C section due to baby's size?

On the size thing, in my induction article a midwife shares this story:

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“... I was involved in a birth a few weeks ago where the woman was induced because of previous macrosomic (big for dates) baby. She had gestational diabetes with that pregnancy and previous shoulder dystocia (first baby, this was her 3rd). We attempted induction at 36 weeks and it failed. Induction was again attempted at 37 weeks which was successful – baby was only 2750g – hardly macrosomic! The ultrasound had estimated a baby weighing 3500g so it wasn’t even close. I think if she had that baby at the first induction attempt at 36 weeks it would have had to go into Special Care as it would have been under 2500g which is our cut off. Frightening.”

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On the size issue, sometimes I think that too much emphasis is placed on how big the baby is going to be - this is from my personal experience, but my first 2 were average 7lb-ers and then I gave birth to a 9lb 9oz baby girl. I had no idea she was going to be that big, I assumed she would be average again, or maybe slightly bigger because she was born at 41 weeks. I am glad that I didn't know she would be that big - I really think that if I had a midwife or doctor tell me that I was going to have a big baby and they didn't know if I could birth her vaginally that that would have seriously undermined my confidence. As it was, Matilda's birth was the best yet - natural, active labour and I gave birth upright. I still tore - but I also tore with Grace and like I said, she was an average size. But I can honestly say that Matilda's labour was no more painful or difficult than my first two - I had no more trouble pushing her out than I did my other babies.

I'm certainly no martyr, but maybe because I didn't have anything to go by I found my son's birth very easy. And he was nearly 10lbs.

If you want to have a c/s own it and thats fantastic for you to make that choice I might add, but weight IMO is not really here nor there. As its not the size of a baby that matters but the productivity of your labour, and every one is different. As my ob said to me he's seen a woman struggle with a 5lber and a woman breeze through a 10lber's birth, its all up to the productivity of the labour.

And the reality is too that ultrasounds (as stated) are not really that accurate.

BUT at the end of the day its your choice, each individual weighs up his or hers risks and goes with that. Thats all you can do. What works for one doesn't for another, and thats fine.

*hugs*
Cailin

I don't know how you gals can give birth naturally so easily; I found it the scariest thing in the world, I felt like I was going to die and cried and cried and went into shock and went mute - couldn't talk to the midwife when she asked me things...lucky nobody else seems to feel it like that hey! Then when I had an emergency c-section (second bub) I felt on top of the world and couldn't stop smiling and chatting - I always wondered why but having read what someone wrote in another thread I think it was something to do with the drugs in the spinal block....

As someone who has recently gone through having shoulder dystocia, I am strongly considering a c-section next time if it appears that i am going to have another large baby.

My baby was macrosomic, over 4kg and his head came out, but then his shoulders wouldn't. After three manoevers he was out, but had to be resussitated. It was frightening and life changing, it is not something I would want to experience again. He is very lucky that he didn't get nerve damage as well. I was in optimal position when it happened, I was birthing on my knees leaning over a bed. I paced my whole labour and kept upright, I actually didn't even sit down at all, let alone lie down.

He was in the same position as my firstborn (posterior) but my firstborn was over a 1kg less in weight. I birthed his shoulders fine. I have read and been told by both the midwife in attendance (I did not have a dr there until the emergency happened and one rushed in) and OB that his size contributed to the shoulder dystocia.

Articles like this on emedicine

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Neonatal: Macrosomic neonates are at risk for shoulder dystocia and birth trauma. This risk is directly related to neonatal birth weight and begins to increase substantially when birth weight exceeds 4500 g and particularly when it exceeds 5000 g. Brachial plexus injury is rare, with an incidence of fewer than 2 cases per 1000 vaginal deliveries. This risk is approximately 20 times higher when the birth weight is more than 4500 g (McFarland, 1986). Mulik et al reported a higher incidence of NICU admissions for neonates with a birth weight higher than 4500 g compared with newborns with a birth weight of less than 4000 g (9.3% vs 2.7%). Risk of shoulder dystocia was 10 times higher in the larger babies (4.1% vs 0.4%).

