How Big Is Too Big??
Big Babies. A reason for concern?
"Your baby is simply too big for your body, we should ____ * enter intervention of choice here*" I spoke to another parent today who has heard these words. Yet again. Upon birth, one in ten babies will have fetal #macrosomia (a birth weight of 8 lbs, 13 oz or more), however a national study found that one in three women are told their baby is too big to birth vaginally. Out of this number, two of three reported that their care provider suggested inducing labor, and one in three said their provider discussed planning a cesarean due to baby size. With those mothers who had induced labor, nearly one in five said induction wasn't presented to them as an option, but as a must.
Evidence aside, we're already seeing a huge issue here; Lack of informed consent and shared decision making between the mother and her care team. If you aren't presented with all of the information and told your choices, then you don't truly have any. One major concern is how these supposed "big babies" are being diagnosed. When using ultrasound or physical exam to predict a large baby, the accuracy rate hovers somewhere around 50%. This means that out of 10 babies estimated to weigh 8 lbs, 5 will weigh less, and 5 will weigh more. ACOG (American College of Obstetricians and Gynecologists) discourages care providers from recommending third trimester ultrasounds to determine weight. In fact, research has consistently shown that the care provider’s perception that the baby is big can actually be the largest concern. If your care provider thinks that you are going to have a big baby, this mindset can potentially be more harmful than an actual large baby itself. The suspicion of a big baby leads many care providers to manage a woman’s care in a way that increases the risk of Cesarean and complications. So, what can be done? If we see that evidence based practices do not recommend routine induction or cesarean for a suspected bigger than average baby, then what IS recommended?
1. A supportive care provider. Since studies show that having a care provider who doesn't believe in your body's ability to birth your baby results in higher intervention rates, choosing a provider who fully supports your personal birth choices is critical. Make a list of questions to ask your provider throughout your pregnancy, to be sure that your birth philosophies align.
2. Knowledge of the birth process. A woman’s body changes to prepare for pregnancy and birth - connective tissues soften in the joints, and the pelvis, cervix, and vaginal tissues expand to accommodate the baby. Baby’s head molds as it moves through the mother’s body, and the hormones that facilitate labor rise and fall as needed. Education on how the body works during labor can empower self advocacy.
3. Freedom of movement. Babies make necessary cardinal movements to rotate through the pelvis, regardless of their size. Knowing how and when to move and change positions during labor and birth can reduce unnecessary pain and help labor progress.
4. Time. Birth shouldn't be on a clock; women aren't averages, and should be given the time their individual body and baby need. Pushing shouldn't be rushed, and often shouldn't begin until the urge to push is experienced.
5. Outside support. Seeking out support - in the form of books, #childbirth education, a #doula, or knowledgeable friends - can offer a valuable resource. Women who are fully supported through pregnancy and birth are shown to need fewer interventions, and have a lower cesarean rate.
Have something to add? We'd love to hear it!
Further Reading: https://improvingbirth.org/2017/05/big-baby-myth-what-you-need-to-know-2/ https://evidencebasedbirth.com/evidence-for-induction-or-c-section-for-big-baby/ https://blog.everymothercounts.org/the-big-baby-conundrum-b3ed5bedcfd1