can we discuss c/s and "big" babies?

[lizajane]

i would like to talk to those who replied in the elective c/s thread (and any others, too) whose OB's said they had to have c/s because their babies were "too big" to deliver.

how did they know your baby was "TOO" big?

did they measure the baby AND the pelvis?

can the pelvic opening be measured?

were their measurements accurate or was your baby actually a few pounds smaller?

did you agree without any argument?

if you argued, how did your OB convince you?

has anyone successfully argued her way OUT of a c/s that an OB said was required? was delivery a success? did you end up with an emergency c/s or scary complications?

i know, i have a million questions and plenty of time before my babe (who might not even be big) arrives. but i am getting tired of the "hmmmmmmm" every time a different OB sees that my first child was 9lbs 9.5oz. COME ON! they thought schuyler was a 7lb baby the day he was born (not via u/s, though) and he was more than 2 pounds heavier! and i had NO trouble delivering him! so would i REALLY need a c/s for a 10 pounder? big babies run in my family (both sides) and no one has needed c/s since my grandmother had a baby with severe birth defeats.

[nathansmom]

>
>how did they know your baby was "TOO" big? my ob knew nathan was big. he was only 2 ounces off on the weight. of course my ob doesn't do csections for big babies but he does like to know what size baby he's looking at. nathan was 8lbs 14ounces.
>
>did they measure the baby AND the pelvis? didn't measure the pelvis as he delivers vaginally in most cases
>
>can the pelvic opening be measured? don't know
>
>were their measurements accurate or was your baby actually a
>few pounds smaller? my ob does u/s every visit for this reason. he says if you watch the size from the beginning you have a better chance of being accurate. as i stated above he was only 2 ounces off of nathan's actual weight.
>
>did you agree without any argument? my csection was an emergency csection so the big baby wasn't a factor in the decision. if you want i'll post the reason for the csection.
>
>if you argued, how did your OB convince you? didn't apply
>
>has anyone successfully argued her way OUT of a c/s that an
>OB said was required? was delivery a success? did you end up
>with an emergency c/s or scary complications? didn't apply
>
>i know, i have a million questions and plenty of time before
>my babe (who might not even be big) arrives. but i am getting
>tired of the "hmmmmmmm" every time a different OB sees that my
>first child was 9lbs 9.5oz. COME ON! they thought schuyler
>was a 7lb baby the day he was born (not via u/s, though) and
>he was more than 2 pounds heavier! and i had NO trouble
>delivering him! so would i REALLY need a c/s for a 10 pounder?
>big babies run in my family (both sides) and no one has needed
>c/s since my grandmother had a baby with severe birth
>defeats.

if you don't like the way they are already talking about a csection find another doctor. i wouldn't want to be fighting with them over this in the days leading up to my labor. last year my ob delivered vaginally 14 babies who were over 10 lbs. maybe you should find a doctor/practice that agrees with your views. my ob is in a practice but the other doctors are in agreement that they will follow whatever the patient and her ob have agreed to even if they don't agree. one of the other ob's in my ob's practice delivers most babies that are measuring more than 8 1/2 lbs via csection.

[LBW]

Big babies run in my family and my husband's family, too. So, I told my OB at my very first appt that my son was going to b huge. He just laughed. I was your opposite -- I WANTED a c/s! I started talking to the doc about having one about half way through. He told me to wait and see, that they'd have a better idea of the baby's size towards the end of the third trimester.

Well, in the week prior to delivery, I had two ultrasounds, all with different results. The one performed in my doctor's office was the most accurate (over 10 pounds), but he chose to go with the results of the one performed in the high risk clinic at the hospital. The doc there told me that they only recommend c/s if the baby is over ten pounds -- their u/s showed he was about 9 1/2.

The result of all of this was that I went into labor the day before my due date. 13 hours later I delivered (vaginally) a 10 lb 13 oz perfectly healthy baby boy. Pushing was really tough. I had an episiotomy and tore -- 4th/5th degree. Recovering from the episitomy tear was awful.

To this day, I wish the doctors had allowed me to have a c/s!

A side note - -big babies are terrific, aren't they? My son came out looking like a 3 month old! He was sleeping through the night and picking his head up almost immediately. He's almost 2 now, and the best thing that ever happened to me!

