Suspected 'big baby' - choices

[Msrivia]

Hoping for some advice/reassurance in what has become a rather stressful end to pregnancy - sorry for essay! I was referred for a growth scan at 32 weeks because baby measured small on the growth chart according to fundal height- he had decided to lie transverse that day so midwife wasn't too worried but recommended a scan just to check. His abdominal circumference was a little big in that scan putting him in the 91st percentile for size. Another scan was advised for 34 weeks and I was told I would have a consultant appointment in week 33. No appointment appeared, I rang the maternity outpatients department several times a day from the second week with no answer, until both appointments appeared in week 36. On that scan his abdominal circumference was even bigger, putting him in the 97th percentile. The scan was on a Saturday and the ultrasonographer was a bit rushed, I had to roll around a few times to give her a better image and to me she seemed very hurried and a little inconsistent in how she was measuring - I'm not a human ultrasonographer but I am a vet and have some experience using ultrasound machines.

I had a rather upsetting appointment with a junior doctor yesterday where he strongly advised either c section or induction at 39 weeks as the risk of shoulder dystocia had doubled. I had to specifically ask what it had doubled to (1.4% vs 0.7%), and he then went on to say that if shoulder dystocia occurred then it would be a big emergency, they would have 4 minutes to get the baby out or else he would have permanent brain damage, I would have PTSD and never want a vaginal birth again, and they could need to break the baby's shoulder or give me a symphysiotomy to get the baby out. I asked in what percentage of shoulder dystocia cases would you expect to have such serious complications, and he said he didn't know and it didn't matter anyway because 1.4% was a serious risk. He then asked why I didn't want an induction and if it was just because I wanted a water birth.

The whole consultation felt very rushed and he seemed taken aback and a bit offended that I didn't immediately thank him for offering a c section and go with that. I'm not anti-intervention but I know that growth scans are notoriously inaccurate, and I don't have any other risk factors for a big baby - no gestational diabetes, normal bmi pre pregnancy, have had a very uncomplicated pregnancy up until now except for mild anaemia which resolved with iron supplements.

I ended up accepting a provisional induction for the 39th week. He also advised weekly sweeps from week 37 - i was under the impression that sweeps were only likely to bring labour forward if you are close to going into labour naturally, but he said no one really knows what triggers labour.

I have since looked up NICE guidelines and some online advice from other NHS trusts and the general consensus seems to be that there is limited evidence for early induction of labour for suspected big babies in women without gestational diabetes. Even the info leaflet he gave me listed induction as an increased risk factor for shoulder dystocia!

The last thing I want to do is to put my baby at risk, but I'm just not sure that the level of intervention he is advising is needed. Has anyone been in a similar situation and would mind sharing their thought process and the outcome?

I would also be interested in others experiences of this!

I’m similar to you, in terms of my baby has a larger AC. I don’t have gestational diabetes and no other risk factors and was hoping for a water birth. I now have a consultant appointment next week at 37 weeks to see what my options are. The sonographer just kept saying I’m having a healthy, happy baby and that I’ll just be induced a week earlier - which isn’t that helpful as this is my first.

I hope you get some answers soon!

I’m in a similar(ish) situation in that I had small bump measurements, but baby measuring big on the scan. (93rd centile on scan at 31 weeks) but I’m a few weeks behind you - currently 33 weeks.

This is my second baby, and I had similar with my first - small bump, big growth scans (over 90th centile). I wasn’t quite in the “official” big baby bracket so wasn’t offered any interventions. He was only 39th centile when he was born (9 days overdue, spontaneous birth). So from my experience the scan measurements are wildly variable (correlates with the many big baby threads on here too).

Did they mention the transverse lie as being problematic? Has the baby been head-down previously?

Do you have another midwife appointment soon? I would be asking what position the baby is in. I know they can move right up until birth but if he’s been consistently transverse, personally it would concern me that there won’t be enough room to manoeuvre into a good position.

The advice on having weekly sweeps is rubbish - there’s not really any evidence that they induce labour. I found them useful to give me information about how far off labour might be though.

https://evidencebasedbirth.com/evidence-for-induction-or-c-section-for-big-baby/

I always post this link on big baby threads too - it says something like the perception that you are having a big baby by healthcare professionals results in more complications than actually having a big baby.

I had a growth scan at 28 weeks (I'm now 31 weeks) and baby's AC was in the 91st centile then! I was sent for one cause I was measuring big (over 97th centile) but after the scan they put my overall measurement on my growth chart just under 90th centile so they aren't taking it any further. But reading your post makes me a little anxious as it would seem my baby may be bigger than yours! Both me and hubby are tall so I'm putting it down to that.

@DuploTrain This is my worry, the doctor said it will be written all over my chart that I am having a big baby so I worry that I will be offered a lot of intervention on the day - fine if needed but I'd rather avoid if not!

Baby is head down and engaged for last few weeks so all good in that respect. I'm just really hoping he decides to make his own way into the world before we get to the point of induction!

Can you seek a second opinion before agreeing to a c section? In your shoes I'd be very nervous about induction as there can be a cascade of intervention anyway resulting in emergency section.

