Please help me make a difficult decision re. Large baby

[pixley]

I would really value some opinions. Have just been for growth scan as am large for dates. Predicted weight at term is5kg. Have just seen the consultant who stated 1 in 80 risk of shoulder dystocia. He says my options are caesarean section tomorrow, cs on my due date or just try for natural delivery! Have previously had 9 13 lb baby with no problems. I don't know what to do. Has anyone else been in a similar situation?

What would you all do?

Well, first of all you have to keep in mind that scans are often imprecise, so your baby could be just 4, 200.
DD was 4, 350 and it was fine, had natural birth ( well, with epidural) and I did tear, but healed very well.
Plenty of women give birth to big babies with no problems.
Up to you, in the end. How do you feel about it? CS also comes with risk of its own.

Just read op again and saw you aready gave birth to a big(ish) baby- in that case, if I were you, I would probably go for natural delivery.

It's a tricky one..........speaking from personal experience, the growth scan I had in my last pregnancy turned out to be hugely inaccurate - I was predicted a 10lb baby and she was 7lb 12oz. However the fact that you had a 9lb 13 baby before does kind of suggest that you will have another big one.........but if you managed that with no problems then I wouldn't be rushing to book myself in for a section. I'm measuring big for my dates this time round too although haven't been sent for a scan yet..........in your situation though I would say no to the section because of the recovery time etc (I have a 23mo to run around after!)

As others have said, growth scans are notoriously unreliable and innaccurate.
As you have already had a large ish baby without problems, I would say you have a good histopry to have another trouble free birth (even if this next baby is larger than avarage).
In my experience bigger babies can be easier to birth than smaller ones (seem to be less likely to get in aqward positions).
I did some searching on shoulder dystocia and it appears it is not associated with baby size (over 50% of should dystocia occurs in babies that are of average or below average weight).
Some links-
www.bigbaby.org.uk/
www.homebirth.org.uk/big.htm
jeremyscorner-grifter.blogspot.com/2009/04/big-baby-is-not-emergency.html
www.theunnecesarean.com/blog/2009/6/17/can-my-doctor-really-predict-shoulder-dystocia.html

Selina

As has already been said, growth scans are by no means accurate. My 3rd baby was supposed to be far bigger than my first two (9lbs and 9lbs 8oz each) but was only 7lbs 4oz.

Another factor to consider is that this time the MWs will have some advance warning that shoulder dystocia is a possibility. My first had SD, and so it was arranged that when I got to the pushing stage with baby no.2 that there would be extra staff on stand-by to help free him. They acted immediately and ds2 was delivered quickly and safely.

They had the same stand-by plan for my 3rd baby but in the end it wasn't needed.

Would a similar plan be possible for you?

Hello. This is not advice specific to your situation, but macrosomia is related to shoulder dystocia. It is far more likely in a baby weighing over 4.5kg (Yes Seline, 50% do occur in small or average babies - however the vast majority of babies are "average", very few are born at such high brith weights - so you can see it becomes proportionally more likely). Depending on the study you read, figures range from 10-20% likelihood for SD in these babies. Of course, that doesn't correct for the fact that a significant proportion of these babies will have other risk factors for SD such as intrumental delivery. The risk may be lower for you personally as you have delivered a large baby before.

Around 10-20% of babies with SD (and again, the definition is variable between practitioners) will suffer some sort of injury - this can range from a transient brachial plexus injury to severe fetal asphyxia, although this is rare.

And to reiterate - scans are notoriously unpredictable at estimating current fetal weight, let alone predicted fetal weight!

Best of luck with whatever you decide.

i would go for natural birth BUT ONLY if head of midwives and you happy with manouveres for releasing a SD. These are very effective, but should rehearsed a bit, so you know what to expect. McRoberts, etc. they are becoming a rarer midwifery skill with frightening speed, as CS takes over as 1st line intervention.

ds2 was estimated 9lb7oz for due date, 2 weeks before due date, and was born 10 days late, 11lb11oz (5.3k) and longer than he was heavy. With an SD, at home, with very experienced MW. we'd practised and I did exactly as needed, lifting leg up, mcroberts, etc, worked on 2nd mcroberts, came out no further worries. But I'm not sure I'd have chosen to do it unless I'd been absolutely sure she was coming out to us.

