Suspected big baby?

What would you do if an ultrasound shows that your baby is big? Many women have to answer that question for themselves. Their options are to plan a C-section, get induced before the baby gets any bigger, or do nothing and wait for labor to begin whenever their bodies and their babies are ready. Some women have extenuating circumstances that muddy the waters a bit, or cause them to have to make other decisions — for instance, some women are “risked out” of a planned home birth because of suspected big baby (macrosomia); others may not be allowed to have a VBAC (that is, if you can find a supportive hospital or doctor any more).

The first question I ask is, “How accurate is the fetal weight estimate, anyway?” Notoriously wrong, actually. Most estimated fetal weights are within 10% of the actual weight. That sounds pretty good. Unfortunately, that’s about a pound or a pound and a half off. This means that if your baby is estimated to weigh 7 &1/2 pounds, it could actually weigh anywhere from 6 to 9 pounds, according to this margin of error. And not all estimated fetal weights are within that 10% margin of error, either. Here is a wonderful link about suspected macrosomia, with a lot of birth stories about inaccurate estimated fetal weight. The stories include just about every variation you can think of — babies that were supposed to be normal weight, but — surprise! — they were actually “macrosomic” (but still completely normal); babies that were supposedly macrosomic, and the mothers had C-sections, or were induced, and — surprise! — they were actually normal weight, or even a bit on the small side. In Henci Goer’s book The Thinking Woman’s Guide to a Better Birth, she notes that when doctors think that a baby is big, they are more likely to intervene or call for a C-section (even when the baby’s actual birthweight is not “too big”), but when doctors think that a baby is not big, they don’t intervene, even when the baby’s actual birthweight is “macrosomic.”

Here are a few other links that I thought were interesting. This is a collection of links regarding various aspects surrounding macrosomia (inductions, C-sections, Apgar scores, shoulder dystocia, etc.). Here is an article discussing cephalopelvic disproportion (CPD), which is the typical reason given when women have C-sections for big babies. An article that appeared in the AAFP Journal concluded that pregnancies with suspected macrosomia should be handled “expectantly” and that interventions should only be used if labor does not progress as expected. It also includes a table with risk factors for macrosomia. This article by the National Institute of Health concludes “The best policy is to await spontaneous birth or to induce labor after 42 weeks completion.” And finally is a webpage that includes a lot of information about macrosomia, but I especially wanted to include it because of the “Big Baby Birth Stories” — most of these babies are in the 9 lb. range, but there are a few that were 11 lb. or more.

As far as personal experience goes, I’ve had one ultrasound, which was done late in my first pregnancy because the midwife thought she might have heard two heart-beats at the prenatal visit; the estimated fetal weight was 7 lb. 8 oz. When my baby was born 10 days later, his actual weight was 7 lb. 5 oz. (3 oz. less than the ultrasound estimate, at a time when babies gain about half a pound a week average). It was nearly 1 lb. off. One of my sisters-in-law had IUGR with her 2nd baby, so they kept close watch on her 3rd baby. A few days before she was born, they estimated her fetal weight as “lucky to be 6 pounds.” She was over 8 lb. (They had a hard time seeing anything of the baby because of the way she was positioned.)

My second son was 9 lb. 2 oz. My sisters’ sons (their 2nd babies) were both over 9 lb. (and we didn’t tear). Another sister-in-law’s first baby was 9 lb. 8 oz. (after pooping and peeing), and she didn’t tear at all, which is important to note because some people will say that “every woman tears when she gives birth to her first baby” and others will say that “all women tear if their babies are big.”

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18 Responses

  1. I figure a plug for this U-Tube video is appropriate for this post…
    Apologies if you’ve already seen it!

  2. OOOO, nice post. I added it as a link on my big baby page! I think this is such a HUGE “problem” these days. So many moms are being scared by their care providers about their “big babies” and it is I think one reason why the cesarean rate is going up. Even if moms choose to have a vaginal birth, they are usually being induced because of “big baby” or even if their birthing time started on their own they and their OB are scared of this big baby so things may not progress as quickly or the OB is so quick to intervene if things are not progressing quick enough.

