told my baby was likely to be "as much as 10lb".

But an important thing for you to remember is that you have given birth vaginal once, so your body knows what to do. The next birth is likely to be easier, especially if you help yourself along.

Hope this gives you a little confidence that it's not all disaster with a big baby.

Thanks for sharing your experience Dilbertian! I’m happy you had a more positive experience in your subsequent births.

I don't think there's any evidence that a woman's body somehow knows what to do after a difficult first labour. That suggests that the reason the first birth went poorly was because her body was somehow ignorant. The truth is, birth is a difficult process that people like to romanticise. What about those who have an easy first birth and a difficult second. Did their body forget what to do?

If i were you, op, id go to my next consultant appointment and ask them to discuss with you the actual risk in terms of percentage of having interventions. Decide what risks and interventions you're happy with. Your consultant should be able to access your notes and talk to you about the risk of what happened in your first birth happening again. Do your own research before you go to that appointment so you're going in informed.

Thanks for the practical advice LearnedAxolotl. That’s a good idea.

I'm not claiming that every woman's body and works
the same way. My experience definitely was that the second time around I recognised sensations and understood better what was happening inside me. Maybe my body didn't 'know' any better than the first time, maybe my brain knew better and I was better able to support my body in getting on with birthing. Labour is not something we can control or be in charge of. The best we can consciously do is support our body.

A planned CS is an excellent choice. But if it is driven by fear and anxiety, having only heard negative stories about birthing big babies, then it is important to hear positive stories as well.

I'm in a similar situation,
Horrific first birth, resulting in forceps (with just g&a) episiotomy and deep 2nd degree tear, I was so traumatised I opted for an ELCS for DD2, on the morning of my section I started contracting, I arrived at the hospital to be told I'm only just 2cm and I'm 2nd or 3rd on the CS list so would I prepared to labour and see how things progress with the idea that if it didn't progress etc I could go for the section. 2hours later DD2 was born in the pool, the consultant came back to discuss progress as I was next on the list and found me with my baby In my arms.
I'm now 31 weeks with DS1 and he's a baby elephant at 96th centile 😂 I've always said I wouldn't want an induction and I don't believe the weights on scans (they told me DD1 was 7lb at 36 weeks, she was born 7lb 15oz at 41 weeks!) However it's so hard not to get sucked into the 'big baby' thoughts and make an informed decision. I'm going to try and be calm until 36/37 weeks and then make an informed decision.
You've got this mama x

My sons femur length etc were very similar to yours. He was indeed long and slim but was long and painful. He wasn't especially heavy when born but very long and still very leggy at 21 months!! If we have another, I'll be having the c section as wouldn't chance another labour like that.

Thank you all for the feedback! It’s helpful to hear from everyone and get different points of view. 💜

I can’t really answer your question as such because I feel like my view is always skewed towards a c-section being a great option. They get such a bad name and ‘natural’ births are so hyped up like it’s what everyone wants when sometimes it doesn’t go like that or isn’t your dream birth. You need to weigh up if you actually want to give birth vaginally or if you don’t have the desire to this time. I had the most amazing elective c-section and I could literally be a sales person for them now 😂 I will tell everyone and anyone about how good it was, even the recovery wasn’t a patch on what I’d heard it would be. I will 100% be doing it again so in your case I’d take a c-section without losing a second’s sleep over it but that’s because I have no desire to experience the alternative option so I wouldn’t be losing out on anything. If you feel you wouldn’t be missing out on anything then 100% go for it, it’s a lovely day 😂😅

Thank you for sharing Goodnewsday. It’s good to see some positive c-section stories!!

Well I'm going to say I'd be tempted to go for the natural birth. I've had 3, 2 on the 50th percentile and one on the 98th! It was suspected on the growth chart that she was bigger than the others but I was glad no one knew or said to me how big!

She was born at home in water, my fastest labour (1.15mins) and the only one I didn't tear at all for. My much smaller 50th percentile babies I had small tears.

When I looked into it afterwards I found size wasn't a particular problem and position is more of an issue for tearing. Women tear with big babies and small babies and both big and small babies can get stuck although it's very rare for both. Also growth scans are notoriously unreliable!

I would try out some hypnobirthing and do some reading around and then see how you feel! I wish you a positive birth whatever that looks like op 🥰

Thank you Noway… I’m glad your birth story was so positive with a large baby! Good to know baby’s size doesn’t always factor in ♥️

ELCS all the way. Mine was amazing compared to my first natural birth. Painless, controlled, stress free and lovely. Also safer for baby than a natural birth going wrong.

Iceballoons, Thank you for your response. Im glad your ELCS was amazing for you and your baby.

Thank you all for your responses to my post. They all helped me to make the decision that was best for me and in the end I decided on an ELCS. I had my baby 2 weeks ago and I’m really happy with the result.

I decided reducing the risk of tears, instrumental delivery and emergency c section to zero was best for me. What that meant was trading my natural delivery for a planned c section in a theatre which has its own risks. I had a really great experience and the doctors said my procedure went really well. I recovered so quickly, much better than my recovery with my DD which really surprised me. Baby and I are doing great, there were no complications and after only 11 days I stopped my painkillers because I no longer needed them.

Turns out my scans were wrong. Baby ended up being a very slender 7lbs 7oz. He was predicted to be over 9lbs by 39 weeks so definitely not an exact science. I’m still very happy with my decision though. I made the best decision for me with the information I had at the time, so no regrets. If I had to do it all over again, I’d pick the c section hands down.