“Big Baby”

We’ve all heard about women who were told they needed to consider an artificial induction of labor or even Cesarean surgery, because their babies “looked big” toward the end of pregnancy. Many of these women were unpleasantly surprised when their babies were born at completely average weights, after they’d undergone a drastic intervention in a healthy pregnancy.

The latest article from our brilliant Rebecca Dekker on her site EvidenceBasedBirth.com is “What is the evidence for induction or C-section for a big baby?”  She confirms some sad news: 1 in 3 women in the U.S. are being told that their babies are too big, even though weight can’t be reliably predicted. Women are NOT being told that procedures such as artificial induction and Cesarean surgery for big babies have not been shown to improve outcomes, and, in fact, may be harmful. Induction for big baby likely increases the C-section rate.

Her article addresses the four “big” assumptions on which this approach is based:

  1. Big babies are at higher risk for problems.
  2. We can accurately tell if a baby will be big.
  3. Induction keeps the baby from getting any bigger, which lowers the risk of C-section.
  4. Elective C-sections for big baby are beneficial and don’t have any major risks.

In maternity care, treating assumption like fact can have devastating consequences.  In this case, we see that the “suspicion” of a big baby is more harmful than an actual big baby!

When it comes to big babies, there is a clear disconnect here between what research says is best and what is commonly practiced all over the country. Please read Rebecca’s article and share far and wide.

Why Is It Important?

Suspected big baby (or macrosomia) is not a medical indication for induction or Cesarean, yet it is one of the most common reasons given for these procedures.  In 2014, the American College of Obstetricians and Gynecologists issued guidelines to care providers recommending that they limit interventions for suspected baby to “avoid potential birth trauma.”

However, we know that it can take many years for guidelines like these and current research to be implemented into routine care.

What You Need to Know

Research shows that common interventions used for suspected big babies, such as induction and cesarean surgery, are actually more harmful and carry more risks than big babies themselves.

★ Non-diabetic, low-risk women are NOT at higher risk of complications due to baby’s size. In some cases, such as with mothers who have pelvic deformities or uncontrolled gestational diabetes, a large baby can be a medical indication for intervention.

Myths and Facts

★ MYTH: It is possible to predict which babies will be big.
FACT: Ultrasound estimates of babies size are unreliable, especially at the end of pregnancy. Predictions of a big baby are right 50% of the time and wrong 50% of the time.

★ MYTH: Big babies are at higher risk for complications.
FACT: In low-risk women, having a big baby does not put them or the baby at greater risk for complications.

★ MYTH: When there is a suspected big baby, intervening in labor and birth can decrease risk.
FACT: Statistically speaking, intervening due to a suspected big baby has been found to be more risky than the big baby itself and can lead to more complications.

For More Evidence-Based Information

Read What is the Evidence for Induction or C-Section for a Big Baby? from Evidence Based Birth

What Do I Do With This Information?

You have the legal right to full information about anything that’s being suggested, and the right to say “no” or to choose an alternative.  Read more here about your rights to informed consent and refusal.

Hospital policies are “rules” for providers to follow, but do not overrule your legal rights to make choices about your care. Hospitals and care providers do not have have the legal right to impose them upon you.

You also have choices in your care.  If you don’t feel comfortable with your care provider, it is never too late to switch to someone else.  Remember, you hire your care provider—not the other way around.  Be an empowered consumer in your maternity care.  Your baby’s birth is one of the most important days of your lives.
DISCLAIMER: Remember, this is for informational purposes only and should never be construed as medical or legal advice. We encourage you to do your research and talk with a trusted care provider about your unique circumstances and your options.

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  1. Ash says:

    I was JUST writing about this. Here are some fascinating things I came across in my research and writing for my article…

    BIRTHS OF SUSPECTED BIG BABIES HAVE HIGHER RISKS THAN ACTUAL BIRTHS OF BIG BABIES
    Pregnant women are often given C-sections when their physician thinks they are carrying a large baby due to the fear of stillbirth and shoulder dystocia (stuck shoulders). Rebecca Decker of Evidence Based Birth found nine different studies on large babies which found that a physician’s suspicion of a large baby led to higher rates of induction, cesarean, and stalled labor than did the birth of a large baby who was not anticipated to be large. One study from 2008 found the greatest risks were with women who doctors suspected to be carrying large babies and who had been consulted on the issues of large babies. Compared to women who birthed big babies that went unsuspected and unconsulted, the consulted women had three times the rate of induction and C-section, and four times the rate of maternal complications.

