Have you been told that you are having a big baby?
Unfortunately, this is becoming more and more common and very often leads to unnecessary fear, worry and anxiety. Read the case study below, about Lydia's experience of being told she was having a big baby, when she was pregnant with her first baby.
Predicted Big Baby Case Study: Is this the end of the dream waterbirth?
When Lydia reached 35 weeks of her pregnancy, she went for her antenatal midwife appointment. At the appointment, her midwife measured Lydia's bump, using a tape measure. The midwife told Lydia that her baby was starting to measure big and it was now measuring on the 91st percentile. The midwife asked Lydia if there was any family history of "big babies" and Lydia explained that her husband was a big baby, when he was born. The midwife said that it looked like history was repeating itself and that there was going to be another big baby in the family. Lydia asked the midwife what would this mean for the birth and the midwife said that she would arrange for Lydia to have a growth scan at the hospital, in the next few days and if the scan was predicting a big baby too, she would probably need to be induced and her dreams of a natural, waterbirth would be out of the question.
Lydia left her appointment feeling worried, anxious and upset. She had been considered low risk throughout her pregnancy, with no complications. She had been reading a lot about the benefits of waterbirths and this was something that she had her heart set on. This new information of having a big baby, changed everything. She spent that evening researching the risks of big babies, the pros and cons of induction and the process of caesarean sections. Her anxiety started to increase more and more and all she could now focus on, was her baby's birth and how hard it was going to be.
Two days after Lydia's midwife appointment, she got a call from the hospital, to say that they'd received the referral for a growth scan. However, due to the high volume of women being booked in for scans at the moment, they wouldn't be able to see her for another 5 days. This made Lydia feel so frustrated and upset, because she was worrying so much about the outcome of the scan and just wanted to know if her dream waterbirth was definitely off the cards and what the next steps would be.
The night before the scan, Lydia found it hard to sleep. She was imagining all kinds of scenarios for her birth. The day of the scan finally arrived and it was good news! Lydia's baby wasn't measuring big after all. He was exactly where he should be and was measuring on the 56th percentile. Lydia's dream of a natural, waterbirth was back on. A few weeks later, Lydia birthed a beautiful baby boy, 2 days before his estimated due date, at home, in the birth pool, weighing a perfect 8lbs 6oz.
Unfortunately Lydia's experience isn't unusual and so many of my clients are being told that their baby is measuring big, when they attend their antenatal appointments. It's almost becoming standard practice now and in most cases, these women are not carrying big babies at all and all that it creates is unnecessary worry and anxiety for a few days or even weeks. I had one previous client who was told that she needed to be induced, due to the scan estimating a big baby. This induction led to complications at birth, which then lead to an unplanned, emergency caesarean section. When her baby was born, he was not considered "big" either. He was a healthy 7lb 13oz, but induced at 38weeks +5. He could have quite happily stayed in the womb, until he was ready to be born and his Mother's birth experience could have been very different.
Ultrasound scans are not very reliable when trying to work out the weight of a baby. A recent Cochrane review (March 2023) states that "the estimation of the baby's weight is difficult before birth and not very accurate." The NICE guidelines consider a large baby for gestational age as having an estimated fetal weight above the 90th centile or weighing over 4000g on an ultrasound. Women who are told that their baby is considered a large baby for gestational age, are often recommended early induction or a planned caesarean section, to stop the baby growing too big. The reason for this is because large babies increase the risk of shoulder dystocia (05.% in non-diabetic women), needing help delivering the baby (e.g. forceps, ventouse) or an increased risk of severe perineal tearing, which would require repair in theatre.
Inductions and caesarean sections come with their own risks too, so if you have been told that your baby is measuring big, weigh up the pros and cons of delivering an estimated large baby and the risks associated with that, verses the risks of inductions and c-sections. Also bear in mind, that inducing a baby early (37-38 weeks) could increase the risk of baby needing treatment when they are born. E.g. evidence indicates that early induction can increase your babies risk of jaundice at birth, which would require treatment and potentially a longer stay in hospital. As ultrasound scans are not very reliable at estimating babies gestation either, it could be that a baby being induced at 37 weeks, could in fact only be 35 weeks gestation at birth. Again, this could create additional issues at birth, where baby might need to go into the NICU (Neonatal Intensive Care Unit) for help and treatment.
Always use the BRAINS acronym when faced with a difficult decision, to help you to make informed decisions, that are right for you and your baby.
B - Benefits
R - Risks
A - Alternatives
I - Intuition
N - Do nothing
S - Second opinion
Dr Sara Wickham has some excellent information on her website about induction and big babies. Another great resource to read about, for suspected big babies in pregnancy, is Evidenced Based Birth. My hypnobirthing courses and my antenatal and birth doula support packages, also teach you all about making informed decisions during pregnancy and how to navigate the complicated maternity system. If you would like to know more about them, visit my website or get in touch.
Julia x