Large baby concerns at 36 weeks and pressure over birth options

[3rdtrimesterwoes]

Not really sure what I'm looking for but maybe some positive stories or advice or I don't really know.

I'm 36+4 currently. I've had a couple of growth scans as baby is measuring large - apparently 4.1kg at present.

I was supposed to have a consultant appointment after my scan, ended up with a dr who immediately told me a vaginal birth is far too dangerous and I need to book in for elective c section I have no other option. I am under the mental health team already and to be honest I am terrified of the surgery. After
I burst into tears dr went to speak with consultant came back and said, actually don't worry about what I said consultant said vaginal birth is fine, we will book you in for an induction. For the next 40 minutes we kind of went back and fourth over everything that would probably go wrong and how there is a high chance by choosing a vaginal birth I would likely end up in an emergency c section. Then to be concluded by saying really not to worry because the scans aren't accurate anyway so the baby might not even be that big. See you in 2 weeks.

I've not slept, eaten or been able to calm down since Friday. I don't know what to do now, I don't know who I can talk to actually get some proper advice on what is best for me and the baby. My community midwife won't see me until day of induction as she is full i have already tried, they have ruled out another scan before birth and said under no circumstances will they repeat that as measuring big is not a medical emergency, they have no available consultant appointments until after I am booked in for an induction.

Neither of my other two were small by any means 8.6 and 8 I birthed them both completely fine with no intervention or pain relief other than gas and air my body just did what it was supposed to do and I trusted it. I feel like every step of the way I have had all my choices and confidence in myself stripped away appointment by appointment. This pregnancy wasn't planned and anxiety is also high due to a missed m/c which resulted in a horrendous haemorrhage loosing over 2.5l of blood, emergency surgery and multiple blood transfusions. I'm trying to keep my cool and have faith in myself but I just can't right now.

It sounds like they don't really know and they're just weighing up the risks - but they should have taken your mental health into consideration. Do you need more information or more control?
Just to reassure you, I was advised to have an elective C-section for a similar reason, which is what I did, and DD came out 2½ weeks early, normal weight and no problems.

I don't really know, I think I just feel like the contradictory information has left me feeling so anxious about making the right choice either medically or for me. Then being told there is no one I can talk to until the day I'm due to be induced, it doesn't give me a lot of time to make an informed decision. I'm just now doubting everything and worried about making the wrong choice. I think part of me also just needs to be able to say it out loud to someone else to get it off my chest

I feel like if this was your first baby then perhaps all their risk warning etc would be most valid for a c section. But your body has birthed a baby, it knows what to do!!
They are right that this new 36 week scan is causing a lot of stress over supposedly large babies which then turns out not to be true.

i would be included to go ahead with a vaginal birth in your case and consider which week you would accept an induction (if any!) I think speaking to your midwife is good and perhaps a senior midwife. Stand firm on what you want and ask them what it would take to get you there (vaginal birth eg)

Sorry you’re feeling so confused and anxious. I felt like this too when my 36 week scan showed my baby was big, the consultant thought 11lbs plus and suggested a c-section. It was my first baby and I was hoping for a water birth and after talking to friends and family decided not to have a c-section. My baby was 8.8lbs when she was born.

You can insist on speaking to a consultant before being induced if you are still feeling unsure about what to do.

I jumped from a 7lb to a 10lb baby, both induced both delivered without further intervention and I’m very petite (hips deet height). The scans aren’t always that accurate.

I did look absolutely huge though and they kept telling me baby wasn’t big.

I would plan for vaginal and prep for a c-section - can you research that. So ask for an epidural which could be switched to spinal block, make a note of when you eat etc. Find out if you can have another scan on the day to check position as much as anything.

When did you go into labour with your older DC? I do wonder if the Dr hadn’t read your notes before spouting off about the dangers. You have had 2 text book births of decent sized babies which also gives you the huge advantage of sensing if something wasn’t “ok” third time around.

It might be fine anyway. My first was 8lb and a difficult vaginal birth. Second was 10lb, induced as two weeks late, totally straightforward 2 hour vaginal delivery.

When I had my second I was placed into a clinical trial as at that time (roughly 5 years ago) there was no evidence on what was best in cases of large babies.

The group was split - 50% to go naturally and 50% were induced early. I got the natural set, but argued as was induced a week early. All went pretty much fine - a bit of stitching needed after but other than that all good.

Not sure if the results of that trial are out yet, but at one point a younger doctor told me I needed a section based on size before the consultant stepped in and told me there were no guidelines/recommendations suggesting that was best at all. I also didn’t want a section but was happy for an induction, which went smoothly.

May be worth looking into that trial if you can find it ?

Sorry about this. Please remember growth scans are notoriously inaccurate. Look at Sara Wickham's website please, she has so much good advice which is evidenced based, including about induction. . Consultants are typically very risk adverse. I had a 9lb baby (4kg), my first, went into labour naturally at 41 weeks(I refused any induction methods) - did end in forceps delivery but was all fine.

Thankyou, I've been doing my own research all weekend, and the general consensus seems to be that most people get on fine, I will hopefully get to speak to a midwife weds!

both induced
1st - heart rate spiking and dipping over period of hours
40+1 pessary, waters broke and contractions started within half hour - born 3.45 hours later 8lb 6 bit of a tear but nothing substantial

2nd - waters broken 40 weeks contractions started immediately born 1.45 hours later
8lbs exactly no tear no intervention

first was resuscitated but it was very quick I think more like just needed a bit of help to get going.