I had 2 babies on 91st centile. Was tested for but not diagnosed as gestational diabetes. Both born naturally with no pain meds for ds1 and just G&A for ds2 who was a home birth. Small tear with ds1, couple of stitches. No tearing with ds2. It didn't hurt when they stitched me up with G&A.

With ds1 he was nearly 2 weeks overdue and was happy enough to have a sweep but would have resisted induction. Ds2 was 1 week overdue (got my sweep in at 40 weeks as I really hate being near 42 weeks pregnant!).

Seems anecdotally lots of people are told they are having big babies that then go on to be perfectly average sized.

I think you are right to mistrust the doctors. A planned section would be preferable to a load of intervention following induction. You roll the dice really on this. My instinct would be to hold out for natural birth with sweeps at 40 weeks and ensure I'm in hospital with a flexible birth plan that allows for any and all intervention up to section. I'd be holding offf epidural , induction and observations that mean I'd birth flat on my back as I wouldn't want to risk ending up with a section after a painful labour.

It's really hard to decide and I think you need a second doctor to advise.

Just to add that although “interventions” do sound very scary, I had an episiotomy (a cut) but no forceps or ventouse.

The episiotomy was literally the least painful part of the whole birth, I genuinely didn’t feel it. They stitched it up after. Healing is surprisingly quick.

Hi,

Just quickly popping on to give some advice - I’m currently pregnant with baby no 3. I had this same problem with my last 2 pregnancies! First baby was 9lb 4oz (I am only 5’3 and size 8-10 so not very big) and he had shoulder dystocia. I was in theatre for forceps anyway but had I not been it would have ended very differently. About 10 drs ran in when they realised his shoulder was stuck and they managed to get him out in time. It was very traumatic and I wouldn’t wish it on anyone.
My second baby was measuring big, I had extra growth scans and a consultant who wanted to induce me at 38 weeks (when a scan predicted baby was 7lb 12oz already) to prevent the same thing happening again. I was told if I waited till 40 weeks I would end up with another 9lb baby and similar delivery. I declined induction and asked for a sweep instead, the sweep set me off into slow labour and I managed to delay induction until 39+3. I had my waters broken and pitocin (hormone drip to induce labour) but the baby came smoothly within 6 hours and I had no tears/stitches. She weighed 7lb 12oz! So the scans are not 100% accurate.
Now that I’m having my third, I’ve been put as high risk for shoulder dystocia again but I will be trusting my instincts this time and will be declining any inductions/sweeps before 40 weeks if I’m told the baby is big on scans again! I wish I had done this last time and not gone through the trauma of multiple sweeps and the stress of an induction.

Definitely trust your instincts and DO NOT be bullied into a c section or induction unless it’s absolutely something you want and are confident with!!

I hope this helped! 💕

My son got stuck during delivery - shoulder dystocia.

I don't want to frighten you but you have asked and this is one of those times when false reassurance is more harmful than honesty.

When my son got stuck, the doctor panicked and pulled his head instead of performing the McRoberts manoeuvre. She started screaming i need help I need help. The midwife pressed the alarm and the room was filled with people. It was terrifying. My legs were brought to what seemed like my ears!! And someone was pressing on my stomach.

He was eventually born not breathing and had to be resuscitated.

The doctor caused permanent nerve damage which has left him with erbs palsy. (erbspalsygroup.org.uk) He was badly bruised and he had to be x-rayed to make sure his collar bone was not broken. (It wasn't)

He was 10lb 4oz.

My second son was an ounce bigger but longer with narrower shoulders and although the consultant delivered him and the theatre was on standby, he was born safely albeit with the cord round his neck!

I would say think very carefully and talk to the doctors and midwives about the risks. Ask them to explain the McRoberts manoeuvre to you and go through their plans in cases of shoulder dystocia.

What matters is how well trained and prepared they are and what level of risk is too great a risk for you.

Thanks everybody, it's so helpful to hear the range of experiences. I'm sorry to hear you had such a difficult experience @IncompleteSenten and I hope your son is doing ok now.

I think I'm going to decline sweeps at least for the next couple of weeks and see how I feel at 39 weeks. I definitely will talk through how the team would deal with shoulder dystocia if it occurred, but trying to focus on the fact that even if he is as big as they think, there's still a 98.6% chance that there will be no issue with shoulder dystocia. In the meantime I'm looking through every old wives tale for bringing on labour naturally 😅

Do not have an induction; they increase the risk of shoulder dystocia, and statistically likely to end in EMCS anyway, for your first birth.

I had two big babies (both over 9 pounds, which is big rather than huge). Had shoulder dystocia with DC1 which was quickly and easily resolved with the mcroberts manoeuvre, no injury to me or DC. When I was in labour, a mean midwife insisted I lie on my back on the bed, which I did not want and which is not an optimum position for opening the pelvis. I feel sure that was the reason DC got stuck.

