Weenie!

Today when I picked up my almost seven year old from school, I learned something about one of his friends. I learned that his friend is circumcised.

How did I learn this you ask? What are these boys doing during recess? Is this a hot topic in elementary school?

Let me explain....

The Good, The Bad, and The Ugly - Words

I've said it before and I'll say it again, and again, and again- The words we use are so very powerful!

There are the obvious choice words that have a negative impact, 

like "my" epidural. Or, "when would you like your epidural?"

and "my doctor is going to let me"

and my least favorite, "I had to get induced"

And then there's the more subtle words, who's impact is quietly wreaking havoc

like "due date" -two little words that don't really mean what you think they mean. 

It used to be that a baby was due, or rather expected, within a certain season or "around Christmas" whereas now, we've come to expect a baby by a certain day! This idea, that a baby should come by a certain day, is enforced by our care providers, by insurance companies, by well meaning friends and family and now, by pregnancy announcements! I recently saw an announcement, beautifully creative with charming colors and cliche phrases referring to a bun in the oven.  It was all fine and dandy until that announcement made known that the baby would be cooked by 7/26/14*. STOP!! For real?! Your due date is not an expiration date! Now I'm sure the well meaning designers of this particular announcement and the loving family were not necessarily trying to imply that this is truly what they thought but when we see things like this over and over again, when we repeat "July 26" over and over again and then that date comes and goes... it really has an impact. The wording in this seemingly harmless announcement encourages the idea that a baby is done being in utero precisely when we say so.

Infographic by: Birth By Heart

Too many women are under the impression that when they pass their "due date" they are "overdue" when in fact ACOG states post dates is past 42 weeks!  Thankfully, not all beautiful announcements are quite such precise recipes; just remember, your due date is simply a guesstimate of the time period around when your baby may decide to be born. ACOG's most recent guidelines are

• Early Term:  Between 37 weeks 0 days and 38 weeks 6 days
• Full Term:    Between 39 weeks 0 days and 40 weeks 6 days
• Late Term:   Between 41 weeks 0 days and 41 weeks 6 days
• Postterm:     Between 42 weeks 0 days and beyond

So, when is your baby due?? Let's say "early spring"

*All dates and time periods and fictional and simply for example. Any similarities to real life scenarios is simply coincidence.

Say What You Mean

You do not have to be induced. No matter what they say. No matter what you say. Even when medically indicated!

*Gasp* Am I proclaiming that you shouldn't get an induction when medically indicated?  No, of course not. But that's you're choice! And that is the point I am making.

I am so tired of hearing women say "I had to get induced because..." You did not HAVE to get induced! You do not HAVE to be induced!

In regards to medically indicated inductions

Please, I implore you, for the sake of birth in our society, consider your words carefully. Because how we speak, how we think, how we view birth matters; it truly, truly makes a difference for women around us and for future generations. What are we teaching our daughters and their future husbands when we say "I had to"? We are teaching them and those around us that it is not their birth, it is that of the institution. Semantics are incredibly powerful. The correct terminology in the case of your suggested medical induction would be, "My care provider recommended induction" And then, do your research or look within or pray, whatever your general go-to method is when between a rock and a hard place. It IS your choice to allow or decline your care provider's suggested induction. Take responsibility for your birth- after all, it's your body, your baby, your birth, your choice.

I urge you, to know and understand what true medical indications for induction are. Take responsibility for your choice.

Did you know: 

According to the NNEPQIN Post maturity (gestational age <41 weeks) is an elective induction.
ACOG, Mayo Clinic and American Family of Family Physicians all discourage the elective induction or scheduled cesarean for reason of a "big baby."
Childbirth Connection and Evidence Based Birth also have a lot to say about inductions.
Lamaze International says

When it comes to choosing a birthday, baby knows best.

