C section due to baby's size?

Ok... just my 2c worth on this... and I am in NO way arguing ;) just my opinion...

I don't want to get off the topic which was c/s for big babies.

BUT, I had a pretty full on birth experience with Matilda which resulted in an emergency c/s. I felt as if all my choices had been taken from me during birth, and that I wasn't able to make informed decisions at the time of labour due to lack of support... I was "told" what would happen next & I would make a decision on that, often saying "No". But it was like I was strange by not agreeing with everything that was said.

This pregnancy I have had support and keep being encouraged but only from outside sources. The hospital's policy tends to be anti VBAC. Not in words or statistics, but you have to fight little battles along the way to get your birth plan across and in place. I will let you know in a few weeks how I go ;).

So IMO some OB's are willing to look after the women, some are more interested in their statistics and looking after the baby. I think the most valuable OB's are the ones most interested in looking after both.

If a woman is told by her OB that her baby is going to be too big and that she will not be able to birth him/her vaginally, so she agrees to have a c/s, then finds out at the end that the baby is a small or 'average' size, then yes that does go against her best interests. The baby could have been birthed quite safely vaginally (not taking into account any unforeseen complications), but the mother was not given the chance to make an informed choice. And even if the baby does turn out to be large (ie. over 10lb), there is every chance that the mother could have birthed him/her vaginally quite safely, but she was not given this option because the OB decided for her that it was not worth the risk, and didn't give her any information that might support the opposite view that a vaginal birth would be fine. The OB is entitled and obligated to give the mother his (or her) opinion, but he (or she) is also obligated to present all sides. And this is basically what it comes down to - informed choice. Have a caesarian by all means, if that is what you want and you have made that decision fully informed of all the facts. And while the aim of any caregiver should be to ensure the safe delivery of the baby, this does not always mean the mother's interests aren't important. Birth is a gamble, no matter which way you do it - no one can guarantee you 100% that you or your baby will be safe at the end. Like Christy said, the best OBs are the ones who are willing to look after both the mother and babys best interests.

I agree with every thing that was said and I know I'm late on reading this but I had a c section done with my second son back in May of this year, not only because of his size also he stayed at zero station for a long time. After 20 hours of labor, I welcomed the surgery because I stated to my doctor when I was 37 weeks that due the diabetes and my oldest being 8 lbs 3 oz, his shoulders being stuck and the doc having to use the vaccum to help pull his head out, that I was concerned that it would happen again and that baby felt bigger than my oldest.

Jeremiah was 10 lbs 2oz. I went in on my due date which was the 18th of May, they had me schduled to be induced on the 25th. I physically and emotionally couldn't wait that long.

My concern now is having another baby that may be a big baby via VBAC. Should avoid having another entirely?

Funny how these topics pop up again! Deeva, shoulder dystocia (where the shoulders get stuck) has nothing to do with size - it's a positional thing. It's unfortunate that they just get into a bad possie. Mother nature hasn't created such hurdles as babies with big shoulders or we wouldn't have survived as we have now :) I don't know anyone who has had this twice and some women go on to have smaller babies - even Lucy had this happen, maybe she will post!

I have lots of articles on the main site about babies and size, have a read:

Pelvises I have known and loved
Small pelvis? Here's some truths...

Make sure you keep off the bed, move around and look into optimal fetal positioning. There are manouvres to help shoulder dystocia without the doctor doing the more major things, like the gaskin manouvre, but often the doctors don't know these... so having a private midwife can help or just for support to keep active etc you might like a doula to help.

Thanks for the tip on the articles about pelvises! The on-call doctor who delivered my 2 1/2 month old, said that my pelvis was wide enough to deliver my then 10 pound bundle it was that he just didn't want to move.

I think my concern is more with my PCOS, having diabetes with both pregnancies and now the c-section, should I consider (even WHEN I lose 105 lbs ;) ) getting pregnant again avoid another rough pregnancy. I guess this some that I have to do the "wait and see" approach.

I want to jump in here now, I am getting to stage of trying for another baby now, but after my very tramatic birth experience with Noah I am torn between trying a VBAC because I want 4 or more children or just opting for the c/s because I have never known pain like that before, considering I didn't really get many contractions before my water broke and around the time I got induced for a stalled labour he decided to go from optimal positioning to back to back. The OB who did my c/s said I would have died in the old days because there is no way he would have fit, is this a scare tactic?? I regret my c/s all the time but after 2 days I could not go on. Must get around to posting my birth story, just don't want to scare people...

I have been told my baby is measuring very big and am having a growth scan this morning to get a more accurate estimate of the baby's likely weight. I had already decided on a caesarian but have to say if I find out the baby will be very big that will reinforce my decision to go the surgical option.....