DC2 was a normal vaginal birth - very quick at home - and shoulder dystocia was a worry due to DC1's birth but I am pleased to report that it didn't happen and she was born normally. (I was on all fours)

Of course this is just my experience and I encourage you to read the evidence on shoulder dystocia. IIRC RCOG has a helpful fact sheet on their website.

https://www.rcog.org.uk/for-the-public/browse-our-patient-information/shoulder-dystocia-patient-information-leaflet/

See also https://www.aims.org.uk/information/item/induction

And https://www.sarawickham.com/articles-2/induction-for-big-baby/

I was told from 33 weeks I was having a big baby, 99th percentile, loads of scaremongering, ended up in an 'emergency' c-section and out came my very average 8lb 1 baby!
I would resist induction as long as you can.

I was the same and was offered an induction or C section at 39 weeks by their dates (I was 38 weeks by IVF dates) I took the induction which failed as after 3 pessaries nothing was happening and no one could find my cervix, on the 3rd day I had a section and he was 9lb, had another baby the year after and opted for an ELCS

I had a big baby, not diagnosed and if I had another and they were another boy, I would consider asking for ELCS as delivering him wasn’t fun.

Definitely have a read of the research, from memory the link is largely with gestational diabetes and the increases in risk are relatively minimal. The tone of that doctor just sounds very off and scare mongering in my opinion. Can you ask to speak to consultant midwife? I did and found them very measured in discussion of risks.
Absolutely not disputing the risk is there and that shoulder dystocia is real and would be a scary emergency but it's still a small risk alongside the many many other risk of child birth!
My own experience, my DD was showing as having 99th centile AC on a growth scan (indicated by a drop on fundal height measurement curve). I had been planning a home birth but was strongly advised against but nil other intervention was suggested. Although they did tell me I couldn't labour on the midwife led ward which I found was ridiculous based on one measurement.
In actuality I ended up with an accidental unassisted home birth! Which was briefly terrifying as I imagined her getting stuck but she was out in 3 pushes, 8lb 12oz and indeed with a large chubby tummy but relatively average sized shoulders!

DD was 10 lb. 11 oz. She did get slightly stuck but our consultant was brilliant - came in, did McRoberts manoeuvre and she was absolutely fine. Ds was 9 lb 2oz and came flying out after that!

I was told I was having a big baby, but she was only 8lb7, so not huge... But she was measuring with a really large abdominal circumference, and they thought I may have gestational diabetes. I had a sweep at 38 and a half weeks, but nothing happened, was booked in for another the week after, but went into labour. She did get "stuck" and the 40 hour labour ended in an emergency C-section, but all was well. I have narrow hips though and although she wasn't huge, I did think afterwards, that would never have happened naturally! (And was almost relieved it didn't) I'm not sure the scans are wildly accurate, as I said they kept saying she was going to be absolutely massive, and she really wasn't.

This was me three years ago. I had initially agreed to an induction as they thought my daughter was going to be 11lb or more. She was 8lb 7oz! I declined the induction on the basis that birth weight alone is not an indication for an induction, and went ahead with a natural birth (ended up with EMCS but it was nothing to do with her size).

It might have been for you; it wasn't for me.

I was measuring big from around 35 weeks. Tested multiple times for diabetes. This was my first dc. At 39 weeks baby was on 97th percentile. I wasn't offered an induction but did have a sweep by midwife at my next appt.

Went into labour at exactly 40wks. Due to baby's size I couldn't go to birthing suite (wanted a water birth). Labour lasted 3 days and resulted in forceps in theatre - very nearly c section (signed all the forms) of they couldn't get dc out in a few minutes due to decelerations. Luckily she did come out. She weighed 9lb5ozs (I'm only 5.1). I did have 4th degree tears and couldn't sit for weeks or have poo (needed lots of laxitives). Then a few sessions of physio.

I was so grateful to have a healthy dc that I blocked most from my memory. In hindsight if I'd have been offered a section or early induction I might have taken it.

Sorry about your experience @squeekychicken

It's a good point about your own size - you say you're 5'1. I'm 5'8. So assuming a pelvis that's more or less in proportion, it makes more sense that a taller/larger woman might have less risk of shoulder dystocia (or other complications) than a shorter/smaller woman birthing a larger baby. I wonder if there's any research or stats on height/size of mother v weight of baby and rates of SD and other complications. It would be interesting.

@Msrivia how tall are you?

Induction is often not a great thing with big babies - seems to work best if waters have broken or you have otherwise had some symptoms of labour.

I was induced at 42 weeks with a back to back 9lb 7 baby. I wasn't offered a section and ended up with an EMCS. I think she was just wedged in my pelvis in a very tricky position, so even though I did a lot on all fours and a lot of walking up and down stairs there was just no budging her. I never had any BH or any downward pressure at any point in my late pregnancy or labour, just lots of throbbing pain in my back.

I think it is different if you go into labour naturally, have twinges etc - baby has at least engaged and is in a good position.

Labour is partly about size of baby but also about positioning. And you can't wholly control either.

If it were me, I'd have a go if I went into labour naturally before 41 weeks with a non back to back baby, but after that I might accept a section.