UpToDate says

Delivery before the onset of labor is indicated when the maternal/fetal risks associated with continuing the pregnancy are thought to be greater than the maternal/fetal risks associated with early delivery

Your due date is not an expiration date 

In regards to elective inductions

The truth is, well you know what the truth is. 

I'll say it again, semantics are powerful. 

"I had to be induced because I'm overdue" means "I'm sick of being pregnant so I've decided to force my baby out because I went past my guess date"  

As I said before, your due date is not an expiration date. You have options.

Sometimes, women feel - due to family circumstances, such as spouse availability, family being in town to help after baby is born, striving to get all of that maternity leave - that they must induce. In these circumstances, please, please, understand the real hormones involved and the importance of labor. Understand, as said before, you should be choosing the lesser of two evils. It is your choice, I give you that but be responsible for it and responsible for what you say, because semantics are powerful. Did you hear me yet? Semantics are incredibly powerful; we are shaping the way our society views birth, not just now but for future generations. So please, if you've chosen an induction for convenience, stop saying "I need to be induced" because you don't! You are choosing to be induced. Furthermore, you should never feel pressured into an induction. "My care provider says I have to be induced" is not, in and of itself, a valid reason for induction. Your care provider may recommend and induction but in the end it is your choice to accept or decline. You do not have to show up! Make an informed choice that supports your birth, your body, your baby and your desires.

To induce or not to induce. That is the question. And it is just that, a question, a suggestion, an intervention. This is your Journey of Life -own it!

Did you schedule your labor or let nature decide?

Don't Hate, Let's Educate {Birth}

Stop the Mommy Wars is derived from the concept that the only choices we have control over are our own. What another mom chooses is her decision – who are we to judge that?  We are each free to make our own decisions and we should support another mother in her own decisions, creating a stronger community.  While I fully believe this is an excellent idea to stop the growing trend of pop culture pitting moms against each other, I also feel we have other battles placed in front of us that must be confronted. So should we fight one another, insisting that each person is in the right? No: Don't Hate, Let's Educate.

Birth

Your birth, your way. I firmly believe that and as a doula abide by that; I support whatever kind of birth my client chooses.  Here's the catch- I educate my clients. They are making informed choices.

The problem lies, once again, in our misinformed culture. Fear is rampant!  Less than half of all expectant mothers will have taken a childbirth preparation course by the time they give birth. A good majority of those who do take a course take one in a hospital setting. In a hospital course you learn how to be a good patient. You learn some basics about the stages of labor but not what you need to know; not evidence based birth. You'll learn what your [medical] pain management options are but most won't tell you all of the risks of an epidural or that a doula helps to relieve your pain naturally and is associated with a more positive birth experience. They'll tell you the process of admitting you to the hospital but not tips to keep your labor from stalling; they have pitocin for that. They don't work to undo the fear that has been bestowed upon us by our pop culture and the collective memory we've built from that culture.  It's easy and cost effective when birthing mothers can be put into the system, boxed up and released.

But we are each individual mothers with unique births, bodies and babies- we deserve to be treated as such. Don't Hate the system because it treated you unfairly, Let's Educate and spread the word that this is a human rights issue; autonomy of choice. This is what I'm talking about!

A cause that directly affects the health and well-being of millions of women around the world. That cause is human rights in childbirth.

You, mother who doesn't research and just does as your told in the birthing room, I judge you. I judge you and I apologize for that but if we are to take back birth then there is no room for mothers who don't care. We need all the support and advocacy we can get because birth matters.

So is this OB vs Midwife? Hospital vs home? Technology vs nature? No! We can all respect one another. I will respect your choice to birth in the hospital with an epidural if you respect my choice to birth at home without drugs. I respect yours because I've researched yours. Have you researched mine? I'm not asking if you believe it, I'm not asking you to achieve it. I'm simply asking you to be informed. Understand that home birth is a safe option for a healthy, low-risk mother. It's OK if it's not the choice for you, I don't judge you; I simply want you to know that pregnancy is not an illness. I want you to know the epidural is not free of risks. Do you know the benefits and joy of natural birth? Or are you overwhelmed by fear of the pain we have been programmed to expect in childbirth?