Thankyou I will look today! I have induction booked in to "save the date" but I haven't committed to it yet, I am going to hopefully see a midwife weds to have an exam to see how my cervix is looking and if we can just gently get things moving we might but I'm really trying to just listen to my body. It can sometimes just really get under your skin and make you doubt yourself!

Seems likely you will have a quick birth even with a large baby!

I've had two big babies, 9 & 10lbers, and the way medical professionals speak around the size can be so panicking!

What gestation is your induction set for? It sounds like you've had two relatively straight forward inductions, I wouldn't imagine that this would be any different.

Questions to ask, if you get the opportunity:

• was the size a massive jump, and if so have you been tested for GD? E.g. were you 50th centile and now 99th?
• what measurements are bigger? They calculate weight by femur length times head circumference times tummy circumference. Tall babies can measure as big because of long legs.
• what position is baby in? If they're back-to-back OP facing, their head circumference will be bigger and harder to get out. If they're OA or right way, it's much easier.

Hopefully the midwife appt will be reassuring, and things get moving from a sweep.

I’m sorry OP, it sounds as if you met a very inexperienced doctor, maybe a junior registrar? Who really didn’t know what they were talking about! Clearly your body is efficient at birthing sizeable babies. Wishing you a positive birth and let us know how you get on!

My whopper was very long and skim, her femur on the 20 week scan were 95th centile or something ridiculous, especially when I am 5’. The last 2 were only slighter smaller.

Induction booked for 38 weeks exactly, I have managed to get a midwife appointment at the hospital to asses if cervix looks ready, and if they can do sweeps. If they can't I'll probably hold off

head measurement is basically dead on 90th
femur is between 75-90th
tummy is the large one at something like 98/99th

no massive jump as such, always on the larger size, checked 3 times for GD all clear

baby is head down, his back and bum is at the front so I guess he would be facing my back if that makes sense so I think hes in the ideal position. Defo feel like he will be long, both my others were long one was chunky and long the other was skinny and long

It sounds like you'll fly it to be honest. If he's already head down, in the right position, and in proportion, with no GD the big is no cause for panic.

One thing I'd also ask about is induction methods. Not sure if they mentioned but the gel is out of stock. I think you mentioned pessary & broken waters before, but just to make sure you know what method they'll go for.

You sound really informed & you've done this twice before. You'll make the right decisions!

Every single one of my babies were over 4kg.

My second was 10lb and my 3rd was 9lb 8. They were born at home!

Unless there is an issue with your pelvis I can’t see the issue. Although I don’t believe this bollocks of “your body won’t produce a baby too big to birth”

Thanks, ☺️ yes he did say no gel he's put a line through that in the patient leaflet, I've been really trying to keep my cool and just trust in my body.

I think it's just that niggling anxiety, and when some one(the medical professional) comes in and makes a declaration serious enough to make you worry about yours/baby's life to then go, ignore/forget I said that you'll be fine, you're just left feeling like, oh okay, I'm not just going to be able to forget that now you've said it

its funny, every piece of evidence I've found online, and every comment or person I have spoken to has said they had text book birth with 9lb+ babies.

there's nothing quite like a dr/consultant putting the fear of god into you though and then just casually telling you to forget they said that 🫪

I'm sure also lots of people have larger babies but because their bump didn't measure big they never had growth scans so wouldn't have known prior. Only baby I've ever personally known to get stuck was my nephew and he was under 7lbs 🤷🏼‍♀️

I’m sorry that you feel you have been given conflicting advice. It’s really good that you’re seeing your midwife on Wednesday. I always found midwives the most helpful.
All my babies were huge and the only one that caused issues was the first due to being back to back (he was still born safely). I agree with @Beachbeach that I would try vaginal but be aware of the possibility of a caesarean. I think that’s true of any birth. I often think the whole birth plan thing can set us up for failure. I always wanted a water birth and never got one but I appreciate how extremely lucky I am to have had healthy children.
Wishing you so much luck and strength. Please let us know how you get on. 💐

Mine are all in their twenties so it’s a while ago but they never measured big and I’m quite slight. The consultant assured me that my first would be 7lbs and he was 10!

I wouldn’t book in for a c section in your shoes. Growth scans are notoriously inaccurate and you have had two fairly large babies naturally already.
Try and take your mind off it, have a chat with your midwife to make a more sensible plan.
Maybe compromise on sweeps and induction earlier rather than later if you don’t go in to labour naturally.

for clarity, if you have an epidural in labour and it works well then it can be topped-up with anaesthetic strength stuff to provide numbness for surgery (an epidural 'top-up'). If you have an epidural but it doesn't work so well then it can be taken out and a spinal injection done if you need to go to theatre. If you don't have an epidural and need to go to theatre then a spinal would be the first choice regional technique most of the time. If a really urgent trip to theatre is needed a GA may be a safer technique than either. You cannot 'switch and epidural to a spinal' just by putting more stuff in (but if you're having a spinal that can be combined with an epidural catheter which can then be used if the surgery lasts longer than the spinal...which is not very often). Once someone has an epidural in for labour analgesia the usual advice is to not eat.