    Here is a great story from one of my VBAC moms who during her birth the OB brought up the big baby scare… baby might be 8 pounds! You might not be able to push her out. Well mom didn’t buy into that fear and pushed out a 9 pound 6 ounce baby in minutes! http://enjoybirth.wordpress.com/2008/02/02/care-providers-of-birthing-mothers%e2%80%a6/

  3. Very Good Article. I am 33 weeks pregant and my high risk doctor just measure my baby at over 6 lbs already. I am gong back in 3 weeks to remeasure and evaluate. I do not have diabetes but i am overwieght. my son was 7.3 lbs at birth but was 4 weeks early. I had a natural delivery with him and not complications. It is sad to say but I will probably opt for the c-section. I am deathly afraid of giving birth to a large baby and having anxiety issues just complicates it more. I will however talk to my docotr on monday and make an informed decision. Thank you for your article as it will help me in my final decision.

  4. Elizabeth,

    Anxiety can certainly cause problems in labor — the good ol’ “fight or flight” hormones are known to slow down labor or even stop it altogether. If you’re that concerned about it, then a C-section is a sensible alternative. To help alleviate your anxiety, you can read numerous stories of women who gave birth to large babies without problems — reading birth stories always helped me. Just remember that weights given in utlrasounds are always estimates, and subject to provider error. And also remember that women have been giving birth for millenia, and many women have given birth vaginally to babies that weigh 9, 10, 11 pounds or even more. Here’s a video of women who gave birth vaginally to babies that were bigger than the babies they had C-sections for “babies that were too big.”

    • im 34 weeks and i had an ultrasound and the baby is already 6lbs 2oz and im scared im a first time mother and i really rather them just take my daughter now then risking everything like her bein over weight or shoulder disability or me tearing

      • Even if the ultrasound weight is accurate, and even if she weighs 8, 9, or 10 lb at birth, it is far better for her to be born in her own time than for her to be a premature baby. There may come a point, due to gestational diabetes, for it to be better for her to be born than to remain inside you, and an induction or C-section will be a better idea than waiting for labor to begin on its own. However, a 34-week baby is not just a miniature term baby, but is a baby that still needs more gestation to avoid things like a higher risk of death, short-term and long-term disability, greater risk of things like asthma and other medical problems, etc. There is a **lot** of maturing that takes place in these later weeks that will harm your baby if she is born early (unless, of course, there is some sort of medical reason that overrides all the risks and harms of premature birth). Even at 37 and 38 weeks — which is “term” by most accounting — increases the baby’s risk of breathing problems, unless labor starts naturally; this is much more the case at earlier gestations. Here are a few posts I’ve written exploring these topics in more detail: Iatrogenic Prematurity and Early Preterm Birth by C-section. The March of Dimes also has a great section on prematurity, including this page which says in part:

        Are babies born at 34 to 36 weeks gestation (late preterm) at risk for medical problems?
        Late preterm infants are usually healthier than babies born earlier. More than 99 percent of these babies survive, though they are (16):

        * 6 times more likely than full-term infants to die in the first week of life (2.8 per 1,000 vs. 0.5 per 1,000)
        * 3 times more likely to die in the first year of life (7.9 per 1,000 vs. 2.4 per 1,000)

        Late preterm babies often weigh between 4½ and 6 pounds, and they may appear thinner than full-term babies. These babies remain at higher risk than full-term babies for newborn health problems, including breathing and feeding problems, difficulties regulating body temperature, and jaundice (17). These problems are usually mild. Most of these babies can breast- or bottle-feed, although some (especially those with mild breathing problems) may need tube-feeding for a brief time.

        A baby’s brain at 35 weeks weighs only two-thirds of what it will weigh at 40 weeks (17). Because their brain development is not complete, these babies may be at increased risk for learning and behavioral problems (17). Most do not develop serious disabilities resulting from premature birth.

        A recent study, however, found that late preterm infants are more than 3 times as likely to develop cerebral palsy and are slightly more likely to have developmental delays than babies born full term (18). Another study found that adults who were born at 34 to 36 weeks gestation may be more likely than those born full-term to have mild disabilities and to earn lower long-term wages (19).