[toomanystrollers]

Geez, I think I would switch OBs too!! I mean you already vaginally delivered a whopper - what's a few more ounces! My 10-lber was the easiest delivery ever :)

[amp]

I had a very large baby...10 lbs 9 oz. I had ultrasounds throughout the pregnancy to monitor a dilated kidney of the baby and they monitored weight throughout. My OB told me on my 1st appt that I had a "small pelvis". I don't know how she determined that, but that's what she told me. The due date for the baby was regularly predicted to be about 3 days to 2 weeks earlier than my EDD by LMP. They attributed this to weight/size of Jake.

At my last US, in the 39th week, they again estimated fetal weight. The estimate was 10 lb 11 oz. They were 2 oz. off.

When my OB read that, she told me that she highly recommended a CS due to large fetal weight/size and reminded me of my "small pelvis". She also told me she would be more than willing to allow me to labor if that is what I really wanted to do, but told me that she did not think it would end the way I'd hoped...with no trauma, serious tearing and a probable CS in the end.

I trust her implicitly, and after some discussion, questions and more than a few tears, I agreed to schedule a last minute CS. We scheduled it for 6 days later. I went into labor about 4am that morning, but went ahead with the CS and had a baby in my arms by 10:30 am. Recovery was very smooth. I anticipate a CS for the next baby, if it is large, and although I know there is lots of disagreement over this, I will likely just tentatively plan on a CS and will be ok with it if that is what is ultimately decided. That's just my 2 cents.

[lmariana]

Before I even got pregnant, my OB had measured my pelvis at a previous appointment and said that it was REALLY small and any baby over 7 lbs would probably not fit! 7 lbs is not big, in my opinion!

Anyhow, she was very supportive, never encouraged a c-section, even though at all my ultrasounds I was measuring 2-weeks ahead. We ended up inducing 1.5 weeks early to avoid a really large baby.

I went in for the induction already dilated 4 cm and effaced 30%. They broke my water first (worst pain ever!), then let my labor kick in naturally, which it did in about a couple hours. The contractions were pretty puny, so they started me on Pitocin. After about 2 hours on that, my contractions were making my head spin in circles, so I got the epidural. After that kicked in, they checked me and I was already at 8 cm. A few hours later we were pushing, which lasted 2 hours.

I pushed for 2 hours with no progress. My OB gave me the option of going straight for the c/s or trying a vacuum. She said they could do the vacuum without having to cut me, so I gave that a go. No luck.

By this point, I had been in labor for over 12 hours and was perfectly okay with the c/s decision. I felt we had both tried everything in the book, and this was just the way it would be.

Gabriel was born at 1 AM, he weigh 7 pounds 13 ounces and was 21" long...with a huge head! I had a good recovery, but was so sore from all that labor and pushing, that I could barely move the next day.

Next time, I'm going for a scheduled c/s.

I'm thinking that if you've already successfully delivered a 9+ pounder, there is NO reason to suggest a c/s out of the fear that the baby will be big. I would just have a little heart to heart with your OB, explain your birth plan, and ask for his/her support. If you don't get their support, then you know it's time to find someone else!

Mariana
www.heinzandmariana.com
Mother of Gabriel, 08/14/2003

http://lilypie.com/baby2/030814/1/5/0/-5/.png[/img] ([img)

[lizajane]

the reason i haven't really considered (yet) looking for another OB is that my practice is one of TWO that "everyone" in town recommends. i know SO many women who used my practice. (including sonia- martiesmom2B, who did leave, but just to follow her fav. OB to another practice.)

so the reason i haven't looked at the other practice is because it delivers at the high tech (super fab NICU that i don't think and i certainly hope we will never need) not-as-warm hospital. all high risk pregnancies are sent there. but since i am totally normal, i don't NEED to be there. and my hospital is the warm, friendly, home-like hospital that has room service style food, a laid back visitor policy (but strict security) and is closer to my home.

