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 had something very similar. Estimated 8lb4oz at 36 weeks and risk of shoulder dystocia. I previously had a traumatic birth with failed forceps and emergency c section - my experience in the hospital was not good. I opted for a planned c section but went into labour the 10 hours before 🫠 once I finally did have the c section it was the best experience. So calm and I felt in complete control. My son was born at 39 weeks and weighed 8lb5 so not exactly big. I’ve been so lucky my recovery has been brilliant, was up and about 5 hours later and was out and about with my toddler 4 days pp. It is such a personal choice and a difficult one to make and a lot of it is luck and what your previous experiences have been. Wishing you all the best @Msrivia

My baby was measuring big all the way through and I took the advised c-section. I had also hoped for a water birth, but after having the risks explained I changed my mind.

My baby was 11oz and delivered safely through a planned cesarean at 40 weeks. I was able to consult with the doctor and all of my wishes were respected (delayed cord, skin to skin etc). The recovery was physically tough for the first two weeks, but my support network were amazing.

Once I had made my decision, I was able to relax and enjoy the last part of my pregnancy. It was 100% the best choice for my health and the health of my baby.

Whatever choice you make will be the right one for your family.

I had a big baby (10lb 11oz) and did have shoulder dystocia. They managed to get him out. Basically two midwives pushed on my belly while another used her hands to internally dislodge his shoulder. All was well in the end but it was extremely painful. I was badly bruised and have some substantial internal scaring.

He was my last baby but if he had've been my first then it would've put me off having another vaginal delivery.

This is interesting!

I definitely think you need to take time, do some research and think about what you want OP.
personally I would NOT be mad keen for sweeps or induction…
i also recommend you think about your plan B if plan A doesn’t work out.

I was induced at 40 weeks for a big baby. Took 3 days before labour even started and didn't end well for me. Baby was fine but I've suffered permanent damage.

I would never ever consent to another induction, unless there were strong indications I was already well on my way.

Had a second baby recently by ELCS and it was an absolute dream. Both in terms of the actual experience and the recovery.

Thanks so much everyone for your response, it's really helpful. I had a midwife appointment today anyway and discussed it with her, she didn't seem too impressed with his approach and managed to get me another consultant appointment to discuss it again - different doctor this time! She also hasn't booked me in for any sweeps just yet.

@NameChange30 I'm 5'4", fairly petite but don't have narrow hips. My husband is 5'10" and not heavy set either so not sure where this baby would be getting his size from!

I was in a similar situation. I was full term and went into labour. The hospital doctor was horrified that I hadn’t been offered an induction several weeks earlier because my baby was too big to give birth safely. In the end I went for a c section because I wasn’t willing to accept the risk of my baby getting injured. The possible injuries were really serious, like oxygen deprivation leading to cerebral palsy and mental disability. It just wasn’t worth the risk for me. I put aside my own desires and concerns about my body and the type of birth I wanted, and I prioritised the safety of my baby above myself.

I’m really pleased you’ve got another consultant appointment OP, hopefully you’ll be able to have a better discussion this time.

@Sparthan I feel exactly the same way. I think either way could end in induction for me or a C-Section even if I was to go in labour naturally.

He is thanks. He's 24 now. He had 2 surgeries and although initial prognosis was not good he's actually got reasonable function now. He can drive a manual car. He has a deformed elbow and shoulder, poorer circulation in that arm, less muscle etc but it's useable apart from he can't raise it straight above his head or out to the side or lift heavy things that sort of thing. Day to day he copes fine. It was bloody scary though. We thought he was dead.

That's why I always say it's so important to discuss risks and know exactly how they'd handle them.

I knew something was wrong before he was born and was told babies can't get stuck! By the midwife. At the parentcraft classes. I realise she was trying to be soothing but ffs! They don't do that nowadays I don't think and that's good.

Just an update for anyone interested, I had a midwife appointment last week and she booked me for a second opinion with another consultant. This consultant was lovely, she basically said odds are good that everything will be absolutely fine especially as I am low risk in every other regard, but because as a consultant obstetrician they see the worst outcomes she would suggest a few changes to the birth plan to be on the safe side. We're going to start sweeps from 38 weeks, booked for provisional induction at 40 weeks, and planning to labour in the labour ward rather than the MLU down the corridor so that doctors will be in faster if needed. She's still happy for me to labour in the pool if I want to, but suggested pushing out of the water for better access if anything goes awry. She was very supportive of us making our own decisions but I feel happy with this plan now.

Interestingly, she said her biggest concern was the ratio of his head to his abdomen - his head measured normal size but tummy was off the charts, and she said this is something that would set off mild alarms for her with regards to shoulder dystocia.

