LGA / 97 percentile baby: induction or C-section?

[Happibara]

Hello, I'm looking for advice and lived experience from people in a similar situation:

I'm 37 weeks with DS2 and had 2 growth scans (at 32 and 36 weeks), both predicting LGA baby, with all measurements on or above the 97th percentile and estimated weight at 36 weeks already clocking 3650g. This means he could well be 4500 at 39 weeks 😱

Not overweight myself, no gestational diabetes, healthy diet and exercise in pregnancy; I'm average build and height: 163cm. Most likely baby is big due to genetics as DH is very tall. Our firstborn was also long (although not as chunky) and his birth was very long and hard, ending with forceps and episiotomy.

I'm 42 so was recommended induction at 39 weeks due to risk of placenta deteriorating. I was okay with that, but now I'm considering elective C-section due to labour stalling and shoulder dystocia risks.

My thinking is that with a baby this big, there's more chance the induction will be grueling and end up in theatre anyway. I want to choose a path with the least risk to the baby, although of course I'd rather avoid having to recover from exhausting attempted labour AND emergency C-section. Seeing the midwife on Tuesday so I reckon I'll need to make a choice then.

Was anyone in similar situation recently? What did you decide and what was the outcome? Would love to hear your experiences to get some perspective! Thank you for sharing ❤️

DD2 had gestational diabetes. The criteria here for an elective Caesarean is a baby, who is going to be 10lbs at 40 weeks. DD2 had the option of an elective Caesarean for other reasons, so she went for it at 38 weeks, because she’d have a consultant doing an elective, whereas if it were an attempt at labour and then an emergency Caesarean, she’d get a registrar. She was also worried about shoulder dystocia, and if she went over 40 weeks, an even bigger baby.

The baby was born by elective at 38 weeks and weighed 9.5lbs. The baby’s father, a doctor and I both agreed that had been the best course of action.

I know this is going to sound unusual, but I'd wait until the day of the induction and see how favourable my cervix is on that day. If my "bishop score" was low (look it up), and I had your history and wishes, I'd be inclined to go for a elective section.

Thank you and congratulations on your grandbaby! I didn't realise there may be a level of care difference (registrar vs consultant), that sounds like a well considered decision

Registers are often superior clinicians for 2 reasons:

1. they are working towards consultancy
2. they do this every day on the "shop floor".

Thank you, I'll look it up and talk through with a midwife!
Not sure what my options would be to decide on the day (I've literally no idea how they make decisions after you're admitted) but I'd definitely want to avoid the "let's just go with the initial plan and hope for the best" attitude that could end us up in emergency section.
Knowing they would change course from induction to elective C-section based on the situation (be it cervix, baby's position or anything else) would be reassuring!

You can decide at any time. The first part of an induction is essentially the assessment where they make sure you and baby are fine to proceed and see how favourable your cervix is for induction. Some people can proceed straight to having their waters broken or the hormone drip, for example. This is the time you can say actually I'd prefer an elective section over trialling an induction because my cervix is closed, thick, and very posterior.

It might be a bit of hassle for them but they definitely can't say no you must proceed. They may tell you to return a different day for the section but most people I know who have done this (3 people), they put them on the emergency list (cat 3) where they put people who just didnt respond to induction at all but they and baby are fine.

Elective 100% I had a textbook birth with 2nd degree stitches and that was enough to make me go for ELCS next and be very annoyed I didnt have it before. It's the safest kind of birth and yes, there's some recovery time but it removes all the scariest variables.

of all the things to factor into the decision the difference between a consultant vs registrar would be lowest on my list - partly because it's not necessarily true and isn't always as important as you'd imagine.

I think you also should consider the effect on your pelvic floor .
A large baby that might end up with high forceps delivery does not bode well .
I speak from.personal experience.

The baby’s father is a doctor, who did an obs and gynae rotation in his training. I am sure, he could form his own conclusions from working with the consultants and registrars in the department, where the baby was born.

Thanks! That's another thing I'm concerned about with potentially long induction and assisted delivery! Had mild problems after forceps use in first labour, and herd many stories that made me realise it could've been worse! Sorry you had a bad experience!

