Advice needed on big baby following growth scans

[Caldey11]

I'm currently 37 weeks pregnant. I've had a few extra scans during the pregnancy to check on my baby's bones and all has been fine. However I had a scan at 34 weeks and the sonographer indicated the baby was measuring 2 to 4 weeks ahead of gestation depending on the body part. I was scanned again at 36 weeks and the computer said the baby is 7lb 10oz so I have been told to consider an induction at 38 weeks or a planned c-section at 39 weeks to avoid the baby getting stuck (shoulder dystocia) in labour at full term.

The situation is further complicated by the fact that if I have an induction at 38 weeks it will be done at my local hospital, but may end up in a c-section if it doesn't work. I live in Wales where partners can only be present when the woman is in active labour so I could spend several days waiting for labour to start/being in early labour totally on my own. Once induction has started I am not able to leave the hospital to even see someone in the grounds.

If I have a planned c-section at 39 weeks it will be done at a different hospital (Royal Gwent in Newport) which are taking maternity patients for 1 week due to a transfer of maternity services from our local hospital to another hospital. With this option I am most worried about post natal care as I have mostly heard that you will be left to your own devices and midwives are often overstretched which worries me. Again I wouldn't be allowed any visitors after the birth until I'm discharged. I've heard they are discharging patients after 24 hours which sounds crazy as I don't know how I'll feel that soon after the operation but apparently that's what the process is.

The third option is to do nothing and wait for labour to start naturally and hope I can deliver without it getting stuck. If I get to my due date I will have to deliver at yet another hospital (a new one opening in South Wales).

I have read that the weight estimates are often inaccurate and that most big babies deliver fine, rarely do they get stuck and its even rarer that it is a real problem but knowing that it might be is making me anxious.

This is an IVF pregnancy so very likely will be my only one and I was hoping to have a normal labour, I know it shouldn't matter how the baby arrives but induction and C-section are making me feel quite sad/anxious, complicated by the hospital moves and no visitors.

I will be scanned again at 38 weeks and will then be asked to make a decision, if anyone has some experience with delivering a big baby I would love to hear from you.

My first was 11 lbs 3 oz - scan predicted 8lbs. Birth was fine - small episiotomy. 2nd two were just under 10lbs and again fine for vaginal births.

Ok, ladies. Just a quick update. My waters broke early this morning, followed by contractions. I still made it to my appointment in antenatal clinic and was offered a section, which I accepted.

@Mc3209
Are you the OP? (Different username)
What gestation are you now?
Sounds as if you've decided on a c-section so best of luck with it.

@Mc3209
Sorry I should have RTFT before posting, I had only read the OP's posts, but I have now read the rest and I realise you are a different person, sorry! Anyway "best of luck" still stands, hope all goes well for you.

@Caldey11 did they give any suggestions for why baby is big? I’ve been tested for gestational diabetes (negative) and I haven’t put loads of weight on either, so I was really surprised to be told baby is big!

@Caldey11

Look at the measurements and centiles for the head, abdominal circumference and estimated overall body weight. A large head could mean a higher risk of a tear or episiotomy (although not necessarily) and a large abdominal circumference and overall body weight could make it more likely that baby will have broad shoulders and be at higher risk of shoulder dystocia. However, plenty of big babies are born vaginally with no shoulder dystocia; it depends on several factors including the position you're in when you give birth. If you have an induction, you're more likely to be lying on your back on the hospital bed (because they'll want to hook you up to a monitor and you may want an epidural) which is not ideal for opening the pelvis. Ideally you'd be in a more instinctive position for giving birth (eg upright or on all fours) which means your pelvis would be more open, and you'd be more likely to achieve this if you go into labour naturally without being induced. (Or if it's a reasonably "light touch" induction and labour progresses well after that which means no drip etc.)

If you look at the Nice guidelines, induction is not recommended for the sole reason that baby is predicted to be big, with no other factors.