I know someone who squeezed out a 10lb+ baby with nary a tear.
I've always heard that presentation is more important than size (within normal boundaries, I imagine size does matter with 12-13+ lbers).

DS1 was supposed to be a 10lber -- he actually was born under 7 lbs, sigh.

Not much to add - so many others much better informed than me - but just to say DS1 was 10lb5, DD was 11lb10 and DS2 who the MWs were dithering about 'probably being an even bigger baby' although they never actually said I was big for my dates, was 8lb 10.

The consultant I saw re home birth was perfectly happy to let me go ahead and said scans for sizing were notoriously unreliable. I just had to be prepared to transfer if the MW was concerned, which I obviously was

Good luck with it all..

Just my own personal experience here, but I had a completely natural birth in a midwife led unit for ds2 and he was over 5kg (11lb4 in old money).

My midwife confessed afterwards that she thought he was going to be 10lb+ but is very pro natural birth and knew that was what I wanted, so didn't tell me how big she thought he was. She just told me the baby was a good size but because he was my second she was confident I could do it.

I'm extremely grateful to her for this, as I had such a positive birth experience this time after a horrible ventouse delivery with ds1 at only 8lb2. Had I known how big ds2 was going to be I think I would have opted for a hospital birth to be on the safe side, and probably ended up with more intervention.

I have no idea about the shoulder dystocia issue, as ds2 didn't have it, so I guess all I'm saying is go with what feels right for you since IMO and experience a big baby is not a valid reason in itself for a cesarean.

Thanks for all the advice. When I had a nuchal scan at 12 weeks my husband and I felt a risk of 1 in 100 was unacceptable. We've therefore decided to go for elective section on due date. This baby does feel bigger than my first so would not be at all shocked if came out well over 10lb. I was 12lb when I was born so maybe I should just blame my mother!!

Just to agree that growth scans be wrong.

I had a scan at 3pm that said baby was going to be 7lb 12oz. He was born 4 hours later weighing 6lb 12.5oz.

Let us know how it goes - we'll be all agog!
Beat of luck.

re growth scans.. last week (Tuesday) the consultant told me my baby was weighing 3580g. Then on Monday I was sent by the MW back to be observed and the scan result came out at 2860g on all the scan reports there is a + or - 780g next to the weight so really the margin for error is just under 1kg.

But seeing as you had abig baby previously I would be tempted to go for a natural but the choice is ultimatley yours hunny, good luck xxx

good luck pixley, post us your birth story when the time comes

My DC3 was 10 lbs. When pregnant with DC4 was told over and over in last 3 weeks that the baby would be over 11lbs and not to hang around at home once labour started. Baby was smallest of all @7lbs 13oz.

Best of luck! Let us know how big this one is!

I would go for the ELCS too in your shoes, good luck!

I had 4 growth scans and was told throughout that I was going to have a mahoosive baby, and that is what I got! I waited til 42 weeks before finally being induced (was scared of intervention after much talk of CS and complications too much fluid, high risk of big bleeds etc etc)

I didn't need much inducing, I started labour at about 5am and 'little' Tristan was born at 11am. His shoulders did get stuck but the midwives just shoved my legs back and manouvred (can't spell it!) him out. I needed 3 small stitches in my perineum and was fine to go home by 5pm. The only trouble I had was with trying to wee after as his big head bruised me so much!

I only had gas and air as pain relief and lucozade to keep me going!

Tristan was 12lb 5oz! and I would not have missed his birth for a CS unless absolutely necessary!

My first baby was 9lb 2oz so similar to yours!

GO NATURAL it is possible to get big babies out without help!

12lb 5 is 5.6kg I think, for the metric minded!

I ended up going into labour naturally the day before my elective section. The decision was made to do the section early. Henry came out weighing 11lb 6oz. Must say I was pleased I had had the section. I guess I'm one of those people in whom growth scans are accurate.

yes, I would have been pleased too! congratulations on the safe arrival of Henry.