[tinkerbell1217]

Well, with my elective CS with DS, they estimated him to be around 9 pounds about a month before his due date and he ended up being over 10 pounds. So, I think they were right on target. With DD, they estimated her to be about 8 pounds and of course she was my first so we had no idea how I would labor and what would happen, but my OB never said I looked small or anything. Turns out I was too small for her and she was 8 pounds 5 ounces. She literally got stuck and I could not dilate anymore. After the CS, my doc said no more L&D vaginally for me. He said my hips are not very wide, although I tend to disagree with him on that. So, weight wise, both times they were right on target, but I KNOW I never could have had a 10 pound baby. I am 5'2" and it was rough carrying him at all! Let alone giving birth vaginally! CSection me anytime!

[pritchettzoo]

I had a failed induction and wound up with a c-section. Gracie was 10 lbs, 1.3 oz. They knew she was huge and the u/s estimates were right on. My doctor (based on an internal exam) said (with great surprise as I am not a small person) that my pelvic opening was really tight. The other two doctors that I saw in rotation near the end all said the same thing after the internal check and all seemed surprised. I was surprised--I had some freaky relative at a family reunion announce to the entire table I was sitting at that I had great birthing hips. I was 13 and wanted to die of embarrassment!

Gracie's head never even engaged in the birth canal, so I really don't know what would have happened. I do wonder about it, and I'm really going to research VBACs when the next one comes around. I don't consider what happened to be an elective c-section, but I was given a choice of resting and seeing if Gracie's stats improved and trying the induction again in 12 hours or going ahead with the c/s. Based on the doctor's advice, I believed it was in our best interests. I really hate feeling like I have to justify what happened... I trust my doctor and believe she gave me good advice. I also completely understand that her advice, ANY doctor's advice, is going to be colored by their need to protect themselves. If the current ACOG guidelines say X, then by not following X or the usual and customary practices of their area, they are exposing themselves to liability should something go wrong.

Have you talked to your primary doctor about your concerns?

I saw one recommendation (doing cursory research) that said one way to help a VBAC is to follow the dietary guidelines for gestational diabetes. Even if you don't have gestational diabetes, a borderline/undiagnosed case can cause a larger baby. I figured I would look into it more (for myself) when the time comes--I don't guess eating balanced meals and watching my sugar intake wouldn't hurt regardless! Disclaimer: That is a very rough and ragged remembrance of the article. Do not take it as the gospel truth. Do not take it as medical advice. I am not a doctor. I do not play one on tv... ;)

What about hiring a doula to be a labor advocate? Just brainstorming here...

Anna

[jubilee]

I didn't have a c/s- my OB was confident that I could deliver a second big baby. (#1 was 9lb 13oz, #2 was 9lb 9oz). It was a surprise that my first son was so big, but the second time around we suspected it all along. I am 5'3" and was a size 6-8 before getting pregnant, so I believe mommy's size doesn't make much difference. Anyway, my doc was sure that since I had already delivered such a big baby that I certainly could again. And he was right, and in fact it was SO MUCH easier the second time. The first time my son had to be vacuum extracted out, but the second time the doc had a little extra work getting out the shoulders, but all was perfectly normal. I'm sure you'll make the best decision for you and baby!

[stella]

Whoa!!! 10.13? You are some woman!!! I am in awe!

[nathansmom]

Well if it was me I'd be looking for another ob. If they are giving you a hassle now whats it going to be like at 36 weeks? Unless you want to do a csection. If your trying to avoid one it doesn't sound like your ob is willing to try.
I didn't think I would need a fab NICU either but the complications Nathan and I had I was very glad to have it. You just never know what will happen. However the hospital I delivered at was a very warm hospital so maybe I was just lucky.

[tippy]

FWIW I had gestational diabetes with ds (mild) and toward the end they were monitoring me 3 times a week. I had so many ultrasounds I lost count. The doctors were all saying what a big baby they thought ds would be....he turned out to be 6lbs, 2oz! Out in 6 pushes (after stalled labor, no dilation or effacement and needing cervidol and pitocin). Go figure!

[justlearning]

I didn't read your other thread but just thought I'd comment here that my doctor underestimated the size that my baby was going to be. I delivered vaginally without any problems and my son was 10lbs, 13.3 oz. The doctor was sure surprised when DS came out that big (especially considering he was only 3 days overdue)!

I had an episiotomy that healed just fine. Of course, pushing my son out wasn't much fun (I didn't have an epidural) and it did take a little suction from the vacuum thingy to get him out, but it didn't even leave a mark on him or anything. Overall, my labor experience went very well--I arrived at the hospital already dilated 7cm and had DS 4 1/2 hours later.