    THE CHANCES OF BIRTHING A “BIG BABY” IS LESS THAN 8%, BUT THE RISKS OF C-SECTION AND INDUCTION ARE SO MUCH HIGHER
    Another study which Rebecca Decker makes reference to looked at the type of birth for large babies. This study found that the rate of vaginal births for unsuspected big babies was 91 percent, while the rate for suspected big babies was only 52 percent. This is particularly distressing because fewer than 8 percent of babies are born large (over 8 lbs 13 oz). Yet the national birth survey Listening To Mothers reveals that 4 out of 5 women given a C-section for a suspected large baby ended up delivering babies which were under 8 lbs 13 oz. Ultrasounds are notoriously inaccurate at measuring third trimester fetal weight, and medical literature states as much. Have doctors missed the memo?

    DAY AND TIME OF DELIVERY PUTS MOTHERS AT HIGHER RISK OF INDUCTION AND C-SECTION (BUT ONLY FOR HOSPITAL BIRTHS)
    In 2013, the CDC compiled data for their report When Are Babies Born: Morning, Noon, Or Night? According to their data, the majority of hospital births took place Monday through Friday, between the hours of 8am and 5pm. Meanwhile, non-hospital births were more likely to occer between 11pm and 5am. What’s especially of interest here are C-section births. Birth for women who had attempted labor but ended up delivering by c-section tended to happen between 3pm and 11pm. C-section births with labor attempted reached their highest peak between 5 and 6pm. Based on this data, day and time may actually be a risk factor for C-section delivery.”

    http://healingthebody.ca/common-medical-procedures-women-face-and-the-shocking-facts-doctors-arent-sharing/#gs.uC5NlnQ

    And here’s what I learned about shoulder dystocia (the leading “cause” for inducing suspected big babies) writing a post for Green Child Magazine…

    EPISIOTOMIES ARE GIVEN TO PREVENT SHOULDER DYSTOCIA, BUT THE EVIDENCE DOESN’T JUSTIFY IT
    Until recently, episiotomies were believed to prevent brachial plexus injury. The nerve injury was believed to be connected to shoulder dystocia (getting “stuck”) during birth. However, a 2010 study of by the American Journal of Obstetrics and Gynecology revealed that episiotomies had no impact on rates of brachial plexus injuries. An episiotomy may be warranted if baby is under distress, but as we discussed earlier, EFM readings are notorious for giving false positives. Episiotomies may also be used because pushing isn’t “effective” or it’s taking “too long,” but again, baby may just need help with their descent. A change in birth positions might be all the help they really need.

    BABIES BORN BY INSTRUMENTAL DELIVERY HAVE HIGHER RISK OF SHOULDER DYSTOCIA THAN SUSPECTED BIG BABIES
    The idea behind assisted deliveries is to help get baby out, but there are times where they may do the exact opposite. A 2012 analysis by UK’s Norfolk and Norwich University Hospital of nearly ten thousand births showed that assisted delivery increased the chances of shoulder dystocia; with vacuum/ventouse delivery increasing the risk almost threefold, and forceps upping the odds nearly 3.4 times.

    INDUCTION IS PERFORMED WITHOUT EVIDENCE-BASED MOTIVES
    Induction comes with further controversy because inductions are often prescribed for low amniotic fluid levels, and suspected big babies are often induced out of fear of shoulder dystocia or birth complications. However, there’s a handful of evidence that stresses that low fluid or a possible large baby aren’t actually medical cause for induction, and other evidence suggests that inducing these births come with greater risks than waiting for labor to happen on it’s own. And induction may be provoking labor for a baby that isn’t properly engaged in the pelvis, or a cervix that isn’t yet soft and ripe — and that may mean a longer and harder labor. The information out there certainly alludes to that as induction nearly doubles the odds of a Cesarean.

    EPISIOTOMY RATES ARE HIGHER FOR WOMEN WITH BIG BABIES, BUT THE LARGEST DETERMINER OF EPISIOTOMY IS THE MOTHER’S BIRTH PROVIDER
    An analysis of episiotomies by Boston’s Brigham And Women’s Hospital revealed that their incidence of episiotomy was higher among women who had (1) received an epidural, (2) were induced, and/or (3) birthed babies at higher weights. The real shocker was the rate of episiotomy between the types of care providers. Compared to midwives, faculty physicians were almost twice as likely to perform episiotomies. As for private practitioners (ie. surgically-trained ObGyns), they were four times more likely to slice during birth.

    http://www.greenchildmagazine.com/birth-interventions/

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