Sarah, read those two articles I posted above, they will help you decide if you think it was a scare tactic. Sometimes baby wont fit not because it's size but malposition. I have had a client need a c/s due to malposition, no way the baby was being born with it's head in the awkward position it was. But that doesn't mean every baby will get into a bad possie. In fact her waters had been ruptured for days and often this happens - the baby has no water to help with buoyancy and seems to have more trouble getting into the right spot. More reasons to leave the waters alone.

I had a stalled labour at 5cms and was then augmented with the drip. It was hell to say the least and I could not have done it without the epidural. However, my second birth was a wonderful, drug-free speedy birth, I got into hospital at 9cms and pushed him out.

Don't let bad experiences put you off too much hon, when specific circumstances played a role - birth is not always like that and first births can be a bit of a bugger sometimes! Get yourself some good support, keep off the bed, learn about your pelvis with the Pink Kit and go to some good independent childbirth education classes. Birth doesn't have to be that way and it often isn't with a little research and help.

Sarah, one more thing. I would be all in favour of trying a VBAC (I've had two!) but I want to add that, even if you wanted 4+ children, you COULD have them all by caesarean. Being told that 3 is the limit is itself a scare tactic.
I read an American book years ago which talked about this. It was written by a doctor, who opened by saying, "There is probably no limit to the number of caesareans a woman can safely have. Ethel Kennedy, for instance, has had eleven of them." (Bobby Kennedy's wife, SIL of JFK--her first had to be delivered by c/sec, during the time when the classical vertical incision was done, so it really was not safe to try a VBAC.) He then talked about how most OBs feel that 3 c/secs is "enough" and would offer a tubal ligation at the third. Three is an arbitrary number, based on feelings (or what some call GOBSAT--good old boys sitting around tables). No one would jump for joy at having 11 caesareans (!!) and there is some increased morbidity with multiple abdominal operations, but most of the increased risk applies once you have the first caesarean. In other words, women having a c/sec bear greatly increased personal risks over a woman having a vaginal delivery. However, a woman having her 2nd caesarean does not have twice the risk, a third does not have 3x the risk.
Whether you end up with all caesareans or go for VBACs, this should not have to limit your desired family size. A woman recently delivered vaginally at the John Hunter in Newcastle, who had had FOUR previous c/secs and two normal deliveries. The staff specialists were comfortable with this as long as the woman was well informed. If your pregnancies and labours/deliveries are generally stressful and difficult to recover from, then that would certainly be an issue in deciding your family size. But don't be hung up over three as a magic number. HUGS--I know this is difficult. Post that birth story! I'd love to read it.

Berry, I hope your scan has gone well. I understand your feelings and I know you've already decided on a caesarean, and that you are well and fully informed. I hope the scan is reassuring and that you enjoy having another look at your bub! If it shows that bub is big, please do not stress over that. When DD was born prematurely a year ago, I had a scan done less than 12 hours before her birth which suggested a fetal weight of 2300g. In fact, she weighed only 1800g. These scans are useful, but not terribly accurate. They are most useful to find something that is widely variant from normal. Mine was done by the head of maternal-fetal medicine at the local teaching hospital, so I can't blame it on someone who didn't know what he was doing!

Castle, there have been lots of studies of late about multiple c/s and the complications dramatically increase with each one... (mum and bub) I will see if I can find the link, but it's in the new studies section in the pregnancy forums. These studies conclude that women planning c/s should seriously consider this if they want bigger families.

Here tis:

Repeat C-Sections Raise Risk of Maternal Morbidity
Reuters Health Information 2006. © 2006 Reuters Ltd.

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NEW YORK (Reuters Health) May 31 - As the number of repeat c-sections increases, so does the risk of bowel injury, ICU admission, and other maternal complications, according to a report in the June issue of Obstetrics and Gynecology.

In light of this finding, "the number of intended pregnancies should be considered during counseling regarding elective repeat cesarean operation versus a trial of labor and when debating the merits of elective primary cesarean delivery," lead author Dr. Robert M. Silver, from the University of Utah School of Medicine in Salt Lake City, and colleagues note.

The findings are based on analysis of data for 30,132 women who underwent c-section without labor in 19 academic centers from 1999 to 2002. "There were 6,201 first (primary), 15,808 second, 6,324 third, 1,452 fourth, 258 fifth, and 89 sixth or more cesarean deliveries," the investigators report.

The risks of placenta accreta, cystotomy, bowel injury, ureteral injury, ileus, postoperative ventilatory use, ICU admission, and blood transfusion of at least 4 units were directly related to the number of cesarean deliveries. In addition, both the operative time and hospital stay rose as the number of c-sections increased.

The rate of placenta accreta ranged from 0.24% in first-time c-section patients to 6.74% in women with six or more c-sections. In women with previa, the rates were much higher, ranging from 3% in first-time c-section patients to 67% in women with at least five c-sections.

The hysterectomy rate was lowest in second-time c-section patients and highest in those with at least six c-sections, ranging from 0.42% to 8.99%.

