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    Jun 30
    2010

    maternal size as a risk factor

    Archived User

    A relative of mine is expecting her first baby. She is still in the first trimester, but her doctor has already told her she is 'borderline' risk because of her size - she is 5'0 and about 100 pounds. She is in her mid-twenties and very fit and healthy.

    Is she really at higher risk of complications solely because of her size, and if so, what complications are they? Is there any good evidence supporting induction for petite women?

    From what I've read, you can't tell whether a normal vaginal birth is going to be successful based on measuring the pelvis or guesstimating the baby's size. Also, anecdotally I know of many women who've successfully had healthy average-sized and large babies, but I'd like to have some objective data to point her to.


    Thanks in advance for your time.

    Henci Goer

    The real risk here is your relative's doctor's belief that she is likely to be unable to birth her baby vaginally. For example, although the specific issue is somewhat different, the concept is the same, I've got six studies all finding that when the ob wrongly believes that the baby is going to weigh more than 4000 grams (8 lb 12 oz), the likelihood of cesarean is substantially increased compared with babies weighing what the baby actually weighs. The reverse is also true: when the baby actually weighs more than 4000 grams, but the ob doesn't suspect it, the cesarean rate is greatly reduced compared with babies actually weighing over 4000 grams. I would strongly suggest that your relative download "Having a Baby? Ten Questions to Ask" from the Coalition for Improving Maternity Services website. It will enable her to gauge whether her doctor practices in a way that best promotes safe, healthy birth. While no one can guarantee your relative--or any woman, for that matter--that her baby will be born vaginally, she will greatly increase her odds by having a care provider who believes in her ability to birth her baby until proven otherwise.

    -- Henci 

    P.S. Get back to me if your relative decides she wants to change care providers.

    Archived User

    Thanks Henci. Would you be able to post citations to those studies in case she asks for them?

    From what I understand, my relative's doctor also implied that her pregnancy as a whole, not just her birth, was at risk of more complications because she is short. I think I can safely assume that, given she has a singleton pregnancy, this is not evidence-based.

     

    Henci Goer

    I would be delighted. Let me know if she does. As for the concern about the health of her pregnancy in general, I don't know if there are data on an association between short stature and poor pregnancy outcome, but even if such evidence exists, having a risk factor doesn't mean she is going to have the problem. Frankly, the real problem is having a care provider bent on instilling doubt and fear and whose judgment cannot be trusted because the care provider is already convinced that your relative cannot birth vaginally. 

    -- Henci

    Archived User

    Just wanted to update you on this: my relative was put on bed rest until 37 weeks for pre-term contractions, then was told the baby was 'measuring large, would be 10lb by 40 weeks, we will need to induce you before your due date'. She went into labour on her own just after 38 weeks. Unfortunately she ended up with a c-section after epidural, subsequent maternal fever, and questionable FHR (the baby was fine, and incidently just over 7lb).

    I feel like she dodged one bullet only to run straight into another one - I don't think she realised that epidurals can have fever as a side-effect. However, she is happy, baby is healthy, and breastfeeding is going well.

    Henci Goer

    Damn! Although I'm glad to hear she and the baby are doing well. If you feel you are in a position to do this, you may wish at some point to ask some open-ended questions about the birth such as: "How do you feel things went?" It's a delicate issue, and you will have to be sensitive to where she is, but sometimes silence can communicate that everything was ok and couldn't have been different to a woman who is wondering whether that was, indeed, the case.

    ~ Henci


    All Times America/New_York

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