"So many North American women have experienced the pain of labor, and then had an epidural, that our collective memory about birth is now full of hurt but is missing the feelings of ecstasy and success that natural birth provides." -Cynthia Gabriel

Our culture has been programmed to fear birth. When birth moved out of the home and into the hospital it became a mystery. Little girls no longer see birth as a normal part of life but as an illness that needs medical care. Everywhere you turn you see complications and pain and no mother wants to be the only woman in the birth circle talking about her blissful or ecstatic birth. Are you getting your information from the media? Are your friends, coworkers and complete strangers bombarding you with horror stories? What would happen if you surrounded yourself with positive birth stories? Have you considered finding a birth circle? Do you have a doula or other caring support persons?



Midwives may provide an excellent source or childbirth education but if you're getting your information from an obstetrician, you must understand that they are trained surgeons; they are trained to manage complications in birth! Don't be ignorant when choosing your care provider. Do you know your care providers birth philosophy? This should be one of the first questions you ask when in search for a care provider. You shouldn't have to settle or compromise. [<--Trigger warning]

Why is it that we get pregnant and call the surgeon! 

The United States spends $98 billion annually on hospitalization for pregnancy and childbirth, but the US maternal mortality rate has doubled in the past 25 years. The U.S. ranks 50th in the world for maternal mortality, meaning 49 countries were better at keeping new mothers alive.

So what's different here than in those other countries? Do they have better technology than us? No. What's missing here, in the United States, is the midwifery model of care. Only 8% of mothers are seeking a midwife for their prenatal care and birth. When are we going to catch on? When are we going to realize that birth is a normal life event. Not only does birth matter, mothers matter! It's not enough to merely say "the baby's healthy, that's all that matters."

There's not near enough of a concern for the rising cesarean rate. Can a cesarean save lives? Yes. Are all  these cesareans we're having necessary- not even close. The WHO recommends a cesarean rate below 15%; anything above that and our outcomes are not improving alongside of the rise in this major abdominal surgery. We are at a national average of 32%.
 
Take charge of your birth. Know what interventions increase your likelihood of a cesarean.
It is NOT ok that we are using pitocin to elictively induce labor.

Daily Med Plus

Don't Hate, Let's Educate. Surely, a mother who knew the risks of induction to her baby and to herself would not choose this. But as a culture, we have made pitocin far too permissible in birth and ignored the dangers of it. Roberto Caldreyo-Barcia, MD said,

Pitocin is the most abused drug in the world today.

We are disregarding the importance of mother nature and creating detrimental affects.

Infographic courtesy of Plumtree Baby

Beyond all of this, it's more than just this moment, this birth; pitocin impacts so much more. Michele Odent, MD first began exploring the desensitization of oxytocin receptors.

Oxytocin is the hormone of love and bonding and human connection. If the oxytocin system is damaged, or a child’s oxytocin receptors become desensitized, the ramifications are huge. Click here to read more about how pitocin impacts can be life-long. 

A recent ACOG survey found that in 43% of malpractice suits involving neurologically impaired babies, Pitocin was to blame. Is this really a risk you want to take because you're uncomfortable towards the end of your pregnancy? Of course not! But mothers are not being told of the risks and so we are overly seeking convenience. This "convenience" is affecting us as a society. This is what I am so angered by. I don't know your circumstances, I don't judge you; what I judge is ignorance. What I am enraged by is the lack of knowledge and respect for choices made surrounding birth. Why is this risk such an easy option to obtain but to VBAC you have to fight? You'll be told the risks of that and you'll be told in a way that makes you fearful, regardless that a vaginal birth may be a safer choice.

Fear mongering is not ok! Ever!