I'd always try for a natural unless the doctor advised not to. You'll never know otherwise.

I had one induced early due to size and it was fine. They have quite a long list of things to look out for so no guarantee you'll make it to 39 weeks anyway. I wouldn't rush to it my my first but a second is totally different. That said, the slightest sniff of the drip and I'd go for the c section.

first child was a similar sized baby at 42 weeks after induction. They were “star gazing” and never really descended and labour took 20 hours. Took a vacuum and episiotomy to get them out. It was a month before I was fully recovered- would say a similar recovery to a C section. Second baby was the same size, induction at 41 weeks, very straight forward, labour was 6-7 hrs. Fully recovered after one week. Anyway, I think the only benefit to not having had a C section the first time (considering the recovery was about the same) was being able to have such an easy time the second time round. (Obvs no guarantee of that) but you may want to consider the long term eg are you planning more kids in the future?

Genuine question: what do you consider “natural”? A baby that size will very likely need a vacuum/forceps and episiotomy, do you still consider that “natural”?

C section in my opinion. But I speak as someone who had a difficult vaginal birth (failed ventouse, forceps, episiotomy, 3b tear) followed by two ELCS, and found ELCS recovery much easier. Other people may have had different experiences.

One thing to factor in is that if you are induced and things don’t go to plan when the baby is already low down the birth canal, it’s not always a good idea to switch to a c section. Pushing the baby back up can be dangerous for both you and the baby. Just putting this out there because it’s not something that was explained to me before I had my first baby.

My DC2 was a big baby too and I faced exactly the same conundrum. I’m quite tall and DH is very tall so it wasn’t surprising to me but everyone around me was determined there was another reason so I did multiple gestational diabetes tests and monitoring, despite having an okay BMI and a very tall husband!

I’d had a natural birth with DC1 who had been very overdue and like your DC1 was long but not very chunky! When I looked at the dimensions and the weight of DC2 I could see we had a different scenario. The doctor that I talked to said he would recommend either an induction or a C-section at around 39 weeks, although if I went the induction route, he recommended that I had an epidural on arrival and that they made sure that one of my midwives was trained in delivering babies with shoulder dystocia. Weighing it up, the risks just felt too high for me and DC2 to go down the induction route so I had a c-section. I have zero regrets! My DC2 is pretty slim now that he’s older but he still has a very broad chest which was one of the markers on the scans that kept making them test me for gestation diabetes as they thought had a large stomach!

Thank you! it's really good to hear from somebody with similar experience as so far I'm getting no clear advice from the midwives: yes they can show me statistics but are really unwilling to come out and just say what they would do themselves, or advise a female friend/ family member in a similar situation... Having replies where I learn about people's decisions and how they felt afterwards is great.

As an update I've had the week 38 appointment with the midwife and I'm now booked for an induction next week. But to be honest I'm increasingly leaning towards just asking for a C-section on the day instead, unless by a lucky turn of events they discover I'm actually on the brink of spontaneous labour.

From the research I've done it's not the size of the baby that concerns me it's the combination of an induction + LGA baby that seems related to majority of elevated risk factors. The longer I think about it, the less confident I feel about a typical several days long induction, so that's where plan B comes from.

Oddly enough I feel quite alright about the prospect of birthing this baby should I just go into labour with no intervention. Really hoping it will start naturally before I'm due to show up at the hospital!

I'll try and update the thread after in case anyone is curious, as for future readers with the same dilemma.

Aaah it’s a really tricky position to be in isn’t it? I remember that nobody was willing to give me a definitive answer either about what I should do, I suppose our scenarios are a bit different to an emergency situation or a pre-existing condition that would mean an automatic C-section so there is a genuine element of maternal choice. But of course that doesn’t make things any easier!! I remember having a really strong instinct that I didn’t want an induction at any cost as my fear was that I’d reach a certain point and then need an emergency one anyway (which of course could easily not have been the case, but it was a concern of mine). I think also because I’d had a “natural” birth with DC1 I didn’t feel a strong urge that I needed to experience it again - I really just wanted the baby out haha!

