Baby measuring 98th percentile at 33 weeks, induction or c-section?

[FTMJul26]

I am currently 33 weeks pregnant and our baby is measuring 98th percentile. I have been offered to have an induction or c section at 39 weeks but am so torn on what to do. From the start I really didn’t want to have the c section but now I am terrified of my baby’s shoulders getting stuck so I am leaning towards the c section. I also read that 25% of women who are induced go on the have an emergency section anyway so I do feel the planned one could be better.

just wondering if anyone has had a baby measuring this size before or has any advice please? I just want to do whatever will get my baby here safely

My second baby was measuring LGA from 25 weeks, my 38 week scan said be was 9lb 7oz so I was induced as they said anything above 4.5kg was a much larger risk of shoulder dystocia and so recommend c section. He was born 8lb 2oz😂

@Jellybunny98 yes I think that’s why it so hard to make a decision because I know the growth scans can be inaccurate as well! I’m just worried that the whole labour I would be worrying about the shoulder dystocia being a possibility

Congratulations on your baby.

It’s true that scans can be widely inaccurate. In fact a recent study showed that almost half of babies induced because they were ‘big’ were born at an average weight. This same study also showed that routine induction for ‘big babies’ didn’t reduce the incident of shoulders getting stuck.

Dr Sara Wickham has some great resources on this.

It’s also worth knowing that some babies are big. A lot depends on genetics. I’m 6ft and my husband is 6ft7… it’s no surprise our babies were over 9lbs.

If baby is in proportion (so head, legs, tummy etc) are all on the upper percentiles then it is likely they are just big.

Melanie the Midwife has more information on this on her podcast.

TBH I’d not be making any decisions now. Ask for more information about the risks as they relate to you, do your research and make a decision when you want to.

Your 33 weeks… you’ve got at least 6 weeks to decide.

My first baby was 75th centile when he was born, had been measuring similar through fundal height etc. V long and tedious labour, over days, coming and going I think because he was back to back, forceps etc. All fine in the end.

My second measured exactly the same on fundal height / predictions etc and I went ahead with the water birth that hadn’t worked for the first. When he popped out after a totally straightforward labour, he was 99+th centile or something - 5kg baby. Midwives were getting other midwives to come in and look. I’m 5ft 7 so not tiny but also not Brienne of Tarth.

So not sure if it’s helpful but wanted to share my “unexpectedly birthing a ginormous baby no problem at all” story, and how the “normally sized to me” first baby was a much worse labour because of his positioning.

After being induced I’d never do it again. C section all the way

I got this as well but baby was smaller - she measured larger as she has long legs and the percentile
can vary depending on who measures you - it’s like a guesstimate . I was an induction which ended in emergency c section. If I go again, ill go for an elective c section

As someone who had an (unexpectedly to me) big baby and ended up with shoulder dystocia and all sorts of other problems, take the c section. It was never offered to me

Can you ask for a repeat growth scan? It's important to have more than one data point for baby's size when making decisions. One scan showing large could be a rogue measurement, two are more definite.

Also ask about the breakdown. Size is estimated by head circumference x abdominal circumference x femur length. Long femurs / tall babies don't cause shoulder dystocia, but do bump the overall size up.

If you opt for induction, ask about your bishop score. This is an indication for how likely it'll be to be successful. Low bishop score means it's more likely you'll have an EMCS.

Also ask about your baby's position in the womb. An OP or back to back baby is a lot harder to birth when they're big and induced.

Plus what your consultant / hospitals stats are around successful induction.

The M consultant wanted me to have a c section as he was convinced DS was going to be too big for me to birth vaginally. I hadn’t met him before that day.

However, the F sonography doing the scans disagreed.

I decided to trust the sonographer.
DS was born at 42 weeks and 9lb13oz but he was long and skinny, not chubby so no danger of shoulder dystopia.

I probably shouldn’t have taken the risk, but I didn’t like the bossy attitude of the Consultant. 🤔

No advice on birthing big babies but having had both an EMCS and an ELCS I’d take the ELCS if offered. You can still have skin to skin during the section, DH was able to cut the cord and recovery was fine both times. No regrets.