In conclusion: we must respect each women in the choices she makes for her birth and understand that she made the choice she felt best with the knowledge and support she was given. Don't Hate, Let's Educate. We need to stop bashing one another for the choices the other has already made and start reshaping the way our culture views birth. If we can influence the way we think about birth- trusting mother nature, understanding this normal life process- we can begin rethinking our choices and positively influencing future generations. But with so much negative influence from pop culture and a lack of prevalence in the midwifery model of care, where is a simple consumer to begin improving birth? [<---The answer here.]

Previously in Don't Hate, Let's Educate: Vaccinations and Baby Feeding

For more in evidence based birth to help you make informed choices, follow the Journey of Life.

What's important for your birth ?

Standard of {Your} Care

The Stir on  cafemom came out with this article you can read below and I desperately wanted to leave a comment but what I had to say was too long. I felt this warranted a blog post! 

There is a term often used in our society that I have come to question. That term is "Standard of Care"

Initially, I think of my care provider taking this approach to care for me in the best way s/he knows how for my situation. What this term really means is, 'this is the problem, this is the solution' across the board.

 Pregnancy and birth are such intimate times and each woman and baby so unique; is this really the kind of care you want to receive. Standard not being what's best for you and yours but what's most commonly used (not necessarily evidence based or the best) throughout America.

I urge you, don't accept merely the "standard of care" but strive to discover what is best for you, as an individual, in your personal life and circumstance, creating the standard for your care.

Be empowered with informed choice and refusal. 

I have two overused and unnecessary pregnancy procedures to add to this list by Michelle Zipp- vaginal exams and IV fluids. 

Most importantly vaginal exams. They are not necessary in pregnancy or labor and can lead to the overused, and often inappropriate, diagnosis of "failure to progress" in labor. In pregnancy, many women think they need to know if "they're getting close" by vaginal exams as they near their due date. Getting a vaginal exam does not predict when you'll go in to labor. As a birth doula, I've had clients be at 2cm for weeks before labor starts and clients who weren't "showing any progress" go into labor the next day. I put "showing progress" in parenthesis because there is so much more going on in labor than a cervix is telling and the cervix dilation is the last thing to happen. In labor, not only is your body preparing to open and birth your baby, but the baby is preparing as well; it's an delicate dance, best left undisturbed. Maryn Lyster describes birth as "being, not doing."

Now along those lines of the position of baby- I've read a lot of comments in the original article of fetal monitoring and fear!!! We don't have to have the electronic fetal monitors and not having them should not create fear.  A hand help doppler or fetoscope works just as well. For years and into this day and age, women safely deliver babies at home without these efm's. Not only can electronic fetal monitors can be read wrong but they also restrict your mobility. Did you know that your position can also affect baby's heart rate? For example, if you're lying on your back, which you are doing quite often when on the monitors, you can be compressing the baby's cord which can cause a dip in the heart rate. Too often, unnecessary panic and cesareans are caused by these monitors. Before panicking, try changing positions. Also consider and internal monitor if you're being faced with a cesarean. Also consider, are you being directed to push and doing so on your back? 

This brings me back to the vaginal exams. Pushing should be left to the experts- the laboring mother. If you have the urge to push, you're care provider or nurse may want to make sure you're fully dilated- whether you allow this or not is up to you, but if you have the urge, you have the urge and if you don't, you don't! Quite often while attending births as a doula, I see [too] frequent vaginal exams during labor and then mother reaches 10cm and she's given "permission" or sometimes directed to push before she has the urge. As I said earlier, there is so much more going on than cervical dilation, including the position of the baby. Perhaps, though mom may be fully dilated, the baby is not in the most optimal positioning for pushing or perhaps she's lucky enough that her body is allowing a break before the 2nd stage. Going ahead and pushing on command could have a negative affect on baby and make it harder for mom, when she could be enjoying this nice break or using this time to re-position herself or work with her doula or partner, trying rebozo sifting or other methods of encouraging the baby to get into position.

IV's - when and why?