You’re able to change your mind at any stage, do you have an instinct about what you’d like to do? I think sometimes we know in our heart what we’d like to do, but we’re a bit worried sometimes about vocalising it ❤️

soemtimes I don’t know how accurate scan is … I was told my child was 62 percentile, then I delivered a 9.5 pounds girl who apparently is approx 95 percentile. I was induced but the induction failed as my cervix won’t dilate enough, then as I was waiting for alternative options, I think my natural labour came on, then I was from having 1cm dilated to water break and give birth all within one hour… no instrumental / complication in delivery, second degree tear which required stitiches. Baby is very well and looks very strong from day 1.

Hard to know what would happen. Make a decision based on what you are comfortable with. Labour is such an unpredictable thing, it may or may not go the way any of us imagined. C section will be calmer but to me, it’s still an operation where they cut your body open. I personally would want to avoid it if I could but that’s a personal choice.

@Happibara if it's of any reassurance to you, my 3rd son was an LGA baby! which we only found out AFTER he was born 😂 i ended up going into spontaneous labour with him at 37+5 and he was born vaginally weighing 8pounds8oz, 91st centile i think, would have to check his red book.. no tears or grazes! i must admit looking back, once his head came, i did physically struggle to push his shoulders/body out 🙈 but with a little extra help from 2 midwifes & my partner i did manage too eventually! xx

Thank you! That's still what I'm hoping for, I think if I managed to go into labour spontaneously, then I wouldn't be as concerned! Your birth story sounds like a positive empowering experience, we need to hear more of those!

Thanks, and wow what a difference in your scans / predictions and the actual birth weight! You must've been shocked!

I did read up on the scans inaccuracies and the "big baby trials" findings, it's definitely food for thought! Although in this case I think all data points lean towards actually large baby: measuring 1 week ahead on the 12 week and 2 weeks ahead on the 20 weeks scan, both growth scans 97 percentile, large bump... and that's an IVF baby so there's no possibility of inaccurate dates 😄 I'll definitely let y'all know what his birth weight is!
I'll be called for an induction tomorrow, and will use the initial consultation to go through the scenarios again. Hoping for a high Bishop score and effective induction🤞Same as you, I'd rather avoid the C-section

Hello all, am update from me: went ahead with an induction and was successful!

Arrived at the antenatal ward at 4pm and had cooks balloon fitted within an hour. as Bishops score was assessed as 7, with 2cm dilation. Was then able to go out of the ward for a nice walk around the grounds and a canteen dinner, felt a bit crampy but fine and able to settle for the night. Didn't sleep much but due to noise in ward and repeated checks, not discomfort.

Balloon fell out around 5am and was transferred to Labour ward at 10am. Waters popped around 10:30am, went for another walk and breakfast then came back after an hour and got the oxytocin drip. Contractions ramped up until 1pm when I asked for an epidural, went through consent but was fully dilated before the anesthesiologist returned... so no luck!

got paracetamol, codeine and some gas an air until phase 2 fully begun around 14:30, then it became impossible, as I was throwing up as a side effect from the drip. That was probably the biggest unwelcome surprise and the worst moment (the vomiting didn't end until the baby was born, antiemetics didn't work) but otherwise I'd say the delivery was quick and very well supported by the midwives. Gave birth naturally with no further pain relief at 4pm.

Outcome; baby boy born at 39+1 weeks, 9 points, 3900g, 57cm long and chunky! big head, shoulders did get stuck but the 2 attending midwives managed to get him out just as the crash team they called descended on the room.
2 small tears / grazes, no sutures needed.

All in all would recommend giving induction a chance based on my experience, and the fact it was my second labour. for first birth experience if advising a friend I'd tell them to get an EC probably!

Thank you for all the advice and your stories, I think it really helped me see the scope of the good and bad I could expect!

Awww OP what a lovely update! And well done!! 👏 It sounds like you did really well and kept a strong head on your shoulders throughout it all. Be super duper kind and gentle with yourself, you deserve to rest and be looked after - it’s a mammoth task giving birth! Sending lots of love to you and your little one (and I hope you got the magical tea and toast after baby arrived! Best tea and toast of my life haha!!)