Large head

[ARV1981]

I've been having extra scans, all the way through my pregnancy. The baby's head has been measuring on the large side.

Yesterday, (37 weeks) the measurement was off the scale big.

I've been booked in to be induced on the due date (which I had to argue for as the rest of the baby is 'normal').

I asked if the baby's out of proportion head size was a concern and the consultant didn't want to answer my question, kind of fobbed me off with an explanation that the 20 week scan was normal, so chances are that it's just because of genetics.

My husband has got a big head. I have a tiny head... my head is so small I can fit child-size hats rather than adult ones! But, I'm a twin, and they say twins have slightly smaller heads because we had less space in the womb. My older sister (not my twin) has a big head, as did my dad. My maternal uncle and grandmother also have quite big heads. So although I have a small one, big heads do run in both families.

I realize the chances are, the baby's head is big because of genetics and the Dr is right but I can't stop worrying! I am terrified of there being something wrong with my baby.

I know I only have three weeks to wait, but I was wondering if anyone else has had this, and what the outcome was?

I'm also terrified of the birth. I guess it's very likely I'll tear, or have to have an episiostomy which is really freaking me out. Will it take ages to heal?

Dr didn't think an elective c-section was necessary. I fact Dr said that the baby didn't meet the guidelines for an induction even because the rest of it was normal sized (estimated weight is under 4kg) - I said I was worried about getting such a big head out so he went to his superior who said I could have an induction.

Thanks, and sorry for the long post!

Hello
My DS had a big head according to 2 late scans last year. The Sonographer got her more experienced boss to check as well and they were confident it was just big rather than there being an underlying problem. I am sure your sonographer would have told you if there was anything to worry about.
I then discovered that all the babies in DP's family have big heads!

As you have big heads in both your and your DH's family, I would expect it is genetic too, so don't worry, your baby sounds fine.

In the end I elected for a CS at 1 week overdue, due to the big head, large baby (9lb in the end), previous CS, my age, & failure of DS to show any signs of wanting to come out.

Given your circumstances, you should be fine with your induction.

My DS was born with a head circumference above the 98.5 centile, and was off the scale when last measured. He is fine, it doesn't look unusual but he does need big hats!

Good luck with the birth in a few weeks and enjoy your last few weeks of peace & quiet in the meantime!

My story won't be so reassuring. Ds's head was in the 99.6th centile (this wasn't known until after he was born, though) and I had a very long and difficult labour because he got wedged in my pelvis.
It was 3 days, took forceps to get him out and, frankly, I think I should have had a csection, due to the difficulties in the labour and the resultant damage to me.

If I were you, and with the benefit of hindsight I would say you want to speak to an obstetrician and put together a birth plan together.
In it I would want that if labour is slow, to consider it might be a poorly positioned baby (uneven head pressure on cervix makes contractions ineffective) and to discuss c section early. No 'wait and see' approach. I was in labour for over 70 hours, 40 of which in the hospital, 20 or so on a syntocinon drip.

Keep 2nd stage short (mine was 2 hours before I was taken to theatre). Ds was 10lbs 5 so with a huge head and a heavy body, I could not have pushed him out myself, especially as my contractions stopped when the syntocinon drip ran out.

If baby is not descending much, then you want to be offered a c section. Early. Leave it too late and baby will have begun descending into the pelvis, making a c section riskier abd forceps the least worst option. But forceps come with long term risks to you. They cause a lot of damage. In hindsight, it's avoid forceps at all costs. It's only like having a csection but with the stitches in a less hygienic place. Took me months to recover. Still have problems with my pelvic floor (levator ani avulsion - it's where the pf comes away from the pelvic bones.

Obstetricians do not see this damage, because the women go to see a gynae to discuss why they're incontinent long after the birth. It's a birth injury that can't be fixed surgically, either.

I would be going back and finding out why they want to induce if the consultant doesnt think head size is an issue. I wouldnt put my body into the hands of someone who wouldnt answer my questions.

Start some perineal massage, and that will help with stretching everything

Roly - that's a very scary story. I don't know what to do about this.

Drs don't seem very worried because the baby's weight is in the normal range - 3.26g and the guidelines say don't induce if baby's under 4g... only reason they have for induction is because I made a fuss about the size of its head! Which is above the 97th centile.

I was in a bit of shock at being told this and with my mum not my husband. Mum wasn't that worried! Like I say, my big sis has a big head... I am now terrified (or even more so) of the birth.

The drs don't seem to be that worried but they don't have to push a massive huge (headed) baby out! I do. And I'm feeling really worried now.

Ok if weight isn't such a concern you can rest a bit easier. My friend's baby was above the 97th centile for head circumference but she had a very straightforward delivery without pain relief in under ten hours.

So don't take my experience as how it will be. Do, however, kick up a fuss IF things don't progress.