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is one such one that refers to size being an issue with shoulder dystocia. In fact, if you google shoulder dystocia causes, there are many articles that come up indicating that a large fetus is a risk factor.

I want to know for my future babies, can all these articles, dr's and my midwife I had be wrong? I mean, it makes perfect sense that a large fetus will contribute to a shoulder dystocia risk. Yes, many women can and will birth a large baby with no problems, but someone like me may not. I have a partner that is over a foot taller than me, he is a large person, I am small. So surely there can be cases where a women's pelvis is just not big enough?

I'm not a midwife or doula, I'm not trying to argue, but I'm someone that went through shoulder dystocia and it is frightening and horrible. I have a big fear of stomach surgery due to a botched one a few years ago, but seeing that happen to my baby was far more traumatic than surgery which is why I will opt for c-section if having another large baby and I know this will be suggested to me by OBs.

Tara, I hear many women say the same thing about dystocia, it can be a very frightening situation... so no arguments there. Shoulder dystocia is a positional thing and less likely if you have an active labour, and I have not met someone who has had it twice... but of course you need to weigh up the decision for you as it's a very emotional one. Fwiw my second was a pound lighter than my first.

Exactly the same reason we are all here Brooke, to share experiences. Since we're asking what makes you qualified to contribute too?

Brooke, if you dont like listening to birth attendants, or should I say, me, then perhaps you will listen to what other mothers are saying. Try THIS. I am not the only one lovey but perhaps you have a problem with authority or something. Everyone else seems to be able to have a civil discussion here.

If you don't like the theme here at BellyBelly then please, go elsewhere, you have caused enough trouble.

Brooke, there is a world of differance between telling women 'not to listen to thier obs' and encouraging them to educate themselves in order to recieve the best possible birthing outcomes for themselves. I would have thought that you were intelligent enough to understand the distinction...

Tara i'm sorry you had such a frightening experience :(

Size DOES contribute to dystocia but i think the problem is that many Obs suggest ALL big babies will become stuck and overdiagnose which babies are actually big, whereas of course as your figures show, the chance is less than 1 in 20 even for big babies - that could mean 95% of c-sections for possible dystocia were unecessary, even more when you consider that some babies are incorrectly diagnosed to be macrosomic.

If both your babies were posterior this would have been a contributing factor in dystocia risk. Having 2 posterior babies would maybe suggest that there's something about the inside of your pelvis that encourages bubs to settle that way. Would it be worth, next time, having a chiropractor work on your pelvis during late pregnancy to try to help bubs get into an occiput anterior position? There's a method (Bradley?) which has good success for a lot of women. I think Spinning babies website has more info in that. If this failed and bubs was still posterior at term you could always opt for the ceasar if you felt it'd be safer? It sounds like you did everything possible during labour, i'm pretty sure i'd consider caesar in your position if i'd tried everything and i was having a big still-posterior baby at term.

B456 i don't know the answer to your question. I only know that the Ob who told me my baby would die if i homebirthed had nothing to lose by saying it and the midwives and doulas who told me we'd be just fine had nothing to gain (i wasn't paying any of them, it was all NHS and the doulas were lovely women on here and 2 scottish doulas i emailed with for a while, i didn't have a doula attend my birth). Looking at the statistics the midwives and doulas had likelihood on their side, but no doubt that ob had his reasons too. Obs are in the unfortunate position of seeing many births go wrong, as the ones which go easy are attended by midwives or occur before the ob arrives in the labour room, and because when something good happens you remember it for a while, when something bad happens you never forget it. Of COURSE if you see women suffer everyday or every week or even only once a month you're going to be more cautious but sometimes this caution spills over into not believing a woman's body can birth, seeing potential tragedies instead of potential joys. This is not because they are bad people, it's because they have to pay insurance and see too many things go wrong to have faith. Obs are in a very important position of trust and it's important they don't abuse their power by misinforming. Education is the key. The figures Tara quoted show that less than 1 in 20 very large babies suffer dystocia, and fewer than 1 in 10 very large babies end up in NICU, If 5% get stuck but 10% go to NICU then logically half of those in NICU had nothing to do with dystocia. We don't even know if the NICU group were all vaginally birthed - some could easily have injuries/problems from a caesar birth.