And FWIW, this was my personal experience:

DC1 born at 41+4 (after I went into labour naturally) weighing 9lb4. I was monitored due to meconium in waters and bitch midwife insisted on me lying on my back on the bed. Shoulder dystocia which was mild and resolved quickly and easily with no injury to baby and no lasting injury to me (I'd had an episiotomy before he got stuck and was very sore afterwards but recovered fully). I am convinced the shoulder dystocia was caused by my position lying down.

DC2 born at 40+1 (again went into labour naturally) weighing 9lb1. Straightforward vaginal birth with no shoulder dystocia or other complications. I gave birth at home on all fours!
During the pregnancy we did discuss the risk of shoulder dystocia and I had a growth scan; IIRC baby's abdominal circumference on something like the 97th centile, overall weight prediction was around the 75th centile, but in spite of this she didn't get stuck. This has made me even more convinced that it was my position in labour that made the difference.

That's just my experience though and I do advise you to make an informed decision. Look at the Nice and RCOG guidelines on big babies, induction, shoulder dystocia etc. Also the AIMS website has good advice on making decisions.

@peachypetite I don't have GD and haven't put on that much weight, the midwife doesn't seem to think so anyway. My DH was a big and long baby back in the 80s (only 8lb 4) but the midwife told me that was big for back then and that in general babies are getting heavier. I did read that IVF babies have a tendency to be bigger so that may also be a factor. It was growing normally until 26 weeks, it was only at the 34 week scan it had had a big growth spurt, who knows why.

If midwife palpates, does she agree it's a big baby?
I've known too many scans to be wrong (wildly wrong in all directions). Midwife having a grope is better to get relative size estimate for gestation.

It's your body & your choice how you give birth.

@Caldey11 me too! My husband was a big baby but I was small. I also only found out at 34 weeks at a scan regarding my placenta position.

@NameChange30 Thank you very much for your comment, you make a good point about induction being more likely to lead to other interventions and therefore it being more likely I'll end up on my back, I hadn't really considered that, although I know using UFO positions are best for giving birth. I really think that makes me rule out being induced. I have had a look at the RCOG guideline which have actually freaked me out a bit regarding complications for me that I was unaware of. I think we will have to hope it doesn't put on too much more weight (unlikely I think) and go for natural labour or if the projections are over 4.5kg at 40 weeks I will book for a c-section. The belly measurement is actually off the growth chart so if that's an indicator of broad shoulders that's not good! Thanks again

I know that a lot of people have birthed with shoulder dystocia and it was fiiiiine, but in my nephews case he was out of oxygen for a few minutes, needed resuscitation and he really nearly died. I wouldn't risk it. If this is your only chance to have a child then you'd probably want a healthy, living one.

I think that part of the problem for you is that it's sprung on you so late in the pregnancy. I have type 1 diabetes and have known for 2 decades that if I'd ever give birth it would be induced and tgat my chance of c section is higher. I got used to the idea years ago so it doesn't worry me anymore. It would worry me if it was sprung on me so suddenly, so take a week to get used to the idea. Plenty of people habe births that they didn't envision and most turn out fine.

Now with the pandemic I've known for most of this pregnancy that there is a chance that DH might not be as involved as we'd like to. Like you it's an ivf pregnancy and basically last chance. Although I really don't like the idea, we will survive and after all we've been through the baby is worth it. If I don't like the postnatal care I'll discharge us and hire a private nurse. Can you keep that as an option?

"If this is your only chance to have a child then you'd probably want a healthy, living one."

Bit of a weird thing to say, I'm pretty sure everyone wants a healthy, living child and not a dead one, whether it's their only chance or not!
I see your point though which is that shoulder dystocia can result in serious complications which is true, it is thankfully rare but it is possible.

OP regarding induction, you could ask them to assess your Bishop's score, if it's high it could well be worth trying induction as it would be more likely to succeed and go smoothly. If it's low you could decline induction and go for ELCS. If you did attempt a vaginal birth you could have a low threshold for switching to c-section if it's not progressing smoothly for whatever reason.

Anyway your decision, best of luck with it.

