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    Sep 12
    2013

    Csection for my daughter because ultrasound shows big baby

    martha mccoy
    My daughter is 40 weeks today had an ultrasound and everything was fine except they said looks like baby could be 9 1/2 pounds. Lady did say there was a 1.5 pound error range. Of course as soon as my daughter saw one of her obs he said we need to do a csection because of the weight and your baby hasn't dropped. He used the shoulder issue with her. Se told him no she didn't want to be induced and certainly didn't want a csection. He then made a comment about the health of her child being an issue. It wasn't very nice either. My daughter is very upset and is now second guessing herself about a csection. She made an appt tomorrow to talk to one of her favorite obs in the office and we will see what he says. I have a feeling they will bully her into it. She was so adamant about not having a csection. These drs should really be called out on the way they are treating their patients. She does think she is going to have a big baby. Her husband weighed 8 1/2 pds and she weighed just 7.11. My smallest was 7.0 pds even any advice. Concerned grandma
    Henci Goer

    This is a difficult situation, and I hope she got better news from the other OB. The research literature does not support inducing labor for suspected big baby, let alone planned cesarean surgery. Here is what the American Congress of Obstetricians and Gynecologists, the U.S. ob/gyn's professional organization, has to say about inducing labor and planned cesarean in its Practice Bulletin on managing suspected fetal macrosomia ("big body"): "Current evidence . . . does not support a policy of early induction of labor in term patients with suspected macrosomia," and, "The sum of these reports does not support a policy of prophylactic cesarean delivery for suspected fetal macrosomia with estimated weights less than 5,000 g [11 lbs]." ACOG also acknowleges the inaccuracy of fetal weight estimates in the Bulletin.

    Worse yet, studies of inducing for suspected big baby uniformly find that a woman is much more likely to have a cesarean when her doctor suspects the baby will be big than when the baby actually is big (usually defined as estimated weight more than 4,000 g or 8 lb 13 oz), but her doctor didn't suspect it and vice versa. That means that whether your daughter has a cesarean if she labors depends more on her ob's judgment than on whether her body is physically able to birth her baby, and her ob is of the opinion that she can't. (I can supply multiple citations on this point if you or your daughter would like to see them.) 

    I think your daughter should find out if there is anyone in her group who doesn't routinely recommend induction or planned cesarean for suspected big baby. If there is, I would have a heart-to-heart with that person and ask that she or he agree to attend your daughter in labor even if it isn't their shift. Also, has your daughter hired a doula, a woman trained and experienced in labor support? It is great if she has because that will give her and her partner someone in their corner who can provide emotional support and ideas for how to help labor progress. If any case, here are some tips for maximizing the chance of birthing a big baby:

    • Begin labor spontaneously.
    • Stay home until in active, progressive labor. If you go into the hospital and it turns out you are still in early labor, go back home. 
    • Stay active in labor.
    • Push in an upright position so that gravity is working for you.
    • Use pain coping techniques other than an epidural so that you can stay active and push effectively.
    • Refuse a cesarean based on arbitrary time limits for making progress.
    • Give birth on hands and knees. or be prepared to turn to hands and knees if the shoulders don't come easily. (This can be done even with an epidural with help.) A study showed this position is most likely to avoid injury to mother or baby if the shoulders do hang up.

    If you wouldn't mind, I would like to hear how everything went, and I wish your daughter a safe and healthy birth.

    ~ Henci

    martha mccoy
    Hello my daughter agreed to the csection it is scheduled for today the 17th. 5 days after her due date. She did call me at 6am this morning and said her water broke. Her doctor said go ahead and come in and they will see what's going on. No pains yet. Her baby still has not dropped. I will keep you posted.
    Concerned grandma


    Sent from my iPhone

    On Sep 15, 2013, at 4:48 PM, Henci Goer <[login to unmask email]> wrote:

    > This is a difficult situation, and I hope she got better news from the other OB. The research literature does not support inducing labor for suspected big baby, let alone planned cesarean surgery. Here is what the American Congress of Obstetricians and Gynecologists, the U.S. ob/gyn's professional organization, has to say about inducing labor and planned cesarean in its Practice Bulletin on managing suspected fetal macrosomia ("big body"): "Current evidence . . . does not support a policy of early induction of labor in term patients with suspected macrosomia," and, "The sum of these reports does not support a policy of prophylactic cesarean delivery for suspected fetal macrosomia with estimated weights less than 5,000 g [11 lbs]." ACOG also acknowleges the inaccuracy of fetal weight estimates in the Bulletin.
    >
    > Worse yet, studies of inducing for suspected big baby uniformly find that a woman is much more likely to have a cesarean when her doctor suspects the baby will be big than when the baby actually is big (usually defined as estimated weight more than 4,000 g or 8 lb 13 oz), but her doctor didn't suspect it and vice versa. That means that whether your daughter has a cesarean if she labors depends more on her ob's judgment than on whether her body is physically able to birth her baby, and her ob is of the opinion that she can't. (I can supply multiple citations on this point if you or your daughter would like to see them.)
    >
    > I think your daughter should find out if there is anyone in her group who doesn't routinely recommend induction or planned cesarean for suspected big baby. If there is, I would have a heart-to-heart with that person and ask that she or he agree to attend your daughter in labor even if it isn't their shift. Also, has your daughter hired a doula, a woman trained and experienced in labor support? It is great if she has because that will give her and her partner someone in their corner who can provide emotional support and ideas for how to help labor progress. If any case, here are some tips for maximizing the chance of birthing a big baby:
    >
    > Begin labor spontaneously.
    > Stay home until in active, progressive labor. If you go into the hospital and it turns out you are still in early labor, go back home.
    > Stay active in labor.
    > Push in an upright position so that gravity is working for you.
    > Use pain coping techniques other than an epidural so that you can stay active and push effectively.
    > Refuse a cesarean based on arbitrary time limits for making progress.
    > Give birth on hands and knees. or be prepared to turn to hands and knees if the shoulders don't come easily. (This can be done even with an epidural with help.) A study showed this position is most likely to avoid injury to mother or baby if the shoulders do hang up.
    > If you wouldn't mind, I would like to hear how everything went, and I wish your daughter a safe and healthy birth.
    >
    > ~ Henci
    >
    >
    > Site Links: View post online View mailing list online Start new thread via email Unsubscribe from this mailing list Manage your subscription
    >
    > Use of this email content is governed by the terms of service at:
    > http://www.lamaze.org/p/cm/ld/fid=2
    >
    Henci Goer

     Please do let me know what happens. You and your daughter are in my thoughts.

    ~ Henci

    martha mccoy
    She went with the csection and delivered a 9 lb 1 oz baby boy. He was 21.5 inches long. Everything went fine. He was a big baby. I know in the future she would love to have a vbac hopefully she will be able to. Thanks for all of your help.


    Sent from my iPhone

    On Sep 17, 2013, at 8:15 PM, Henci Goer <[login to unmask email]> wrote:

    > Please do let me know what happens. You and your daughter are in my thoughts.
    >
    > ~ Henci
    >
    >
    > Site Links: View post online View mailing list online Start new thread via email Unsubscribe from this mailing list Manage your subscription
    >
    > Use of this email content is governed by the terms of service at:
    > http://www.lamaze.org/p/cm/ld/fid=2
    >
    Henci Goer

    I am glad that everything went well for your daughter and your grandson and sorry that it wasn't the birth that you and she had hoped for. May she make a speedy and complete recovery from her surgery.

    ~ Henci


    All Times America/New_York

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