Women need to be properly informed about pregnancy, birth and risk, properly cared for through pregnancy (including help with optimal foetal positioning to ease the way), and properly supported physically and emotionally through birth, be it vaginal or surgical. When these things are happening for all women perhaps we will hear less stories of those who have suffered terrible emotional trauma during childbirth only to find afterwards their suffering was needlessly inflicted.

Bec

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So long as those birthing outcomes are what are advocated here, isn't that right ;)

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You've been a member here for long enough to know that the birthing outcome we advocate is empowered, educated and happy Mums birthing healthy babies :)

Thanks for your great post Tara - it is really helpful to me! :clap:

Also, I have the issue too where hubby is a foot taller than me and I am of small build and I'm sure that has something to do with my baby measuring big for me and for my gestation. I'd love to feel guaranteed I could safely birth my baby naturally but I can't feel confident of that, so will let the ob do all the work getting her out in a c-section.....

Here's my experience.

I had no idea how big DD was going to be. i had a 5hr induced labour(due to PE) at 41 weeks. I couldn't push her out(mainly because no one told me how to push!) so they used the vacuum exctraction after 1.5hrs, which ended in a shoulder dystocia. She weighed in at 9lb 5oz. No pain relief either. I was told to have a c/s next time as she was apparently too big for me.

Fastforward to DS's pregnancy. I had a scan at 36 weeks(due to others reasons) and he was measered at being 8lb something. This scared me a bit because of my pervious experience. I was booked in for an induction at 39w4d but when i got to the hospital i was already 3cms dilated so i was sent home. The next moring i went into labour. He was born 37hrs later(had a stop-start labour so was only 14hrs). I had an epidural(but turned off to push) so was also on the bed BUT DS slid out like a bar of soap with only 30mins of pushing. He weighed in at 9lb 0.5oz.

So DS was pretty much the same weight as DD yet he came out no troubles. I'm really glad i didn't listen to that OB who told me to have a c/s!

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So long as those birthing outcomes are what are advocated here, isn't that right ;)

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Have you ever noticed how many mods have had c/s? I think it's pretty close to half. Now if BB only advocated vaginal birth as you are implying here, why on earth would half of the moderators be c/s mums. Surely if Kelly had an agenda of only supporting vaginal birth & non-support for c/s surely none of her mods would have had caesareans????

Just my thoughts.

Sarah H-I agree with you about the ultrasounds. The technican who did the ultrasounds for both of my boys said that they estaimate up by a 1 pound.

Berry,

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I have the issue too where hubby is a foot taller than me and I am of small build and I'm sure that has something to do with my baby measuring big for me and for my gestation.

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My SIL is 4 foot 9 and my brother about 5 foot 8, the whole way through she was told she was having a big bub. The fact that there sure wasn't as much room in her body for bub to stretch out showed with a nice round tummy. Bub was a big boy, he was born at 4.04kgs. She did an awesome job, no epidural, gas for the last 30 minutes and not a graze in sight.

My other SIL is tiny, she is 5foot tall but only a size 8 (well, she was back then) my brother 6 foot 2, she went on to birth 2 little girls, who were both only around the 6 pound mark. I truely believe that your body will only grow a baby that you can birth. It will only grow what it can fit inside of it.

At the end of the day though, if a c section is truely what you want, don't feel like you need to justify your decisions. It just makes it sound like you aren't confidient in your own decisions.

Brooke, haven't seen you around in ages. Hope you and the kiddies are going well.

Brooke I did not get your email so you will have to resend it. Just like another member who recently went off the deep end at me for not responding, when I did, but her email had problems, I would appreciate the benefit of the doubt.

Can you tell me where I have implicitly stated for women not to listen to their Obs? Women need to listen to them, then educate themselves or get a second opinion and make their own choice, because I think it can be unfavourable to let an Ob call all the shots. If thats how a woman prefers to do it then fine, but the majority of the women here come to BB and/or love BB for the other side, the other options and learning. You don't want to do this, so hence I suggest the many other sites. This is BB and this is how it is and will always be, different from the others. It may not benefit you and I admit it will not be the place for everyone, but it has benefited a heck of alot of women.

