What is the issue with a 'big' baby

[BabaandBump]

31 weeks pregnant with DC2. Been under consultant led care due to low platelets and BMI of 35.1 at booking in.

Platelets have come back up, blood pressure, urine etc. fine throughout pregnancy and GTT normal at 28 weeks.

Saw consultant today, they agreed that they'd release me back to midwife led care but stated the midwives probably wouldn't accept me due to having a big baby. Bump has been measuring 2 weeks ahead since 25 weeks so had a growth scan today which had baby's stomach and head measuring slightly above 97 percentile. Amniotic fluid in normal range.

Pushed the consultant and got an appointment with consultant midwife at 36 weeks so I can at least discuss it rather than making a decision based on a probably.

What exactly is the concern with a big baby if diabetes has been ruled out? Is it about the risk of the baby getting stuck?

DD was 9lbs and a normal vaginal birth without pain relief and I'm not exactly a small person - good childbearing hips as my nan would say! Going to speak to my community midwife when I see her next week, would just like to understand a bit more.

TIA

I am not knowledgeable about GD as officially I didn't have it - I had the GTT at 28wks and it was negative

However my 2nd child was big - 11lbs 14oz (11 days late). We suspected he was big quite early on, in fact the sonographer joked "ooh you've got an 11lber there" at 12wk scan, but on the day he ended up being born, the doctor (incidentally the only time I'd seen a doctor throughout the entire pregnancy) felt my tummy and said he would be average . Nobody mentioned diabetes or potential problems, when I said I was scared, she reassured me that as I'd had a good VB before (8lbs 4oz, minor grazing) I was unlikely to tear. Nobody ever mentioned a CS.

Anyway. Birth was very easy compared to my first, he came out very quickly. I have heard bigger babies are easier to birth. His issues were jaundice - he was very bruised and swollen like a bulldog, apparently due to being born so fast?! And his blood sugar was very low, which was a problem for the first few days. Doctor said this may be because I'd developed GD later in pregnancy but we will never know!

After that it was pretty plain sailing though, despite lots of people telling me BFing wouldn't be enough for a big baby

I was in a similar situation measuring a couple of weeks ahead and as my first dd was 8lb 12oz there seemed to be lots if 'comments' and hmming about the size of dd2. However midwifes never really spelt the issues out, just kept asking me if I had a 'natural' birth first time and them saying things like 'well you are big yourself, maybe you just make big babies' (I'm 5ft 10). Therefore I just assumed it was worries about whether I'd be able to deliver dd2. As it was 13 days after my due date and 2 attempts at being induced out she popped at 9lb 9 less than 3 hours after my waters broke. However my friend spent 12 hours trying to deliver her 'big' baby before the midwifes finally sent her for a cs. Her dd was well over 10lb and ended up spending 2 days in neonatal due to the stress of the labour. Maybe it's better to have them being a bit cautious and monitoring you a bit closer

There is a risk of shoulder dystocia (sp?) and I had what they termed an "arrest of labour" which meant my body stopped contracting at six cm, My DS was 10lb 14oz and was an EMCS in the end.

I didn't have GD either.

scans are notoriously unreliable predictors of size.

there is a risk of shoulder dystocia with any baby, it is higher if the baby is larger.

Thanks for the information, it's really helpful.

I haven't got my heart set on the MLU or anything but would rather avoid the consultant ward if I can (the MLU is in the same building as the consultant ward so easy transfer if it comes to it)

Just to add - the way the doctor today was talking you'd think I was giving birth to an elephant, the midwife sonographer didn't even seem to consider him that big so was/am a little cofused by the whole issue!

Even scans and computer measurements are unreliable.

I had a scan with DS2 three weeks before he was born and they said he was 7.6lb at that time. Three weeks later he was born at 9.8.5oz. Either the system is wayyy out or he gained 2.2 pounds in 21 days flat.

From my experiences of my big baby their main worries are shoulder dystocia and PPH.