I'm still hoping he decides to come by himself in the meantime but feel a lot happier after this discussion. And no mention of symphysiotomies!

No two of us are the same and yes this thread is great for opinions but you will have to make your own decision. My first baby I had a tiny bump, I’m quite Petite, but baby measured on 95th centile. Due to my frame I was booked for sweeps at 37 weeks and induction at 38. Waters went at home at 36 and I was induced 24 hours later due to infection risk. Unknown to us baby was slightly on her side and had a shoulder dystocia. It was the most horrific 10 mins of my life, she was born blue after a huge episiotomy and had to be resuscitated. She was 6lb 4. Baby number two was similar size wise, I was booked for induction at 37 weeks and wanted a scan to confirm not lying on his side, but said if no joy quickly to move to section. As it happened my waters went at 33 weeks and I had a breech emergency section.

Glad you feel more comfortable with the plan now OP. Wishing you all the best x

Sharing my experience as I was in a very similar situation and feeling the same.

DS started measuring big at 36 weeks. Everything had been 50th centile until then. Normal BMI, no gestational diabetes (but lots of testing!). They offered induction from 38 weeks but after doing my research I was dead against it. I felt that the measurements could have been inaccurate (my bump was never huge) and my gut instinct was that, in the absence of any disorder like diabetes, my body wouldn't grow a baby too big to deliver.

I went into labour dead on due date. My waters broke and were meconium stained. No other signs of distress but they wanted to move things along. I was offered a choice between pitocin and c-section. I went with the c section and DS was born healthy and indeed big at 10lb.

I desperately wanted a natural birth but in the event the section wasn't bad - very smooth and everything under control. I did feel sad for a few weeks after about not getting the birth I wanted, and I did wonder a lot about how things would have gone had I continued to labour naturally, but I had a lot of people putting it in perspective for me. Once my hormones settled I got over it, and now I'm just grateful everything went so well and we were both healthy.

I'm glad this consultant was more reassuring and wishing you the very best of luck!

Thought I'd come back with an update in case this helps anyone in the future. Long story short labour started at 39+5 and baby was born on his due date. He was not as big as estimated -8lb5oz vs 9lb5oz - but I ended up having an emergency c section due to foetal distress unrelated to his size. He was having massive heart rate drops during contractions and it turned out his cord was wrapped twice around his neck - even with a section he needed resusc as came out in shock. Doing very well now though.

Overall I'm happy with the decisions I made with the information I had. As suspected he wasn't as big as estimated and an earlier induction wouldn't have done him any good - possibly some harm if the distress hadn't been picked up. Obviously these things are easier in hindsight!

Congratulations on your healthy baby boy! As your birth has shown- it's so hard to plan and predict these things. We make the best choice we can.

I had growth scan at 34 weeks. Was told to expect a 10lb baby at least with a giant head.
she was 5lb. To be fair she has got a big head though.

congratulations! I’m so pleased he’s doing well!

My little one was measuring 97th percentile from 30 weeks. scan at 36 weeks measured him at 8.4 lbs. Full term projected 9.4 lbs.

I had a sweep at 37 weeks and induction at 37+6. Born 38+1 at 7.12 lbs.

Last minute c-section (got to 7cm).

They said labour was tougher on both of us as induced, however I was struggling towards the end (5ft).

Sweep didn't do anything bad loose mucus plug. Was 2cm dilated at the app (Wed) and still 2 cm the day after the induction was started. I got another sweep at the induction, then two pessarys, Waters broke the following day and put on the drip which they had to turn off as my contractions then got too strong haha.

Obviously I'm no expert and can only share anecdotes. But I had two big babies with no intervention-short straightforward labours. I was offered induction for the second one- I was 41-but I agreed to frequent monitoring after 39 weeks and he was born at 40+3.

One of the reasons (once again, my experience only) I felt confident about letting things take their course was a lovely doctor I saw at about 36 weeks who felt my bump and gave me a huge grin and said "Ah, a lovely sturdy baby!" I still remember him-it was so nice to hear something so positive!

Just for balance my DC1 was measured as big and was indeed born big at 10lb 7. Still has a large abdominal circumference to this day although not overweight. So sometimes the scans are spot on,

Congratulations! Really pleased things went well for you.
My first was measuring big and she was indeed 10.7 pounds. I was induced at 42 weeks (never offered a c-section). I had a forceps delivery but all went well.
My second also measured big. I agreed to be induced at 40 weeks but didn't want a c-section. She was smaller at 9.5 pounds ... no interventions needed.
My midwife sister tells me that so many women are offered unnecessary inductions and c-sections these days. There is a real fear of potential complications and repercussions, which I guess is understandable. But such a shame when women feel pressured to take these routes.