If things progress well, all should be fine. It IS possible to push out a big headed baby and not have big tears, prolonged labour or other scary stuff. Remember your ancestors all pushed out big headed babies, presumably passing on the big head gene and a wide pelvis one, too :)

Good luck. I don't think you should opt straight for a c section because things may actually go really smoothly. Like my friend who turned up to the hospital alreaday at 8cm and actually doing fine.

Mine was posterior as well as big headed as well as 10lbs 5oz as well as two weeks overdue. So a bit of a perfect storm.

But I am serious about avoiding forceps at all costs. I've read too much negative information about their use.

Thank you for replying.

I spoke to my sister this afternoon about it all... her son has a massive head too. She had a forceps delivery (eeek) but says she's forgotten all the pain now. She also said she thinks my hips are wider than hers... not sure which mirror she's using, but I disagree! I think we're about the same! Lol!!! Gotta love sister's, eh? Although in fairness my hips have definitely widened during this pregnancy - my mum has some wooden armchairs... pre-pregnancy I fitted in them with space on either side, now I kinda get wedged!!! But apparently it isn't that noticeable (according to my mum, so I take it with a bucket of salt )

I think I'm going to go back to my head in the clouds approach - la la la... childbirth can't be that bad... women have been doing it for millennia... what's the worst that can happen??? Forceps... they don't exist!!! Venteuse? What is this witchcraft of which you speak??? no, it'll be fine. Nothing to worry about!!

I hope I can maintain this manic mindset...

I was told the same at 36w with Dd1. Birth was fine, a bit long but not too bad for a first birth, and she was 9lb with 38.5cm head so off the chart! Dd2 was super speedy and easy labour and head was 39cm, so 5cm bigger than average. Don't stress about the birth, the skull bones are designed to move and allow the head through your pelvis (I am a wee 5'2" with teeny feet so in theory if I can do it anyone can!) Both dh and I have huge heads so def genetic and both girls still have big heads now :)

My Ds4 had a huge head, well all my babies had big heads but ds4's was off tye charts big, he was 10lb 13oz, very quick Easy delivery in birth pool. I am 5 2 and fairly petite. I think what helps is babies position, so look at optimal fetal positioning and spinning babies to help encourage baby into a good position.

Mt hardest labour was actually my smallest baby, but she was back to back.

Thank you both for the positive messages! I'm feeling a little more hopeful now.

I don't think I'll be allowed a water birth though as I'm being induced? I think that's what the nct lady said...

Depends on the type of induction, I was induced with Ds4. They just broke ny waters and as all was fine I then got in pool as contractions began asap.

If you have the posting pecessary on your cervix and that kicks everything off you could still use the pool, ditto if you have your waters broken, but if you need the syntocinon drip then obviously you couldn't go in the pool.

I have been induced for all five of my labour's as I always go overdue, three weeks over with ds3!

Speak to your midwife, different hospitals have different policies.

DS has an extremely large head - 6 month sized at birth, adult circumference at the age of 3 - but was 50th centile weight.

Not picked up because only had normal scans at 12 and 20 weeks.

Got stuck (unsurprisingly), had emergency C-section (that was fun - 2 people pulling his legs, 1 person pushing back up from below....). large haemotoma, but no long term effects.

Dr in America (we moved when DS was 6 weeks - now that I DON'T recommend, compared with that,birth was a breeze) was convinced that DS had hydrocephalus due to the size of his head. Luckily my elder brother was visiting, so we got the dr to measure my head, DBro's head ... he then conceded that it might just be familial!

Had extra scan for DD, but she was 50th centile all over, straightforward natural birth.

My DD has a large head which was measured very average on scans, so first of all it may not be at all accurate!

I gave birth to her relatively quickly, so it didn't impact in that way, but I did need a fair few stitches. This wasn't in the least traumatic to me and healed fine, your mind is elsewhere by that point with a newborn to look after!

I'm not sure of the logic or wisdom of having an induction because of that though, as far as I've heard having one increases the chance of needing further intervention, as baby may not be ready to come? The size of the head is not going to be different if at 40 or 42 weeks I wouldn't have thought? So I would get further explanation of that if I were you.

Good luck and try to relax, what will be will be!

Tfoot... I don't know if the baby's head will stop growing. I do know it grew a lot in the last three weeks though, so I think I'm being fairly realistic in assuming it may grow more between now and the due date (now only two weeks away!)

But a an with you on what will be will be. This has been my feelings about the birth all the way through. Until I realized about the size of it's head! That is scary! But I'm resigned to an episiostomy if necessary (better that than tearing?) Or c-section... but would prefer to do it au natural if possible - gas and air, water and tens was my original plan! But epidural if needed. I don't want pethidine though. But will see what happens on the day!

Thank you all for your kindness in making me feel more relaxed about this! I'm sure I'll be fine!