IV fluids are needed if you plan on or need an epidural. The hospital will administer fluids, via and IV, to help reduce the likelihood of your blood pressure dropping too low upon administration of the epidural or spinal block. IV's are also used to administer medications such as pitocin or narcotics.

If you don't plan on any of these interventions and are low risk, you don't need the IV. The hospital will encourage you to have a heplock, "just in case" but think about it- Getting the heplock is not going to administer the fluids, that you probably don't want any way, it's just there. So, it doesn't have a head start on much "just in case" and if you're trusting the hospital to be a safe place for the birth of your baby, I hope you trust the skill of the personnel enough to place an IV should the medical need arise.

Use your best judgement; do what's right for your body and your baby, know your options, be prepared for your birth- don't skimp on the childbirth education. The conclusion of all of this is to trust birth and to trust your body. Too often these "standard of care" medical procedures cause the very problem you'd like to avoid. If you are low risk, a low intervention birth is probably in your best interest. 

How will you be empowered on this Journey of Life?

VBAC

So you've had a cesarean - does that mean your other births must be a cesarean?  No! In fact, a VBAC (vaginal birth after cesarean) may be a safer option for you and your baby. What about 'once a cesarean, always a cesarean'? -Evidence shows otherwise; surround yourself with support and encouragement, educate yourself, hire a doula, choose your birth place and care provider carefully and avoid induction to improve your chances for a successful VBAC.

What are the benefits of a vbac?

An official statement by ACOG says

a vaginal birth after cesarean (VBAC) is a safe and appropriate choice for most women who have had a prior cesarean delivery, including for some women who have had two previous cesareans

See the full article.

 

Bonding

Labor is an intricate dance of hormones; the most important of these- the "hormone of love" -oxytocin. This is not to say that you can't bond with your baby if they are born via cesarean but this very important hormone that enhances the bonding experience is lost in an [elective] cesarean section.  A cesarean section is major abdominal surgery and can be painful to recover from.  This associated pain can inhibit the bonding you experience during breastfeeding and can make breastfeeding more difficult. When a baby is born via c-section milk may take a few extra days to come in- don't let this discourage you.

 

The Big Squeeze

When a baby is born vaginally, fluid is expelled from the lungs when the baby is 'squeezed' through the birth canal. When a baby is born via cesarean section this factor is lost and can result in faster, shallower breathing; this is usually resolved within 24-48 hours. Another benefit lost to cesarean section would be delayed cord clamping.

 

What about a uterine rupture?

According to a recent UK study, the risk of uterine rupture is .2%; the study goes on to say

For women with a previous cesarean section, risk of uterine rupture increases with number of previous cesarean deliveries, a short interval since the last cesarean section, and labour induction and/or augmentation.

The fear of uterine rupture is the most common concern I hear in regards to a VBAC; according to the NIH consensus, 99.5% will remain intact. [This blog shares the evidence for decreased risks after multiple VBAC's.] There are risks associated with both an RCS (repeat cesarean section) and a TOLAC (trial of labor after cesarean)- the problem lies in that most women who are considering a VBAC are told of the risks associated with a trial of labor but not the risks associated with a cesarean section.

 

Risks of Cesarean

Risks for Mother	Risks for Baby
·         Infection ·         Longer hospital stay ·         Hematoma ·         Return to hospital ·         Extended recovery time ·         Injury to organs ·         Ongoing pain (6-12months post delivery) ·         Chronic pelvic pain ·         Hemorrhage ·         Mortality ·         Negative emotional reactions	·         Respiratory problems ·         Pulmonary hypertension ·         Difficulty breastfeeding ·         Premature birth (in a planned cesarean) ·         Fetal Injury ·         Lower APGAR scores
Risks for future pregnancies
Risks are greater after 2 or more cesareans. It is recommended to have a minimum of 18 months before a TOLAC.       ·         Placenta previa       ·         Placenta accreta       ·         Placental abruption ·         Uterine rupture

The fact of the matter

VBAC Support

Cesareans don't just require physical healing, they impact us emotionally and socially as well.  Both mothers and babies benefit from a successful VBAC with fewer complications, easier breastfeeding and a more positive outlook of the birth experience. There are many factors that go into achieving your VBAC, the most important of which is support.  Finding a care provider who will support you and a birth place where you are comfortable are critical components. You will probably find doula support to be indispensable -- a doula will support you prenatally as well as offer emotional [and physical]comfort during labor, which may be a central component to your VBAC. For online resources and to find support in your area, visit my helpful links tab.