        So, I don’t have a crystal ball and cannot tell you what will happen. I can only say what the statistics show. If I can talk you out of being scared of birth and getting a C-section, I will; but it’s your decision, not mine. I would ask you to consider waiting until at least term, unless some medical condition presents itself which makes it obvious that the baby does need to be born earlier. Shoulder dystocia is only loosely tied to the baby’s weight — half of all dystocias take place in babies that are not “overweight” or “macrosomic” (although as a percentage, more macrosomic babies do end up with a dystocia). Again, without being able to foretell the future, neither I nor anybody else can tell you what will happen. Shoulder dystocia is not extremely common — I think it’s something like 1% of all births, but you do have risk factors for it, with having GD. If it’s a tremendous fear for you, then you may have a valid reason for a maternal-request Cesarean. But not today, when your baby needs more intra-uterine time to grow and mature.

        I’m trying to put myself in your shoes, but I gave birth to a 9lb baby over an intact perineum in just a couple of pushes (although he was my second), so I don’t have the fears that you do. That said, I’m trying to imagine having these fears, so thinking, “What would I do?” It appears that you’ve got several options — an elective induction and/or C-section now or at any future date within the next several weeks; or wait until labor begins and decide to try to have a vaginal birth then or a C-section. I think most doctors like to have moms with GD to give birth around 38-39 weeks [forget exactly why, but due to a higher risk of either maternal or fetal/neonatal problems after that time]. So, I’m assuming that there will be a medical reason for induction and/or C-section at some point in the next 4-5 weeks. Until that point, I’d sit tight, due to the higher risk of neonatal death as well as health problems for the babies that comes with premature birth. As a first-time mother, especially with a preterm baby, you almost definitely will have a low Bishop’s score, and since your body will be trying to protect your baby from an untimely birth, you are more likely to end up with a failed induction and a C-section. In my mind, if I’m going to end up with a C-section anyway, I’d rather have one when the baby is fully mature and ready to be born, rather than to go through induction (which definitely has its drawbacks) and end up with a premature baby who needs to be in the NICU for 6 weeks.

        Ultimately, this decision is up to you. There are no guarantees, no matter which course of action you take. Ultrasound is not always accurate; shoulder dystocia occurs in babies that are not big as well as in babies that are; women have torn with small babies and had big babies over an intact perineum, and vice versa; gestational diabetes adds another layer of uncertainty to the mix, in that your baby has a greater likelihood of being bigger than she otherwise would be; but 34 weeks is premature and your baby will have a greater risk of health problems now and in the future if you allow an unnecessary induction or C-section.

  5. I am currently on my third pregnancy and i must say i am glad that Doctors err on the side of caution. My first son was born at 9lb with no complications, my second son was born 11lbs 5oz and had a complicated birth with Shoulder Dystocia and Erbs Palsy, it was very traumatic, but throughout the pregnancy my Midwife assured me he was going to be around the same weight as my first son. I have never had gestational diabetes, and i am not overweight, i am 5ft 7 and do have a family history of large babies. Now on my third the Obs are scanning me more frequently and at 31+4 weeks i was measuring 37 weeks, to be honest i am hoping for a Cesarean, my son should never have been born naturally and i dont want the same to happen again.

  6. I am also currently on my third pregnancy and now about 36 weeks pregnant. My first daughter was 10pds 10 oz, I am tall and did not have diabetes either. that birth went well. My son was 9 pds 2 oz I was induced with him a week earlier because he was going to be pretty big also his shoulders were so broad and would not come out that they fracture a bone in his shoulder trying to take him out that was painful for me because I believe in natural birth. Know with my daughter I will be induced at 37 weeks because I guess she can weigh up to 12-14 pounds my dr says because now I got gestational dietetes and since my dr has always been right I will not risk my babys health or the chances of a still birth good luck to you all and hope you make a good decision for your self and your babies.

    • im 34 weeks and my baby is 6lbs 2oz and its my first and i have gestaitonal diabetes and i just want my doctors to induce me or give me a c-section because im so scared and afraid of having her to big or me tearing do u think thats a good idea? i think about it all time and it makes me cry.

  7. Thanks for posting this!! I’m 38 weeks and my doc says (no ultrasound yet) that the baby is “a big one”. Who knows if this is even accurate, but if it is, your blog has inspired me to be confident that I can deliver vaginally and not to be pressured into a C-section just because of size. :)

  8. I just had to read this link again after having a 10lb baby! I sincerely wish that I had listened to my OB when he said I was going to have a “big baby”! Instead I read a post that was linked to this page, exhorting women to birth naturally and not be afraid of doctors who recommend C-sections.

