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.