Expert Advice

Good Chance You Don’t Need a C-Section Just Because Your Baby Bump Seems Big

By SP Turgon

 

Whoa! That’s a huge baby bump you have there, and before you’ve even begun labor, your doctor says you need a cesarean section. But a big baby doesn’t automatically mean you need a C-section. Every low-risk mother has the option to choose a trial of labor, no matter how big her baby is predicted to be.

The scheduling of C-sections without first recommending a vaginal birth is an outdated, but routine, medical practice that needs reassessment in these modern times.

Here’s another reason to know your birth preferences and to seek a care provider who will help you work with them. If you want to give birth vaginally, ask your doctor, nurse, or midwife how they work with a big baby. In your birth plan you can state that you want to try to give birth vaginally, unless true medical reasons prevent it.

 

SO, WHAT’S UP WITH BIG?

Shoulder dystocia (dis-tosha) is the issue. It means baby’s shoulders get stuck on the way out and could cause nerve damage that’s usually temporary. It’s a concern with big babies, but average-size babies do this, too.

Dystocia is hard to predict, which is why it is important to go to a skilled professional. While almost all dystocias feel critical in the moment, many are handled smoothly when a mom is able to move into a different position. The most successful position is called The Gaskin Maneuver, created by midwife Ina May Gaskin.[1]

What is critical for a grace-filled birth is your care provider’s attitude about big babies and unmedicated birth. Ask what your provider recommends for you if your baby seems large. You can ask:

  • What do you consider a big baby for my body?
  • When do you think a C-section is truly necessary?
  • How do you deliver big baby shoulders when a mom can move, or when she can’t move because of pain relief medication?
  • Do you know the Gaskin Maneuver?
  • What techniques do you use and what positions could I be in for shoulder delivery?
  • How many of the big babies you’ve delivered needed a C-section?

With a conversation about these questions, your care provider knows your birth plan and preferences. This way, you’re both on the same page. When you review your hospital bag checklist, be sure your most recent birth plan is on it – the one you wrote after talking to your care provider.

 

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YOUR CARE PROVIDER’S ATTITUDE INFLUENCES YOUR BIRTH OPTIONS

Your care provider’s attitude toward big babies will influence what range of birth options you have. Studies show that a hurried doctor’s attitude will make them less patient with labor, and they will suggest a C-section[2] more often. “Physicians are astonishingly up-front in discussing how much more efficient scheduled inductions (and scheduled cesareans) are. They claim that women will not have to worry about middle-of-the-night births and that hospital staffing and bed turnover can be better managed.”[3]

Here’s where unnecessary medical interventions matter. If you don’t have them and can move around, there are positional changes a mom can make to birth a big baby’s shoulders. But when you’re in the hospital with an epidural or hooked up to a fetal monitor so you can’t walk around or move, a C-section is the most frequent decision.

C-sections can have multiple health risks for mom and baby, and they can add a fortune to your hospital bill.

Even without landing in C-section surgery, most women with suspected big babies will be convinced by their doctors to induce labor to prevent any more growth. Evidence shows this induction increases the chances of C-sections but doesn’t decrease the chance for shoulder dystocia[4].

Perineal tears and postpartum hemorrhage (PPH) are also concerns with big babies. But no study proves these concerns are more threatening to mom than the risks from having a C-section. Research shows when moms get episiotomies, instead of helping to prevent perineal tears from big babies, these can tear beyond the cut and all the way into the anus (3rd or 4th degree tear)[5].

 

DOCTORS AND ULTRASOUND AREN’T GREAT PREDICTORS OF BABY’S SIZE

Doctors and ultrasound aren’t great predictors of baby’s size. Knowing for sure that your baby is big is like flipping a coin – statistics say neither doc nor ultrasound can say for sure, and each gets it right about half the time[6]. Even the most recent study from December 2015 states that, “Only one in five US women who were told that their babies might be getting quite large actually delivered infants weighing ≥4000 g. However, the suspicion of a large baby was associated with an increase in perinatal interventions, regardless of actual fetal size.”[7]

About one in ten U.S. women will have a “big” baby weighing more than 8 pounds, 13 ounces (3629 g) – 9 pounds, 15 ounces (4082 g)[8]. When you’re in good health, you can bring a nice big baby into the world vaginally, just like Miranda Kerr or Busy Phillips.

Having diabetes (gestational, Type I, or Type II) means there’s more chance of your baby being larger than average. But even if you have gestational diabetes (GD), getting treatment for it lowers the possibility of having a big baby.  

To give yourself the best chance of having a low-risk pregnancy and birth, start early to get nutritional and exercise counseling that will help prevent GD and other related health issues. If your midwife or doctor doesn’t discuss diet with you, just seek out the support of a licensed nutritionist.

If you are non-diabetic – especially if you are healthy and low-risk – your care provider can advocate for the birth preferences you wanted when you planned your birth. With a skilled midwife, nurse, or doctor on their side, healthy women with suspected big babies can have every chance to labor naturally and give birth vaginally, according to their birth plan. Remember to include your final birth plan on your hospital bag checklist!

 

[1] http://www.thefarm.org/midwives/dystocia.html

[2] http://www.ncbi.nlm.nih.gov/pubmed/22902073

[3] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595289/

[4] http://www.ncbi.nlm.nih.gov/pubmed/?term=sanchez+ramos+AND+macrosomia

[5] http://www.medscape.com/viewarticle/721538_8

[6] http://www.ncbi.nlm.nih.gov/pubmed/16098852

[7] http://www.ncbi.nlm.nih.gov/pubmed/26140835

[8] http://www.ncbi.nlm.nih.gov/pubmed/8903259

 

To learn more about birth options, download our free Birth Plan eBook now. After three years of research, collaboration with more than 100 childbirth experts and resource centers from Healthy Child Healthy World to the American Association of Neonatal Nurses, the Best Ever Baby Birth Plan Guide is available for a free download.

This new resource for pregnant families is a compilation of top tips and advice from more than 20 nationally-recognized experts in the field including renowned pediatrician, Dr. Alan Greene and the GraceFull Birthing founder, midwife Elizabeth Bachner.  These trusted experts offer thoughtful guidance for whatever type of birthing experience parents want, in whichever setting they choose.

 

Published: March 13, 2016 | Reviewed by: Kim Walls, Natural Products Expert, Elizabeth Bachner, LM, CPM, L.Ac., Midwife | Last reviewed: March, 2016

Sabriga TurgonGood Chance You Don’t Need a C-Section Just Because Your Baby Bump Seems Big

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