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    Questions? Ask Henci!


    Find out what other moms-to-be are asking. Join in the discussion with Henci Goer, whose expertise is determining what the research tells us best promotes safe, healthy birth. If you would like to contact Henci outside of the Ask Henci forum, send an email to Goersitemail@aol.com.

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    Archived User
    I'm so glad to have found this forum!  I've been searching for information about attempting a VBAC with a baby that is "measuring large." 

    My first child was born by c-sec after almost non-existent fluid starting at 32 weeks.  After weeks of hospital bedrest, she was born at 36 weeks.  I had orginially hoped for a natural birth, but with such low fluid and she was breech, the doc said we had no choice.

    2 years later, I'm now expecting our second child due the end of June.  As a mother of fairly short stature (5'3") I've been told that the baby is predicted to be 10 lbs by due date.  My doc is suggesting we may not have an option except for another c-sec, due to concerns about the risk of attempting VBAC with a large baby.  Can you tell me how accurate the predictions of a large baby are?  Is it worth it to begin trying a natural birth only with the possibility of emergency surgery?
    Henci Goer

    Expecting a large baby is not a reason to plan cesarean surgery. Your odds of VBAC are better than 50:50 if you labor whereas if you plan a cesarean, they are 100%. Planned surgery for suspected large baby (macrosomia) has not been shown to improve outcomes, and you would be exposing yourself and any future babies to the hazards of having an increasing number of cesareans. And, yes, predictions of birth weight aren't very accurate. Predictions that the baby will weigh more than 8 lb 13 oz (4000 g, the usual definition of "macrosomia") do only somewhat better than flipping a coin. 

    (By the way, inducing labor for suspected big baby isn't a good idea either. It doesn't improve outcomes, and it increases the cesarean rate. Inducing women having VBAC labors has also been shown to increase the repeat surgery rate, and a number of studies have shown as well an increase in scar rupture over labors starting on their own.)

    I am sorry to say that you may be caught between a rock and a hard place. A number of studies have shown that when an ob thinks the baby is too large, the mother is much more likely to have a cesarean than when the baby actually is large but the doctor didn't suspect it. The ob's belief that the woman will ultimately require a cesarean colors judgment. So, for example, research shows that women who had prior cesareans for lack of progress (not your case, but the principle is applicable) were given less time in labor than women who had cesareans for other reasons. It is also true, unfortunately, that many doctors who start off by saying that they will honor a woman's right to VBAC start finding more and more excuses to push repeat cesarean as the pregnancy advances. "The baby is going to be too big" is one of them. Your saying that your doctor told you that repeat surgery was your only option with a big baby suggests this may be the case with your ob. Any competent adult under any circumstances always has--or should have--the right to refuse surgery. Your ob's casual assumption that this is not the case raises a red flag. But if your doc is trying to talk you out of a VBAC, so few obs are doing VBACs that you may not be able to find someone else to take you.

    I suggest you find out more about your ob's attitude toward VBAC. Ask what percentage of your doc's patients with prior cesareans plan VBACs and of them, what percentage have vaginal births. You should hear a reasonably high percentage of women opting for VBAC. If it's only a few percent, it means your doc is discouraging them, setting unreasonable restrictions, or both. And of the women who plan labor, 3 out of 4 should have vaginal births. Numerous large studies have shown this is achievable in a general population. If the number is much less, your doc isn't trying hard enough. I also recommend you surf the International Cesarean Awareness Network website. They will almost certainly have content that is helpful. 

    -- Henci 

     

    Archived User
    Thank you so much for your thoughtful and prompt response.  I appreciate your insight and the link you provided to ICAN. 

    I've never had such a wonderfully detailed response to a post before - so my sincerest gratitude goes out to you!

    Hopefully the post and your wonderful response will be helpful to others as well.

    Best wishes and thanks again. 
    Henci Goer

    You're welcome! Glad you found my post helpful.

    -- Henci

    Archived User

    You can do it, mama!  I've had two amazing VBAC's (planning my third now) - my first was 10 lbs, the second, 10 lbs, 10 oz.  (with no tearing or episiotomy needed)

    I think that your preparedness/calmness has more to do with your ability to birth a large baby than anything else.  Make sure you feel safe with your care providers and that they aren't going to be telling you how "large" your baby is during your pregnancy and while you're laboring.  (as a doula, I've seen mothers wind up with c-sections only because the OB felt the baby was too large for the mother to birth).  Negative energy is difficult to work with.  I would also strongly recommend having a doula with you. 

    Best wishes for a wonderful birth!

     

     

     


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