My friend also recently had a baby who was 10lbs, 13.8 oz vaginally without any problems. Furthermore, my mom gave birth vaginally to my brother who was 10 lbs, 11 oz. and my mother-in-law gave birth vaginally to my husband, who was 10 lbs., 12 oz. So, vaginal births of big babies seem to run in our family! :)

I hope all goes well with your birth, whatever you decide to do.

[jennyriver]

ok...i don't want to brag here or offend other mommies so please don't think i am! i just want to say that...a woman having a pelvis too small for her baby is *truly* rare. basically, nature grows a baby that you can handle. i KNOW there are exceptions to that rule (gest. diab. probably being one, although not always). small women birth large babies all of the time. remember, the national rate of c-sections has increased substantially in the past 30 years w/o any drop in maternal/fetal deaths. thats not to say c-sections don't save lives but a very general fear exists for a very special circumstance. it's almost like saying you were afraid of being a sniper victim during the whole DC sniper scare...it happened, people changed their habits, ended up safe and may have attributed it to their actions when in reality, they were never in danger anyway. (kind of a dated analogy but you get my point).

i, personally, can say i am SO glad i did not have any guesstimate of my baby's size before birth. i was 7lbs 2oz, DH 8lbs and i predicted DD would be 8lbs too...midwife only predicted when i was in labor (ON my due date) and then guessed 7lbs 12oz. DD was born 9lbs, 5oz, 22in. i was in labor 36 hours (on and off for 1st 20) but labored at the hospital only 13. pushed for 1 1/2 hours which isn't bad for a 1st baby. i'm not big - 5'6", 130lbs normally, size 4-6 my whole life. labored/delivered naturally. hurt like hell but not one complication and i attribute that to minimal interventions. once you start to worry about complications and plan for them, they seem to happen. i'm a big believer that labor/birth is natural. i know c/s are necessary for some women and don't want anyone to think i am saying they didn't really need one but the national average of 25-30% is much higher than it needs to be. and besides, doctors are often "off" when guessing baby size, even w/US so i would not use that as an accurate indicator of why you need a c/s. if you want to deliver vaginally, i would always tell the doc thats what you want (don't forget, you don't NEED his/her permission!) and ESPECIALLY if its your 2nd large baby...you will probably be just fine!

good luck.......and i respect ALL moms, regardless of their birth choices!!!!

[dowlinal]

Liza,

I think you are so smart to research the issue now. I unsuccessfully tried to avoid having a c-section. I had pre-natal hypertension and at 37 weeks I started going downhill so my OB "made" me have a c-section. What I wanted to add is that I had a horrible time with it, but I think it was because I was so dead set against having a c-section. Honestly, the surgery and the recovery weren't bad but since it was not what I wanted I was miserable. I agreed to it in the doctor's office because I was freaked out but I had a day to think things over before it was scheduled and during that time I decided that I was not going through with it. I wanted to go on complete bed rest until I went into labor. My ob convinced my husband that it was the right thing to do and they in turn got me to agree to it again. In truth, I think I just reached a point where I was just to tired to argue anymore plus I was questioning whether the end of pregnancy hysteria was affecting my judgment. Now six months later I still have serious regrets about not standing my ground.

The point of my post is that I think you need to be comfortable with whatever option you choose. It sounds like you have doubts about having a c-section so I would have a really serious talk with the doctor about it now when you still have time to do something about it.

[colette317]

Liza,

I have not had a c/s, but I have done a LOT of reading. Please get more info before you allow your OB to talk you into one.

The book Ina May's Guide to Childbirth, by Ina May Gaskin, will tell you some truths that doctors do not reveal about the dangers of unnecessary medical intervention.

Ultra sound can be off as much a whole pound in estimating the baby's weight, and the majority of the time they err on the heavy side.

If you must have a c/s, make sure to tell your dr you want a double not single layer suture afterward. Single layer suturing puts you at greater risk for future uterine rupture.

Ergh! I hate it when drs forget that pregnant women are NOT SICK!!!