Like has been said though shoulder dystocia can happen with any size baby but there is supposed to be more risk with a larger baby. I was told though that most big babies that have SD tend to come from mothers who have gestational diabetes (and other causes of a large size baby).

The PPH is because a larger baby will have a larger placenta which leaves a bigger wound on the uterus when it comes away. If it's known you're having a big baby they will watch out for that though. I had a mild PPH with mine but I think it's because they were really on the ball monitoring my blood loss after seeing his size and very actively treated it.

Also they may check you very thoroughly for any tears . I had a 2 degree tear with my 11lber but they had a good furtle all round to make sure it wasn't any bigger than that. Might have just been due to the 2 minute second stage though, I don't know.

Scans can be very inaccurate but my 97th centile head and abdo measurements were bang on. I seem to be one of the few who has it happen like that! But from my experience with DC3 the doctors were the ones who were all doom and gloom. The MWs were matter of fact and didn't make that big of a fuss.

I had a tear with DS. But not from the birth. I only had slight grazing, MW decided to put a stitch in anyway, and I flinched and got a big painful nip! Oops.

Placenta was actually massive and cord was so thick it looked like one of those plastic covered bike chains :o MW actually said it was exemplary and wished there were students around to show it to.

I had no idea about all these other risks (probably a good thing as I'm a worrier at the best of times).

I have been unwell since the birth (2009), and doctors are considering the idea that the birth (which is a physical trauma) was the cause of my M.E., I have no idea if that's anything to do with the fact he was so big, 2nd stage was 18mins I think compared to nearly 2hrs with my first.

There are so many factors in pregnancy and birth that you can't predict much at all it seems!

Thanks all, plenty to think about here. I did have a 2nd degree (internal) tear with DD but that was largely down to me pushing when I was told not to!

Ds was 9 1/2 lbs and was born a week early so is likely to have been well over 10lb had I have gone over.
I was originally booked at a midwifery led unit. I went for my routine check at 38 weeks and all of a sudden measured 42 weeks so was sent to see the consultant. He refused to do a growth scan and said it was just a 'big baby' and told me I would have to have him at hospital because of the risk of shoulder dystocia etc. scared the living shit out of me! He also said that being somewhere that could give adequate pain relief is an advantage with a bigger baby as sometimes it can mean the difference between an emcs or a natural delivery.
In the end I did have him at hospital and I'm glad i did. It was a long and painful back to back labour, I ended up needing an epidural which in all honesty, saved me from a section as I was able to get an hours sleep which enabled me to have the strength to push for 2 and a half hrs. I also tore quite badly and needed lots of stitches.
I guess all of that may have had nothing to do with his size but I def think it contributed.
I guess

My friend had an 11lb baby,

The MW had to break his collarbone to help get him out, :-(

And my friend is now waiting to get reconstructive surgery,
Due to the baby being so big, :-(

Both are fine and he adorable, but it was a long, hard, very painful labour!

Few things:

1. Big baby doesn't necessarily mean difficult labour
2. HCPs are VERY bad at estimating sizes of babies
3. The fact you had a good first birth to a substantially sized baby is encouraging
4. You can have big babies without having GD

DD1 was 9lbs 8oz. I am 5ft1" and very petite, generally. Consultant said it was the equivalent - and I quote - "of a normal sized person having an 11-12lb baby."

Scans at 20 weeks and 36 weeks said baby was "on the small side of average".
Had a difficult birth, but that was more to do with complications with inductions than the size of the baby. No GD. Some consternation that someone so small produced such a big baby. BF was a doddle - despite comments about "You'll never be able to excl. BF a baby of that size..."

DD2 was also 9lbs 80z.
20 week scan also predicted her to be average ? although I suspected this was bollocks. They were convinced I had GD because DD1 had been so big, so I had GTTs every 2 weeks (YUK) from 20 weeks onwards, plus weekly blood tests and a finger-prick thing to check my blood sugar at home. Guess what. No GD. Super easy birth. 4 hours, just water. a few sucks of gas and air when she crowned. BF for 18 months, excl. so for 6 months and she remained a little fatty!