Just been induced at 38 weeks with a 97th centile baby that turned out to be 9lb. I ended up with a caesarean but not sure what decision I’d have made if I had to do it again.

I chose induction because I didn’t want the post caesarean recovery, but after the birth I just felt annoyed that I’d done a full day of contractions and still needed the surgery.

What is their reason for offering induction? The baby being big alone is not a reason to induce unless there is some concern about either of your health or wellbeing. Do you have gestational diabetes? This increases certain risks if you have a big baby vs the baby being big just because it’s big.

my baby was measuring above 99th centile at both 32 and 36 weeks. I read around a lot and decided to attempt a vaginal birth if I went into labour before 41 weeks. In my trust if you go overdue by a week they offer you an induction at 41 weeks. I decided the cumulative increased risk of shoulder dystocia from being big AND from induction was not what I wanted and I had a c section booked for 41+2.

i went into labour at 40+3 after a sweep, laboured for 36 hours but in the end he wouldn’t descend, I got stuck at 8cm and certain markers of my own health became concerning. An EMCS was recommended which I was fine with and he was hauled out in theatre to the sounds of our music. It was fine, and absolutely the right decision. His head was the size of an average 6 week old and he was 10lb 12oz.

Some people can birth babies this size in a fairly straight forward way, others can’t. Unfortunately it’s not possible to know beforehand which camp you fall into. If I had my time again I probably would go for an ELCS so that I wouldn’t be so tired going in.

Sorry I somehow did not get notifications for all these replies but thank you so much everyone for your thoughts and experiences!

@FullCrimp no I do not have gestational diabetes the reason for offering induction is to try and reduce the risk of shoulder dystocia.

I think I have decided now that I will book the ELCS as I do not want to be induced and labour for a day or 2 and then have to have an emergency one and be exhausted anyway. I also think now because it’s been spoken about by the consultant so much I would be panicking the whole time about the possibility of shoulder dystocia. I’m not sure why the consultant has mentioned it so much as online seems to say it’s always a risk and the midwives don’t seem concerned about it.

We tried for 4 years for this pregnancy and ended up doing 4 ivf transfers in the end before getting our positive test so I think I’m just more nervous about everything anyway. I do know that the scans can be inaccurate and baby may not be as big as they are saying but also it could be bigger then

It’s actually outdated advice to offer early induction for large babies to avoid shoulder dystocia as it isn’t shown to work particularly well and carries other risks; it goes against NICE guidelines if I remember correctly.

the consultant will be worrying because they tend to only get involved in births that are getting complicated, and so will have seen the worst, whereas midwives specialise in straightforward vaginal births so are more likely to have seen straightforward vaginal deliveries of large babies - a bit of confirmation bias either way probably!

most incidents of shoulder dystocia occur in “normal” sized babies, because most babies are not big in the way ours measured. However, shoulder dystocia occurs at a higher rate with large babies. It’s more likely in scenarios of gestational diabetes because the baby’s abdominal circumference tends to be disproportionately large due to the effects of the high sugars, whereas in a baby that is large and in proportion I guess if its head makes it out the rest tends to follow!

I really sympathise with you - my baby was also our fourth transfer in ivf, and it was a long road. When he was finally here I was just so relieved that he was here and safe and well, I really couldn’t care less that he came out the sun roof! It sounds like you have made a carefully considered choice that is right for you. Good luck!

@FullCrimp that makes sense re the consultants seeing the more complicated births only!

that is exactly how I feel now, before I really wanted a completely natural birth at a midwife led centre but now I just want baby here safely whatever is the best way for them!

I would either schedule the c-section or wait for spontaneous labour. Let your body do its thing and get baby into the best position it can ready for birth.

I would be particularly put off the c-section if you plan to have more children in the future, unless you don’t mind the idea of having multiple c-sections.

As PP said lots of babies predicted to be big on scans aren’t big at all!

Neither personally, knowing the evidence and having had LGA babies myself