Above all, be empowered in your birth by making an informed choice on this Journey of Life. I hope this blog post can help support that decision and would love for you to share your VBAC story here!

Why the wait? {Delayed Cord Clamping}

Delayed cord clamping is all the rage - but why?

Skin to Skin

Along with immediate skin to skin contact, the blood baby receives from the cord aids in stabilizing her temperature.  Furthermore, if baby is still attached to you, the chance of a nurse whisking her away to a warmer for typical newborn procedures is minimized.  Besides her blood, you may also want to let baby keep her vernix; avoid/delay the baby bath.  Like blood, vernix also can help regulate body temperature and has antibacterial properties, as well as being natures best moisturizer so it is best to rub this slimy cheese-like substance into the skin rather than wash it away.

Blood Flow

At 1 minute after birth approximately 80mL of blood is transferred from the placenta into baby.
At 3  minutes after birth that becomes approximately 100mL of blood according to the WHO.

Delayed cord clamping is defined by waiting about 3-5 minutes after birth or until the cord stops pulsating.

 Cord just after birth- still pulsating with blood.








Limp cord- blood fully delivered to baby.
Photo courtesy of Perfect Chance Photography

So why is this important?

Baby gets much needed iron supply.  According to Michelle Roberts, a BBC Health Reporter, iron deficient anemia is "a significant health problem because it can harm a child's brain development."  Allowing a child to receive the full potential of blood and iron stores meant for him ensures a good start; "babies with delayed cord clamping had better iron levels at four months of age." (Roberts, 2011)  This iron supply is especially important in premies who may have not had those last 8 weeks in utero to store up iron.

The brain is afforded some extra protection with this blood flow.  In babies with complicated births, especially a lack of oxygen, this layer of protection is crucial to the brain.  Oxygenated blood travels through the cord to the baby helping to prevent hypoxic injury and associated long term problems due to lack of oxygen.  
Elizabeth Perry describes a birth in which 

the baby was resuscitated physiologically through the intact, unclamped cord.

Perry, E. (2012). Redefining Normal. In N. Halseide (Ed.), Second Stage: The Pushing Phase of Labor, Midwifery Today, Inc. 
 -A highly recommended read from this Collection of  Articles from Midwifery Today Magazine.

The Count

A full-term newborn has an average of 120 ml of blood per kilogram of body weight, or an average of a total fetal-placental blood volume of about 480 ml (16.9 oz.) At any given time about 70 % of his blood is in his body and 30 % is in the placental/cord unit.

- Frye, A. (2004). Holistic midwifery. (Vol. 2). Portland: Labrys Press.

In premature babies and babies born to mothers with gestational diabetes these are very significant numbers. By receiving his full quota of blood, your baby is less likely to have low blood sugar and an increased count of white blood cells means better ability to fight off infection.

Q- Even in uncomplicated births and healthy babies, why not allow the baby the blood belonging to them? 
Jaundice is a commonly heard response, however studies show "no evidence of adverse affects from this."  Studies have shown that jaundice and polycythemia are not curbed by immediate cord clamping as there are other factors involved in their derivation.
A- Cord banking may be the only accurate answer to that question. More on this here.  The chances of a low-risk baby needing his stored stem cells is 1 in 20,000. 

To clamp or to delay clamp? That is the question.  One of the many decisions you'll make for your newborn on the Journey of Life.  What will you do?

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.