I recently went to see my OB (at 24.4 weeks) and she measured me at 32 centimeters and predicted that I would have a "very large baby" (she didn't say just how "large"). My question, then, is how out of the ordinary is a 32 centimeter measurement at 24 weeks and what sort of problems might it cause? To give you some background about my health, I've gained 13 lbs (starting pregnancy at 5'5 and 140 lbs) am carrying a boy and have continued to be complication free throughout these past 24 weeks. I haven't yet had the gestational diabetes test yet. I'm getting worried that the estimated size of my baby might keep me from having a normal birth. What advice might you have for me? Thanks! By: Caryn_Schwarze

My advice is to ask your ob her recommendations for women carrying "big babies" in order to minimize problems at the birth. Here are the answers you DON'T want to hear because they are not supported by the research: "I like to induce labor a couple of weeks early so the baby doesn't get too big" or "It may make sense to plan a cesarean."

I also suggest you ask your ob what her cesarean rate is, which I would phrase as: "How often do you find it necessary to perform a cesarean?" If you hear a number over 15%, again, this is not in line with what the research says can be attained in typical populations, that is, some women with problems that increase their likelihood of needing a c/sec but mostly not. If she dances around the issue with responses like "I only do them when they are necessary" or "I'm in the average range" -- which nationally, by the way, is a shocking 29% as of 2004 -- or says she doesn't know, take that as a bad sign too.

If you get any of these "red flag" responses, then I recommend that you seek out a care provider whose practices are more in line with what the research establishes as safe, effective care. Here is a source that can tell you how to do that: How do I choose my caregiver?. My book, the Thinking Woman's Guide to a Better Birth, also has chapters devoted to choosing a caregiver and the place of birth. The book can be purchased through the Lamaze bookstore by clicking here.

Having a care provider on whose judgment you can rely is the most important thing you can do to maximize your chances of a normal birth, but you may also want to surf around this website and find out more about practices that support it. You may also want to take a look at Tips for Avoiding an Unnecessary Cesarean

-- Henci By: Henci Goer

Caryn,
I wanted to reply as well since I've been in your shoes With my last pg, I was measuring a good 7-8 weeks ahead in my last month. I went on to have a wonderful homebirth with no complications.

Now, not to scare you, but he was 11lbs8oz BUT BUT BUT you can measure ahead for lots of different reasons. Not necessarily a big baby. It can be how the baby is lying, the amount of amniotic fluid you have, how your uterus is positioned...I wouldn't worry at this point because there are so many variables.

I truly think our bodies make babies we can birth, whether they're 6 lbs or 12 lbs! Good luck! By: dalaimama

Thank you for such a reassuring post! I'm now getting closer to "normal" - at least average - measurement, thank goodness, but my OB and others still predict an above average weight baby. But, it's great to know that big babies can be successfully birthed vaginally. Good for you - as I see it, big babies = more to love! Thank you again for your message - I'm due in 6 weeks, so I'll let you know... By: Caryn_Schwarze

I thought I'd offer some tips for helping labor progress with a bigger than average baby. But before I start, let me say that I, too, have birthed a big baby. My 3rd and last child (now 20 yrs old and all of 5"1" tall) weighed 9 lbs 4 oz. I weighed 115 lbs at the start of that pregnancy.

* Hire a doula. The emotional support she can offer both you and your partner and her ideas and suggestions can make a big difference.

* Don't induce labor so that the baby doesn't get "too big." The medical research does not report any benefits from this practice, and it increases the odds of c/sec. For that matter, don't schedule a c/sec either.

* Avoid admission to the hospital until you are established in active labor. The research suggests that women will have more medical intervention if they are admitted early in labor probably because somebody gets impatient because labor seems to be taking so long and decides to "do something." With a 1st baby, this will generally mean at least 1 hour of contractions no more than 5-min apart from the beginning of one to the beginning of the next one, at least 1-min long, and strong enough that you cannot walk or talk while having one. If you aren't sure of where you are and your ob's office is open, drop by and get checked. If it is after hours, go to the hospital but explain that you just want to be checked, not admitted. If you are still not sure whether to stay or go back home, hang around for an hour or two walking the halls and get re-checked.

* Have patience. Expect labor to take longer with a bigger baby. This means having a patient care provider who does not impose arbitrary time limits on how long you have to make progress.

* Plan on staying active in labor and pushing in an upright position. Getting gravity on your side and having mobility maximize your chances of getting the baby into the best position for birth and pushing the baby out on your own.

* Avoid an epidural. It will interfere with your ability to walk and change position, and it interferes with your ability to push effectively.

* Plan on using the "Gaskin Maneuver," the only obstetric technique named after a midwife, with your care provider. Sometimes, especially with bigger babies, the head emerges, but the shoulders hang up behind the pubic bone (shoulder dystocia). The best way to remedy this problem without any ill effects to baby or mother is to either have the woman give birth on her hands and knees or have her turn to her hands and knees should it occur. (This can, by the way, be done with today's modern, lighter epidurals.) Here is the abstract: All-fours maneuver for reducing shoulder dystocia during labor

Here are some resources to help you with these goals:

Books: The Official Lamaze Guide: Giving Birth with Confidence by J Lothian and C DeVries; Ina May's Guide to Childbirth by IM Gaskin; Pregnancy, Childbirth and the Newborn by Simkin, Keppler, and Whalley.

Websites: Poke around this one, also the Maternity Center Association website I mentioned in an earlier post. You will find a section on How will I cope with labor pain? and one with info on doulas too. If you are interested in the research on big babies and induction, you can go over to the articles section of my personal website and scroll down to "Labor Induction: When a Big Baby Is Expected."

I hope you find this helpful, and let us know how everything goes.

-- Henci By: Henci Goer

I meant to give you an update MUCH sooner, but now that I have my darling little baby, well, I'm lucky if I have time to address an envelope! Better late than never...

Thanks to your book, Henci (The Thinking Woman's Guide to a Better Birth) and the advice I received from this forum, I had the most wonderful labor/birth experience. It was relatively fast (about 8 hours), beautifully natural, and 100 % life-changing. I managed to stay quite active (walking, using the birthing ball and showering - LOTS of time in the water!) and utilized the Gaskin Manuever per your advice. That was a life-saver!! And although my OB expected a "nine-pounder", Charlie was born at a healthy 6 lbs 14 oz. For more reasons than one, I'm so glad I didn't submit to an early induction like my OB wanted.

So, I just wanted to say thank you for the wonderful support I received from both your book and this forum. I look forward to more of your advice during my next pregnancy!

Many, many thanks,
Caryn

By: Caryn_Schwarze

I am SO thrilled for you! I am also delighted that what you found here was helpful and useful. You have made my day.

-- Henci By: Henci Goer