I work closely with some Obs, one I speak to over the phone every now and again and he recommends me to all his clients and asks for my fliers. I have nothing against them and we are lucky to have them. But just like going to the doctor and getting diagnosed with things, people tend to get online and research, so what is wrong with doing that for pregnancy and birth? I'm not forcing people into anything, just showing them another side to consider so if you like one sided decisions then this is not the place for you. You will get one side from your carers, you will get some in agreeance on BB and you will also get other options. Its not like I am repeating what people already know... its something different. Anyways, I shall bow out now.

I don't think anyone has said don't listen to your ob. Just to get second/third opinions and research yourself.
If a doctor told me my almost two year old son needed major surgery I wouldn't just say sure, okay, you know best! I would look into it myself, find other doctors, research everything I could, in my opinion it is certainly no different to this baby just because they are still inside me.
The point of these discussions I think is to empower women to make up their own mind, and don't just take your obs word for it. If you look into it, make your decision and know you are doing the right thing then good for you, you don't need to justify your decision to anyone. But obs are not the only people who assist women in delivering their babies. There are many experienced (even more so, imo) midwives, especially private ones, who have a far different opinion on many things that obs will just schedule a c/s for.

Okay... I don't normally get up on my high horse about this, but this has gotten me quite riled up. I went away and thought about it, and then came back posted, deleted my post.... and now I'm back. We'll just see if I hit send or not ;)

When I had Matilda, my pregnancy was fantastic, no one mentioned anything about c/s or induction. When I hit 14 days post EDD I went in to be induced. The registrar at the hospital said she couldn't do it & sent me home. The midwife had to explain to me the reasons... An OB phoned the next day to say that I needed to come back for monitoring straight away, no explanations. Again, when I got there the midwife explained to me what was going on. Then an OB walked in, read the trace, told me he was doing an internal exam... did it and then said "your options are c/s tomorrow or daily monitoring for 2 days and then hopefully you can be induced". He asked my decision... I told him I had to think about it & he walked out in a huff. The midwife again explained what was going on, Matilda was no where near the cervix, they couldn't induce me but the concern was about placental function at 42 weeks. Daily monitoring would hold off the c/s and induction for a few days but if she didn't engage we would have to have a c/s. I was happy with the explanation and chose to wait a few days and try for a vaginal birth. Throughout my experience with induction, labour and c/s the OB kept telling me what was going to happen next, no explanations, no choices. And minimal contact. Once I was in theatre and my body was in shock and the OB kept telling me to keep quiet as I was screaming that I could feel it... I lost faith entirely in OB's. They are trained surgeons. That is the basis of their education, so of course they feel more confident with that choice. They are only human.

I don't put MORE trust in midwives than OB's but I do have faith that they are caring for me and my baby and not just themselves. I put even more choice in someone that I have asked to be by my bedside & who is somewhat educated on birthing.

With Jovie I was told when I hit 41 weeks that I would have to be induced. Why would you induce a VBAC?? Only to increase the rate of uterine rupture?? It didn't make sense, I voiced that. I was told I was putting my babies life in danger by waiting, I asked why? I was told " you just are". What would you do "oh whew,.... if you say so" WT???? I read, I was educated and I asked questions. I have friends who are well informed & educated in birthing, I phoned them from the hospital. I had a scan and everything was fine to continue but apparently I had a huge baby, so I was told to have a c/s straight away as the baby was too big to birth vaginally. Luckily I heard women's stories and actually know that they get their measurements from bone length in the leg & not from width of shoulders. I don't think I could have gone through the trauma of c/s again.... for me it was an awful experience so I didn't want to do it again... Jovie was no where near the size they estimated, just tall.

Please be educated and make your choices accordingly. OB are well trained in what they do, and what they like to do. Midwives are well trained in a different aspect of birthing and doula's again are trained differently. Choose your birth attendant by whom you trust to be by your bedside & read & be informed. If you choose a c/s, great its your choice and you have made it. If you choose a VB, great its your choice and you have made it.