    Yes, I had the baby vaginally, but the birth experience was terrible and by the time she arrived, I couldn’t enjoy her. While I cannot say that if I had had a CS that I COULD have enjoyed her arrival, I know that just about any different situation would have been welcome. In spite of the natural birth, my daughter went to the NICU for several days, having picked up a fever and infection from being lodged in the birth canal too long…because she was too big to move by my efforts alone.

    Each woman has to make her own choice. I say, Know Yourself. Figure out what is the most important part of birthing to you! Is it a natural birth? A painless birth? A birth that leaves you energy to enjoy the first minutes?

  9. My 3rd child (a boy) was delivered naturally weighing 10lbs 8oz…my doctor let me go 9 days overdue knowing I would be having a ‘baby bigger than 9lbs, but you will be able to do it’. I had asked time and time again did he think inducing would be a good idea, but he had said no. I ended up with a torn cervix, a major episiotomy, then had a haemorrage, went in for surgery (I had already eaten by this time so could only have an epidural, so was awake for the entire surgical experience) and then had to have 9hrs of bood transfusion (trying to breast-feed with one arm out of action was tricky!) It was definitely not an ideal birth experience. In retrospect I would have got a second opinion. I am now 25wks pregnant with 4th child, so am very conscious of having options available to me and making sure this experience doesn’t happen again.

  10. My second child was born at 34 weeks c-section because my water broke, she was breech and I already had a c-section previously- she was almost 6 pounds and came home with me. Now I am pregnant again, baby is transverse and wedged in there at 34 weeks. Again, the baby is measuring large for my pelvis, I am a thin person…so I am scheduled for an amnio at 36 weeks. If all is well, they will do a section the next day.

    So people – every birth is different and the ultimate is getting a healthy baby…vaginal birth may not be for everyone. And dont put yourself at risk unnecessarily…and dont be an egomaniac.

  11. I just found this blog. My second baby was 5kg ( a bit over 11 pounds). She was born with a broken shoulder, a twisted foot, not quite a club foot, but severe enough that she was placed in a plaster cast for 5 months, which then put her hip out meaning she had a brace for 3 more months. I was told that she would be about 7 pounds…..I’m now week 36 and my gyno says that this one is big as well (estimated 7 pounds at week 32). So I am asking for an induction next week as I don’t want my baby to be so affected.

    I know that I can give birth naturally to large babies, as I have done it (in 2 1/2 hours). But I’m sure (and my doctors as well) that the baby will have less negative affects being born earlier. She most probably won’t suffer from pre-term effects such as low birth weight as I have family history of large babies and my first baby was also nearly 9 pounds, yet will not suffer from possible macrosoma effects.

    I have been preparing for induction with acupuncture, homeopathy and keeping myself fit and healthy to assist in having a normal vaginal birth. Hope it all works.

  12. Just gave birth to my 5th baby, he weighed nearly 12 lbs. Baby 1–c/s, 8.12. Baby 2–hospital VBAC, 9.5. Baby 3–home water VBAC, 10.10. Baby 4–home water VBAC, 9.0. Baby 5–home water VBAC, 11.13. I must say, I definitely feel safer giving birth to my big babies at home with a midwife who is comfortable with the idea of a big baby. Being at home gave me the freedom to do what my body needed to do, in order to birth those babies. Had I been in a hospital we surely would have had complications, but at home there were none at all.

  13. This is a nice article n I do believe people should not just choose inductions n c-sections just because they’re tired of caring. You knew getting pegnant would mean nine months so suck it up unless u have a medical reason. As far as the statement in the artical where she states ur body wont give u what u can’t handle I must disagree. I had a baby who was only seven lbs n three ounces n tried pushing well over threee hours n my pelvis would not seperate causing me to need a c-section then n anyome after. So I’m sorry but i can’t agree that in every case that ur body will adapt for ur baby. N of it is too big for u it is dangerous for it to be stuck for long peroids becauae of their heads being squished longterm.

  14. When did this “big baby” nonsense get started? I had three children in the late 70′s: 8lb.6oz, 9 lb., 10 lb. I am 5’3″. I had all three at home with an ob and a midwife. No one ever said anything about big babies being a problem. What’s up with this???

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