From a medical perspective...

From your original post it sounds like you were talking to a registrar who then had to go and get advice from a consultant.

If you want an elective c section doctors can talk to you about it but the final decision rests with you. Guidelines (I think from NICE) say that if your obs refuses to give you a c section you have the right to be put under the care of one who will.

Firstly, insist on speaking to a consultant and not a junior doctor or a registrar for all of your appointments...if your baby's head is off the scale I don't see that as any sort of unreasonable request. Secondly, stuck to your guns or have a supporting person with you who is wilful/forceful (but in a polite way!) eg partner or relative, to make sure you don't get persuaded if you've made your decision....that is, if you have made a decision and deffo want a c section!

Yes, it was a registrar.

He wanted to go by the guidelines, which apparently say nothing about massive heads... just overall estimated weight of the baby.

I just kept saying that logically, a massive head regardless of the rest of the baby's size was likely to be difficult to deliver. He kept saying "but the guidelines..." and I kept saying "the baby's head is huge, that sounds like it will cause problems, I don't want to go over term and give it a chance to get even bigger" - eventually he did go to the consultant, who obviously agreed with me. I was then given the option of being induced at 39 or 40 weeks. I opted for 40 weeks, as would prefer baby to be "fully cooked" if possible.

I don't think I'm being a terrible mother in thinking of myself in this - I'll need to recover as quickly as possible afterwards to look after the lovely new baby! I don't want to be ripped to pieces and so sore down there that I'm grumpy and don't bond properly with my beautiful new baby.

Thank you for your medical perspective... would you recommend a c-section instead of induction? I thought I'd prefer being induced to c-section, but I'm open to whatever is best for the baby really - and that includes my recovery time. Is it faster to recover from a c-section than an episistomy?

My DD3 had a head measuring off the charts (very odd, as my first child's head is tiny). She is absolutely fine.

But this did push me to get a csection. I had already suffered a third degree tear in a previous delivery and a prolapse.Consultant was laid back about it. But you would be as a man, wouldn't you!

I did a lot of reading and feel I made the right choice. She did indeed have a large head!

Like a PP, DC1's head was off the charts at 38.2cm & this led to a drawn out pushing stage & then forceps delivery in theatre whilst being prepped for a c-section. It was the best part of a week before I could walk properly (was fine shuffling along the road but the mile to the corner shop turned out to be too far & I had to call DH to come & rescue me). DC1 weighed 8lbs13
DC2 was born 2.5yrs later, weighed a mere 7lbs 11 and had a head circ of just 37cm & was out in two pushes 29 minutes after I'd realised I was in labour. I still stroke his head lovingly from time to time! Due to his elephant like ears, he has much more difficulty than DD does in getting tops on & off.

Tbh, I would suspect that induction at full term (40 weeks) would be the worst way to go.

• The head will probably be as large as it is going to be, so you don't gain anything much.

• Induction means that you are not as 'ready' as you would be for a natural birth and so the chances of there being an issue would be likely to be higher.

If you are really worried about the head size, go for C-section, or wait for natural labour but be prepared to go for an emergency C-section early if there is any sort of issue (rather than 'waiting to see'/ forceps / ventouse).

For DD's birth, despite the scan showing a normal size head, the size of DS's head had been so extreme, and the story of my labor so 'interesting' [I overheard the consultant talking to a colleague while reading my notes, as I waited for the head size scan for DD ... 'I can't believe this woman is even considering VBAC. She's either very brave or mad.'] I was prepared for a very early request for a C-section if there were any issues. There weren't, but the reduction in anxiety for me was worth it as I was much more relaxed about the whole affair.

My DS 1 has a head that's off the charts. When he was born it was so big they thought he had hydrocephalus. Even at 3 his head is so big that today I got him a winter hat from the adult section in gap, although he doesn't look out of proportion.

He was born vaginally with no instruments and only a tiny episiotomy.

I recovered from my episiotomy (and tear with ds2) very very quickly.

That's reassuring pottering.

I only have two weeks to wait now. Feeling optimistic about it all now.

What will be will be...

My DD had a 98th centile head at birth - I am grateful I didn't know it was so big before she was born! I was induced at 40+11, got to fully dilated within 24 hours with TENS, gas and air, and then epidural when I went on the syntocinon drip. Then had examination, registrar's face was v doubtful: "this baby is not coming out this way" so I had an EMCS without any fear/urgency as baby and I were both happy. Recovery from the section was quick and trouble-free, and I'd happily have another section.

I do have my doubts about my ability to birth a baby vaginally - I will be keeping track of a second baby's head size, with a view to ELCS if it mirrors DD...

What will be indeed! I didn't know about ds1's head until after he was born so it was never a decision to make for me iyswim? DS 2 has an entirely normal sized head if that helps too!