My 4th baby measured two weeks ahead on fundal height from 28wks. At my 37wk growth scan he was estimated to be 9lb! with a predicted birth weight of over 5KG. I was recommended an induction at 40wks because they didn't want him to get over 5KG (which is huge)

His siblings were all born beyond 41wks (1&3 induced at 42wks) and all big. 3 was 9lb 10. So we had expected him to go to 42wks and be 10.5lb but the growth scan was predicting him to be over 11lb. I'm 5,5 and I put on a stone in pregnancy, though I was overweight no diabetes.

We decided to be induced but actually his size wasn't the main factor in agreeing.

Firstly I was 40.
Secondly I was on bloodthinners and allergic to them, so was 2wks less of them.
Thirdly I was likely to be induced anyway as I had before so might as well be. My 3rd was induced but very easy. Waters popped and she was born in 2hrs.

I found my body isn't as ready at 40wks so needed the drip and epidural. He was born after 4hrs of active labour and weighed a mere 9lb 5. So left to his own devices would probably have been the 10lb5ish we thought.

So my experience was that the scans were out, he would probably have been just under 8lb at 37wks. He was big for sure but not giant.

"The belly measurement is actually off the growth chart so if that's an indicator of broad shoulders that's not good!"

To be fair, I don't know if there is any evidence to say that large abdominal circumference = broad shoulders, it was just a point someone made to me (can't remember who) and the theory does make sense - if baby is big everywhere else they may well have broad shoulders too, but they might not. I was a bit freaked out by the abdominal circumference being so big but my midwife did reassure me that it wasn't a cause for concern, and I did a bit of online research which made me feel a bit better as I didn't find anything concerning. I read that in baby's growth and development, the brain and other organs are prioritised, so if the tummy is big that means that everything else has plenty of nutrients to grow and the excess is getting stored there

Do remember that baby's size (including shoulders) is just one factor though, there are big babies who don't get stuck and small babies who do. Shoulder dystocia is very difficult to predict.

My second was estimated to be 10lb at 38 weeks, she was 8lb born at 42 weeks. They were way out.

@rorosemary You are right, it's because it has been sprung on us late in the pregnancy that it has been harder to get my head around. I don't know if it's possible to be discharged if you still need care, I have no idea how to hire a private nurse. The most important thing is the safe delivery of baby and hope that I do ok, I'll just have to deal with the post natal care, whatever it's like. It sounds more common for people to be recommended for induction or section at 40 weeks so I'm not really sure why the induction is being suggested at only 38 weeks. I would feel a lot happier with a section at 40 weeks as that would avoid me having to go to the bad hospital.

@NameChange30 I think knowing there is a chance the baby is big, I expect a c-section would be recommended early if labour stalls. I do wonder if I should eat less these last few weeks though I don't suppose it will make much difference if the baby gets the nutrients first.

DS measured really big on his scans, his stomach was at 40 weeks when I was 35 weeks and everywhere else was at least 2 weeks ahead, they estimated 11lbs by 40 weeks and pushed for induction. I said no but ended up being induced anyway due to reduced movement. He was born at 39+3 at a healthy but normal 8lbs 11oz. The growth scans can be wrong.

Induction isn’t recommended just for a big baby just because 48% cases of dystocia happen in normal weight babies. There is no evidence inducing early helps. Obviously a c section removes the risk of dystocia.

My baby was measuring large during scans (your baby is massive was what one midwife said ). Head was above the 95th. I asked about delivery and they said it'll be fine.
I ended up with an emergency induction due to ICP/obstetric choelistatis at 37+5. Baby got stuck coming out. Turns out he had a massive head and line backers shoulders. But other than that was quite long. Only 7lbs.I had a vonteous (sp) and 3 episiotomies and he was eventually delivered safely. I had a badly damaged coccyx and he had a damaged skull which was eventually fine after treatment. I know this was unfortunate and won't be the case with every measuring large baby.
I have asked for a C section if I get to term with this pregnancy. Both because of the stress of that birth but also the physical pain I was in afterwards.

3 episiotomies 😱 Your poor thing, I was sore enough after 1

I had my 2nd at 38+2. He was measuring big throughout (serial growth scans, but more head and abdomen than femur length.

