Big Baby BS - Fetal Macrosomia

It breaks my heart and also frustrates me to hear women time and time again share with me the fear that has been implanted in their minds by their doctors concerning the size of their babies. Knowledge is power. Let’s have a discussion today about “the Big Baby Bullshit.” I put this term in quotes because I did not coin this term but ran across some website a few years ago dedicated to this topic.

First, allow me a moment to celebrate a few September births from my yoga class:
Amy ‘s story: “Hi Patricia! I’m the short blonde girl who usually sat in the back corner. I was scheduled for a planned c-section because the doctor said I would have a huge baby.  But, I went into labor on my own on Friday, August 31st (water broke at 12:50 am), I dilated all the way to 10 cm by Saturday night at 9 pm but he wasn’t coming so they wheeled me in for c-section at 1:30 am.  On Sunday morning, September 2nd, Baby boy, Everett James, was born at 2 am and weighed 7 lbs, 14 oz.  Doctors were way off thinking I was going to have a 10 lb baby!”
Another Yoga Mama who declined her doctor’s recommendation for induction/Cesarean for suspected big baby:

Liza’s story: “Hi Patricia! This is Liza from Yoga class. I'm the girl with glasses that sits all over the place and brings non-pregnant family members to learn yoga moves with us. My daughter Lillian Marie was born on Thurs, Sept 27 after twelve hours of non-medicated labor - four at home, eight at the hospital. I used multiple music playlists, lots of dancing and moving, a yoga block, and partner stretches to get me through the whole process. My husband almost passed out doing the slow breathing techniques! Thank you for all your support and can't wait to join the Baby and Mommy classes in six weeks!  By the way, Lillian was 7lbs 2oz, 21 inches long. So much for this HUGE baby the doctor was expecting. So glad I didn't fall for the big baby inducing/c-section BS. Again, thanks to all the yoga mama's for their support!”

Sigh. Need I say more? The examples above are just a fraction of the stories I hear time and time again.  Some become empowered and informed about their choices in childbirth and will escape induction/Cesarean but still many more fall victim to the pressure and scare tactics.  Not all doctors are this way so please don’t post any comments about me being a rebel or doctor-basher. Quite the opposite, in fact, I have a large handful of doctors whom I LOVE and recommend to my students and doula clients.  It’s all about choosing your doctor wisely, one that is “mama-friendly” and one that actually reads the research and studies rather than practice fear-based medicine.

Let’s look at what ACOG Guidelines are on defining and describing the care for suspected Fetal Macrosomia, “i.e. big baby.”
Summary of ACOG committee recommendations for the management of fetal macrosomia:
​ACOG Practice Bulletin 173: Fetal Macrosomia:
Recommendations based on good and consistent scientific evidence (Level A):
* The diagnosis of fetal macrosomia is imprecise. For suspected fetal macrosomia, the accuracy of estimated fetal weight using ultrasound biometry is no better than that obtained with clinical palpation (Leopold's maneuvers).
Recommendations based on limited or inconsistent scientific evidence (Level B):
* Suspected fetal macrosomia is not an indication for induction of labor because induction does not improve maternal or fetal outcomes.
* Labor and vaginal delivery are not contraindicated for women with estimated fetal weights up to 5,000 g in the absence of maternal diabetes.
* With an estimated fetal weight more than 4,500 g, a prolonged second stage of labor or arrest of descent in the second stage is an indication for cesarean delivery.
Recommendations based primarily on consensus and expert opinion (Level C):
* Although the diagnosis of fetal macrosomia is imprecise, prophylactic cesarean delivery may be considered for suspected fetal macrosomia with estimated fetal weights of more than 5,000 g in pregnant women without diabetes and more than 4,500 g in pregnant women with diabetes.
* Suspected fetal macrosomia is not a contraindication to attempted vaginal birth after a previous cesarean delivery. Vaginal delivery is a reasonable alternative to elective cesarean section for infants with estimated birth weights of less than 5000 g and a trial of labor can be offered. For the fetuses with estimated birth weight >5000 g, an elective Cesarean section should be recommended, especially in primiparous women.
Just so we are clear, ACOG is not recommending automatic Cesareans for suspected “big baby” up to 5,000 g.  Here is another published study by the Department of Obstetrics and Gynecology in France, which concluded that “Vaginal delivery is a reasonable alternative to elective cesarean section for infants with estimated birth weights of less than 5000 g and a trial of labor can be offered. For the fetuses with estimated birth weight >5000 g, an elective caesarean section should be recommended, especially in primiparous women.” http://www.ejog.org/article/S0301-2115(97)00242-X/abstract
5,000 g is equivalent to 11 pounds!!  So why are doctors continuing to schedule women for C-sections based on an ultrasound and Leopold Maneuver of a possible 8 or 9 lb baby? The truth is we have no way of knowing the exact weight of the baby until she is born!  And my strong opinion is that the pregnant woman deserves a fair Trial of Labor.
Here is another Blog regarding big babies that I found inspiring http://jeremyscorner-grifter.blogspot.com/2009/04/big-baby-is-not-emergency.html. Adventures in Crunchy Parenthood blog wrote a very comprehensive article siting studies and resources that support the statement that birthing a suspected big baby is NOT an emergency.
I will leave you with this very inspiring video of one of my clients who gave birth vaginally, without pain medication, to a 10 lb, 2 oz baby girl without complications and without a stitch or tear.  A few things helped this mama accomplish that birth: 1) she declined a scheduled Cesarean, 2) she fired her first doctor midway through labor, 3) she was without an epidural and thus able to be upright and dance through labor in order to create more space in her pelvis and use gravity to help baby descend . Pushing phase was less than 20 minutes!
I hope you feel more empowered to trust your bodies and give birth with a suspected “big baby” a fair try.
http://www.youtube.com/watch?v=7SJc-EpUdVA

[Originally published November 2, 2012]