"Women planning large families should consider the risks of repeat cesarean deliveries when contemplating elective cesarean delivery or attempted vaginal birth after cesarean delivery," the authors conclude.

Obstet Gynecol 2006.

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I am a bit worried about the size thing and if that may effect me having to have another ceaser.... Jacob was only 3.950kg but I wouldn’t move past 8.5 cm dilated for 4 hours and then he must have got frustrated and turned posterior on me........then got more impatient and started to become distressed.... the little heart monitor was going spazzo!!! was a bit scary that part!! I was more scared listening to his heart beat than I was when they said if you don’t progress in 1 hour we will have to go into surgery!! I was just like GET HIM OUT AND INTO MY ARMS!! :D
This time around the first 32 weeks are normal pregnancy monitoring then in the last 8 weeks I am moving up to "higher risk" and are going to monitor if I will need to maybe have another ceaser or if I will be able to do it on my own......
At the moment I have been researching the episiotomies vs. a ceaser and I am sooooooooo in two minds!!! Maybe because I have gone through the ceaser I know what to expect but getting cut up the middle on the inside is looking a little more scary..... as I say that’s ONLY because I know what to expect with the ceaser recovery......

We will find out at the end I suppose :)
it doesnt help when in my case I have the hip size of a friggen 13 year old at 27!! :( Not that I am complaining ... but when it comes to child birth I am!

xox

Ok my scan today showed baby to be measuring 6lb6oz (2.9kgs) already, and I have just reached 32 weeks today (my ticker is a few days out!)....the ultrasonographer, like my ob, was saying gee it is lucky you have chosen a c-section.... I have read some scary stuff re c-sections but mainly risks to mum, which I can live with, as long as bub comes out safely!

I've heard that ultrasounds aren't very accurate in determining the size of babies. More times than not they seem to predict bubs being bigger than what they actually are.

When I was doing research to decide whether I'd have a VBAC or elective c/s next time I saw a lot of info about the risks for mum, but really there are a lot of risks for bub too. The thing that worries me about the risks for mum is that what happens, worst case scenario that things go wrong. I need to be healthy & able to look after my baby. I was thinking of poor Cherie who had an issue with stitches & she had to be in a wheelchair for a few weeks after the birth of Jambin. I can't imagine going through something like that & having to look after a newborn as well as Zander. It's just scary.

Kirstie I hated the monitors, drive me mental. Every time there was a slight blip that was out of tune with the rest I would get worried. There's lots of evidence to say that if mum is stressed then baby will become stressed. Maybe without the monitors you would have been ok? It's possible that they were stressing you & therefore causing bub to become distressed as well... Just a thought.

2 days before Jovie was born I had a scan which measured her at 10lb 11oz. She was born 8lb 13oz. The problem with getting an accurate weight on a scan is that they measure the length of bones & then it "estimates" a weight accordingly. This doesn't take into account tall babies. Both my girls measured above on fundal height & weights prior to birth.

Labour doesn't stall because the baby won't fit out, there are so many other reasons why labour can/will stall. The size issue is so rare.

I'm due to be having a baby at the end of the month and I've been diagnosed with Gestational Diabetes. My sister who's a midwife was positive that I'd be induced at 38 weeks (a complication of Gestational Diabetes is that they can be huge babies). Luckily through scans, measurements.etc. it looks like I have a normal sized baby. Not once has any health professional tried to get me to opt out and have a c-section the only time it has been mentioned is when making reference if an emergency c-section is required - apparently ur twice as likely to need one if you're induced early. I think the opinions of the dr's really varies according to their experiences. My sister-in-law delivered baby number 3 vaginally last year he was 10 pound 10 (4.83 kgs).

Kelly, I know about that report. My point was simply, that although there are increased risks with each caesarean, the BIGGEST risk variation is the difference between a normal vaginal birth, and a c/sec in the first place.
Although the risk of complications increases with each caesarean, having a 3rd caesarean is not 3x riskier than a first one. When it says the risks increase "directly", this only means that when one number (no of c/secs) goes up, the other number (for the selected complication) does too. It doesn't mean that the numbers double at each event.
Certainly I don't think that anyone should light-heartedly plan on having a large family by caesarean. But neither should they assume that it's impossible. I have discussed this question of risk at length with my OB, who is at a teaching hospital and is also a biostatistician. (BTW...LOL...I am not planning a 5th! but I wanted to know 'just in case'.) He was emphatic that with careful management, family size does not have to be limited. However, he would also strongly support VBAC--and so would I.

Given my baby's estimated size from the 3D growth scan (5 weeks ahead, 6lb6oz at 32w 0days), my incredibly achey back and daily exhaustion, I'm going to request my ob do the c-section at 37 weeks instead of 38 weeks (but I'll agree to 38 weeks if she thinks its safer)..... I'm not going to be a martyr and squeeze a 10 pounder out through my vagina! LOL