Good luck,

Colette

[american_mama]

Sounds like you really don't want to switch OB practices, so that leaves with only one option: better communication with your doctors. You sound very clear and comfortable in your post, so I hope that spirit comes through when talking to your doctors.

This isn't exactly relevant, but I remember reading an article once about how to better communicate with doctors and it used an example of the patient feeling that the doctor was rushing her. The article said that "studies have shown" that if the patient "calls" the doctor on their behavior and says, "You know, I'm really feeling a little rushed and like you don't have time for my questions," doctors changed their demeanor quickly and listened much more attentively.

You might try a similar approach, "You know, that hmmm makes me feel you think I can't deliver a large baby a second time. Is that true? Why is that?" or "That "hmmm" sounds really discouraging. I really want another vaginal birth and hope you as my doctor can support that." Or whatever... brainstorm whatever sounds right for you.

Good luck. I have found the stories in this post fascinating!

[pastorgini]

My midwife suggested that we induce b/c she was worried the baby would be too big for me to deliver, so we induced 10 days before my "due date." I ended up being in labor when I arrived at the hospital (although they still did petocin b/c my contractions would never stabilize). After 15 and a half hours of labor and pushing for almost two and a half we all realized the baby was stuck and so I ended up having a c-section. He actually had a cut on his head from being pushed into my pelvic bone. My midwife both felt internally while I was pushing and looked during the c-section and shared with me that my pelvis was shaped a certain way that would not allow for this vaginal delivery. If we have another child, the doctor shared that if they did an ultrasound and saw the baby was also going to be large, they would suggest another c-section.

I did, however, have a friend who is very petite and she delivered two children naturally that were both over 10 lbs! I would suggest if you have already delivered a large child vaginally that you fight your doctor on this. My sense is that if your body can do it once then it can do it again!

Hope this helps~
G

[kristine_elen]

When I was pregnant I had a very vivid dream that I was about to give birth vaginally but then I put my hand over my crotch and yelled, "You must give me a c-section!" I told my doctor about this in the course of discussing how huge I was. They did an ultrasound that showed he'd be more than 10 pounds and that he wasn't just fat, but structurally huge, as in, wide shoulders. I was having a panic attack and the OB asked if I really wanted a C-section (something she didn't normally do unless absolutely necessary) and I said YES.

Jack was a scheduled C-section, born at 10 oz., and everything went great. He was also positioned such that one or both of us would have died had I not had a C-section. I have absolutely no regrets and if I have another baby I'll probably just go for the C/S again.
ETA: they didn't measure me but I am only 5'2" and structurally petite (despite the weight I've gained). I think it was obvious there would be great challenges.

[muskiesusan]

This is a subject that I have been reading quite a bit about lately due to a girlfriend who recently delivered vagininally a 10lb 4oz baby. The baby, unfortunately, sustained permanent injuries to his arm from the vaginal delivery (no forceps or vacuum used, my girlfriend is not small, and her first baby was 3 lbs smaller). My friend has been talking to an attorney, and he, among several other attorneys advertising online, believe that any baby over 8lbs 14oz should be an automatic c/s due to the risk of injury (in this case 1/2000 births). Signs they give for determining size are u/s, weight gain of over 35 lbs, etc. I was in shock over the "guidelines" they use to determine if a c/s was necessary. I wonder if the risk of lawsuit is what is driving some doctors to push for a c/s if they believe a baby is big.

I think fetal positioning, which is important in any delivery, but is even more so in that of a larger baby is key to a successful vaginal birth. You should read "Sit Up and Take Notice" as well as visit spinningbabies.com to learn how to get the baby in optimal fetal positioning. When the baby is not in an ideal position, and you have an epidural limiting the positions you can labor in, it makes it that much harder for the baby to decend properly. I personlly believe that it is the malposition of the baby, not size of the mother or baby, that leads to c/s in most cases.

Good Luck!

Susan
Mom to Nick 10/01/01
& Alex 04/27/04

[lizajane]

i JUST had a friend give birth to a baby with a potentially unrepairable arm injury. BUT the baby was 5 lbs 12 oz. so while i was concerned about injury to the baby before (i also know someone whose baby broke his collarbone in delivery- a 9+lbs baby) i am now a little less concerned, knowing that it is really a matter of the mom + the baby, not just the baby's size.