I was induced and he weighed 8lbs so not huge but more than a pound bigger than his older sister who came spontaneously at that gestation. He was also broad shouldered, still is, still has quite short legs too, basically think scale model of a prop forward...

I'm very glad I had that induction, it didn't take that long and the pattern was exactly the same as the spontaneous birth only the ventouse was easier with the induced baby.

I took loads of cross stitch, sudoku, random crappy games on my phone, extra long charging cable and a charging block, plus a Lego set to kill the nothing is happening period. DH couldn't be there overnight anyway, which was most of my hanging around time - annoyingly I had just enough pain to prevent sleep but nothing really productive.

Induction is not necessarily that different to a spontaneous labour - I only needed the gel stuff, waters went on their own and no need for the drip either. There was also options for a big deep bath and birthing pools (not at all my thing, I have never found baths relaxing!)

I can’t comment on induction having never experienced it. However I did have a big baby on bump measurements first time around had growth scans which actually predicted a baby around 6lb 8oz at term (lots of fluid) went into labour naturally at 40+1 but back to back and kept stalling eventually delivered at 40+5 but was assisted and shoulder dystocia which unfortunately did cause injury to me and baby, baby was 7lb 8. 2nd baby I opted for an elective section which consultant actually advised due to high risk of SD again (I’m 4’11’’ and small build). During pregnancy bump measured huge, baby measured around the 90th centile on growth scan. Had an ELCS at 39 weeks and baby was 7lb 5. I have to say my ELCS was a much more pleasant experience than a long labour and assisted delivery. I actually found the section less painful that episiotomy and forceps bruising and was waking around the supermarket on day 4 and driving by day 10. I had my section during lockdown and was only in 24 hours and had ample help on the ward with baby and getting up and about-however it does seem post natal care is a postcode lottery. Having been on the wrong end of SD I would say go for the section but that’s purely anecdotal based on my experience.

My baby was predicted to be a ten pounder from scans so I was induced a couple of days before my due date. Ultimately the induction failed as I didn't dilate very fast and then the baby began to get distressed at the drip used to induce contractions to encourage dilation and so they had to stop it. She calmed down but they couldn't restart it because it may have distressed her again so ultimately I had an emergency section.

She was born at 11.23pm on the Monday night and I went home on the Wednesday - I spent one night on the recovery ward and one whole day and night on post natal and then discharged the following afternoon. She was born at 8.5 pounds by the way.

All I will say is that a planned section is much easier to recover from than an emergency one - you are well rested the night before, you take a number of supplements to prepare and you can organise things at home to be easier for you when you get out. I was desperate to get home because the post natal care is a bit rubbish but I don't think it was made worse by the section - the recovery ward was a god send and they were amazing but the actual ward wasn't so great (I'm not in Wales so can't comment on your hospitals). The operation itself really wasn't so awful and the recovery wasn't that bad at all - I even had a mild infection but it wasn't painful and didn't cause problems. I did have a complication from the epidural though but that is unlikely to happen to you. (I was the fourth in the whole trust that year).

Ultimately I don't know how a natural birth would have gone and DD wasn't as big as predicted but my only regret is not going straight for a section so I could have been well rested and prepared for limited movement at home. I wouldn't go for an induction again.

Can't really give you a perspective on the big baby thing (mine was 8lb 4oz so not too huge but had a 98th centile head!) but I will say being on the postnatal ward alone was bloody awful. I gave birth 3 weeks ago... didn't even have a c-section but had an episiotomy and second degree tear with a lot of stitches and had two cannulas in my arms as well as a catheter so getting in and out of bed and moving around was quite tricky and painful. I was basically abandoned, the midwives were completely run off their feet. If I pressed the buzzer no one came for about half an hour and even when they did they had no interest in helping me. I didn't get a wink of sleep (after a 30 hour labour) and had to leave my baby in a dirty nappy for hours at one point because I physically couldn't reach the nappies that had fallen on the floor. I was literally begging to be discharged by the next morning and made them remove my catheter before they wanted to because I refused to spend another minute there.

Not saying this to frighten you so sorry if I have! Just saying I would do anything to minimise my time in hospital and maximise my mobility after labour if I had to give birth again during covid!