Panicking about big baby at 39 wks: please help me write a birth plan

[bigbubba]

I'm trying to stop panicking about imminent birth of big baby and channel my worry into something more positive by writing a birth plan (though I'm a bit skeptical about their value)

I'm 39 wks with DC 2. I've had three scans since 20 wks and the baby has consistently been big, particularly the head. The head circ is always about the 95th percentile, abdominal circ 97th-off the scale and BPD always off the scale. I know scans aren't always accurate but there is a pretty clear trend here. Baby also not really in great position and a bit back to back (DD was the same). I am not particularly big myself. DD was very average (7lb 5oz, normal head size) and had a 2 day labour, 3 hr second stage, she got a bit stuck so ventouse, episiotomy, tearing etc.

I'm happy to give things a go normally but am really worried about being left for hours again only to find things aren?t progressing and ending up with a very intrusive instrumental delivery (esp high forceps) or failed forceps then c/s and the potential trauma to baby and/or me. I'm also worried about shoulder dystocia. The consultant patronised me and dismissed my worries save for saying I shouldn't go to a mw led unit because of size. I've been very worried about this for months and had to force myself to eat at all for a while as I was so worried about making the baby bigger just putting something in my mouth made me feel sick, have put on less than a stone in total but baby seems to be most of that! I?m worried about going into labour without confidence.I was very calm with DD and that helped me deal with a long labour on gas and air and felt elated afterwards. The only way I feel I can be calm this time is if I know my concerns are taken seriously so that if problems do develop they are caught early and that if it really is going wrong (and there's a choice) they'd listen to me on c/s over forceps.

Sorry for the mammoth post but would appreciate suggestions for what to write so that I'm taken seriously but not seen as neurotic or unrealistic. I appreciate that choice isn't always possible depending on the circumstances so it's more about highlighting worries and preferences rather than a fixed plan. Thanks if you've read all this.

sorry some of the apostrophes have turned into ? when I pasted it in from word - hope it all makes sense and thanks in advance for any advice.

that you would prefer to have a c.s if an instrumental birth looks likely

that you would prefer to have intermittent monitoring, or at least if you have constant monitoring, that you can use a birth ball, lean on the bed and remain upright and mobile

being upright and mobile open up the pelvis more, than sitting/lying on the bed.

you might also find that second time, your body does things a lot quicker, and that you can birth your baby more easily

i would try to avoid an epidural, in as much as you will end up on the bed, which will not help you keep your pelvis as open as possible

there is also a better chance of your baby turning from being back to back if you are upright, active and mobile and avoid having your waters broken

make sure your birth plan is to the point and clear, and that your DH knows exactly what is in it and why and you have several copies , and he is going to give it to the MW if you are unable to do so yourself

you can do it as bullet points and be really clear if you have a preference for c.s over forceps etc

good luck!

Hi hon. I had exactly the same as you, shoulder dystocia with DD, 28 hr labour after being induced and epidural only working one side....forceps failed and ventouse used, terrible tearing etc, baby's heartbeat starting to fail and emergency team rushing in. Horrible and traumatic for me, DH and I should imagaine DD felt a bit scared!.

DS was born by the most fabulous c-section....it was a wonderful experience. Sorry if this isn't what you want to hear but my recovery was MUCH quicker, my MW thought from the start I should ask for a section and I tried to dismiss what she said but her advice was brilliant.

Thanks Lulumama, really appreciate your advice. How would you phrase the instrumental c/s thing? I wouldn't absolutely refuse instrumental e.g. if it's just a bit of assistance with ventouse when things are close to the end or if it is the recommended option in an emergency I would say yes so I don't want to put a blanket 'no' on the plan. What I do want to avoid is them deciding to give forceps 'a go' if things aren't progressing or the baby is looking stuck and then having damage from that (possible with a c/s on top). I'm not sure I'll be with it enough at the time to argue.

I had big baby measurements with DS - last-minute growth scans and massive bump measurements and predictions of an enormous bouncer of a baby. In fact he wasn't that big (9lb2oz) but he did have a large head, got stuck and I ended up with a CS. I think it was the right decision - they didn't let it get as far as an emergency, they recommended a CS after about 24 hours as I really wasn't getting anywhere and DS was stuck fast. So I can see why you want a CS if it is looking unpromising.

Maybe talk to your midwife about a birth plan and make it very clear how worried you are, mention your eating problems and say you are really scared about the birth (which is all true). I wouldn't worry too much about appearing neurotic - if you're scared, you're scared, and IME they do take that on board. Simply put in your birth plan that you are very afraid of traumatic assisted delivery and want a CS if it's going wrong as the head is very big.

Hinnypet - I would love to be booked for a c/s right now! I know some people have an awful time with them and there are associated risks etc but anything to avoid the uncertainty and potential trauma (possibly with a c/s on top) of this one. Unfortunately consultant not sympathetic. He laughed at my concerns, said it was OK as he had delivered a 5kg baby last week (and that helps me how?) but then told me I 'had to' be in the consultant led unit due to size - presumably just in case any of these silly concerns of mine actually materialised...

I had a real issue with the registrar as they consultant was "not available" (the registrar kept fobbing me off with my fears for having another huge baby, and telling me that my baby was not huge, 7lb they said.... and when he turned up at 9lb 12 I felt like shouting at her!!) - so it ended up with tears, my DH demanding to see the senior in charge, consultant turned up and said, yes, I agree, lets book you in for a c section..

Did I mention DD was 10lb 10 ???

It is YOUR birth, YOUR body and YOUR baby - you need to try and make it a positive experience.... take no shite from nobody!!

Bigbubba if your consultant isn't listening to your request for a csection ask for a second opinion. Fear and fear of pelvic floor damage is a genuine reason to ask for a section and they should listen to you - if not keep on until they do.

Not sure if you have seen this site but it has lots of good info on it.

I have had two big babies (5.1 kilos and 4,52 kilos) after my first which was only 3.63 kilos. Each birth is different. In fact my heaviest baby was my easiest to get out!

It sounds like your first birth was quite traumatic and this is influencing and feeding your fear. I think lulumama gave soem good advice and if you really would like a CS then you need to get a second opinion. Maybe a sympathetic mw would help support you in asking for one?

Just to reassure you - I just had a DD#3, 4 weeks ago, lovely waterbirth with 99.6th centile head circumference. DD#1 was nightmare ventouse delivery with episiotmy and issues with that afterwards, DD#2 was straighforwards. It is possible to have a better time of it than last time, even with big measurements.
Good luck