Tuesday, January 22, 2013

Big Baby

According to Frisco Women's Health Blog the top three indications you're Doctor is planning a c-section revolve around having a "big" baby.  How awful is it that women are being scared into c-sections and inductions for "big" babies!!  Are they even being told what a "big" baby really is?  Are doctors following ACOG's said standards of presenting accurate information and a balanced evaluations or are they using scare tactics?  Are insurance companies and business costs affecting the way they practice? 

According to the American Academy of Family Physicians
Fetal macrosomia is difficult to predict, and clinical and ultrasonographic estimates of fetal weight are prone to error. Elective cesarean section for suspected macrosomia results in a high number of unnecessary procedures, and early induction of labor to limit fetal growth may result in a substantial increase in the cesarean section rate because of failed inductions.

Fetal macrosomia according to Mayo Clinic is defined as
A baby diagnosed with fetal macrosomia has a birth weight of more than 8 pounds, 13 ounces (4,000 grams), regardless of his or her gestational age. About 9 percent of babies born worldwide weigh more than 8 pounds, 13 ounces. However, the risks associated with fetal macrosomia increase greatly when birth weight is more than 9 pounds 15 ounces (4500 grams).
So how accurate are predictions of fetal macrosomia in utero??  Not very!  Fetal macrosomia cannot accurately be diagnosed until after birth.  Ultrasound estimates can be off by two pounds or more! 

Q. What about post term gestation?
Well what is post term gestation?
A. Post gestation is a pregnancy that is 42 weeks or greater!  Yes, you're risk for fetal macrosomia does increase, with associated risks occurring more frequently in a birth weight greater than 9lbs 15 oz.  If you're at 39 weeks and worrying about your baby getting bigger, remember, fat is squishy and a longer length can help you while bearing down and pushing during birth. 

Q. What about shoulder dystocia?
A.  70% of shoulder dystocia cases are related to macrosomia but there are many factors that go into this unpredictable complication such as a higher incidence in boys than in girls, in obese mothers and when maternal diabetes is a factor.  Furthermore, one half of reported shoulder dystocia cases occur in normal birth weights.

Your doctor should not be scaring you into scheduling your cesarean or your induction for fear of a "big" baby getting stuck!  Consider first the limitations of medical judgment in predicting birth outcomes. Consider what the evidence says.
A healthy mantra would be "My body will make a baby just the right fit for me."  On this Journey of Life, I urge you, trust your body and trust birth.  The vast majority of macrosomic infants do well when delivered vaginally, even those experiencing shoulder dystocia.

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Jennifer Valencia | Labor & Postpartum Doula | 928.300.1337


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