I am of the opinion that water is your best friend with big babies. Really there's no reason that you shouldn't be allowed the MLU just because they suspect your baby might be big. You just might have to fight for it.

ON the other end of the scale, a very good friend had a difficult time giving birth to her 6lb 2oz DD1. Her 20 week scan predicted that her DC2 was going to be MASSIVE, to the extent that they booked her for an ELCS at 38 weeks. She went into labour spontaneously the day before and had her DS with very little trouble. The 'whopper' turned out to be 6lbs 5oz.

Don't let them scare you. You know what your body is capable of - you gave birth well to a big baby before. Every reason to suspect you will do so again.

And well done for making such big strapping babies!

db
xx

given you have already have a 9lbs baby, i am very suprised they are being so negative.

my last was 9'10 - i asked and apparently that is within what they'd consider normal anyway. i expect this varies from trust to trust.

Both my babies have been termed huge from scans. Dd was 7lb 8 and ds was all of a whopping 6lb !!!!

I'm 5ft2 and my DS1 was 10lb14oz.

No GD at all. However my FIL was (according to him) 12lb when he was born so maybe big babies run in DH's side of the family. I just don't know as he was only 6lb6 himself and to this day I hold the record for the biggest baby in the family!

I am pleased to hear somebody affirm that a big baby does not always mean GD.

I don't follow - why are you so concerned about being under a consultants supervision rather than just midwife led care ? Is it because you can't use an MLU unit ? You don't actually say that though other posters have inferred it?
Personally, I'd think "bonus" and it's an extra pair of eyes on me in a probably understaffed and overworked unit. It's not as though the consultant is actually going to be standing over you while you birth.
Yes - there's a possibility of earlier intervention measures but you have given birth before and if you have discussed a plan and agreed the triggers / indicators for intervention measures in advance; you can be far more confident in your and your DH's ability to discuss next steps if you do run into any problems, perceived or otherwise.

"Personally, I'd think "bonus" and it's an extra pair of eyes on me in a probably understaffed and overworked unit. It's not as though the consultant is actually going to be standing over you while you birth. "

generally speaking, CLUs have fewer MWs per labouring woman than MLUs.

consultants only pop up as and when required, as you say - in fact the majority of women giving birth in a CLU have MW-only care.

just less MW care than they'd have got in a MLU.

Quite... Having had one big baby, and fairly sure I was expecting another, and having read lots and lots about it I decided my best chance to avoid the cascade of interventions I had with my first was water and remaining active.

The first would only be available in a MLU, the latter more likely in one.

My experience of a CLU was that yes, although a consultant safely delivered my baby in risky circumstances, they were also somewhat responsible for creating those circumstances in the first place.

I had fantastic midwifery care in the MLU, you often find the midwives are more experienced, because they're flying solo, so to speak.

db
xx

DS was 9lb - I'm 5 foot 8 and was 9lb myself - my dad is 6''5' ffs - and people tried really hard to scare me silly during my first pregnancy - ooooh it's going to be a HUGE baby, oooooh, are you sure you don't want an elective C-section? (This is in the USA where they push elective c-sections at you like free sweeties, so they can schedule you in at a time convenient to them, then go home/ play golf, and charge you/your insurance company through the nose.)

I never had any problems with GD, was tested for it.
I said no, no ta, no, no, naaah, I'll give it a try, nooo, and STOP IT!
2 hours pushing, normal vaginal birth, 9lb baby. 1 small stitch on a tiny tear that's healed fine.

DS is still 96th percentile in his height range for his age (he's 2) - he's just a bit of a tall lad.

his (foetus) brother is looking to be the same way. I've been told that I'm 'measuring big' and have taken extensive Glucose Tolerance Tests - all came back fine. I'm hoping that they'll chill about it this time (and that it'll be a bit easier/ faster this time around!). :)

Congrats on your lovely big baby. I've got a soft spot for big strapping babies, having had one I find them immensely cute [hgrin]