We had a huge Instagram response to a birth announcement recently. We posted that one of our clients had delivered her 11 lb. 7 oz baby at the birth center.
The Midwives of New Jersey want to encourage you to give labor a chance before scheduling a cesarean for a possible (and may actually be a) big baby. Many women deliver large babies as easily as smaller ones especially if they have already given birth before.
Signs that Baby May Be Too Large To Deliver Vaginally
There are ways to monitor a pregnancy and labor for signs that the baby may be too large to come safely through the pelvis. Things like:
- Excessive weight gain; history of large babies, they tend to get a little (or a lot) bigger each pregnancy; poorly controlled gestational diabetes
- A baby floating out of the pelvis, especially once active labor has begun
- A prolonged, inefficient labor
- A baby’s head not being well-applied to the cervix
- A lack of descent in the labor
- Pushing too long – we have to be suspicious when a second time mom can’t deliver in less than an hour
- I am always a little suspicious of a persistent Occiput Posterior baby. It seems like the find more room for their LARGE selves back by the sacrum!
Misinformation About What Determines A Large Baby
But women are often told that the following things are indicative of a large baby and I do NOT agree:
- A big belly-unfortunately, in many cases, most of that belly is Mommy not Baby
- Short stature
- Not going into labor by the due date. I have caught many BIG babies at 38 weeks and 6-7 pounders at 42. All babies grow at their own pace
- Ultrasound prediction of baby’s size. The inaccuracy of estimated fetal weights at term gestation is well-documented in the literature but it is still used to convince a woman she can’t deliver normally. In most cases, ultrasound technicians never know the accuracy of their estimates. That is why they always sound so confident. As far as they know, they are never wrong!
If Your First Big Baby was Delivered by Cesarean Section, Do Not Assume that You Cannot Deliver a Big Baby
Cesarean is more common in first pregnancies than subsequent ones. Remember that 70-80% of women who have a Trial of Labor After Cesarean (TOLAC) will deliver vaginally-and many deliver bigger babies!
We had a client whose whole family made large babies-they all gave birth without needing a cesarean section. Knowing that, she came to her first birth confident that the baby would be big and even more sure that she could deliver without surgery. Her plan was for a homebirth. The labor was long but normal for a first-time Mom. She pushed a couple hours at home then transferred to the hospital. We started a Pitocin drip to strengthen the contractions and she pushed again for a couple hours. In the end, the 9#14oz baby took an alternate route into the world.
When this woman returned pregnant with her second baby, she wished to have a TOLAC. But then at the end of the pregnancy, it was evident that this baby would be as big as the last. Conversations between Mom, Dad, our doctor and I led to a decision to schedule a repeat cesarean 4 days after the due date.
On her due date, she called me and said she had started labor. She was anxious about enduring labor pain just to end up in the operating room again, so she made her way to the hospital. Long story short, she delivered her second baby about an hour after admission. 10#15oz, no problem! Obviously, the first cesarean was not a sign of a cephalo-pelvic disproportion. It just happened, You can see from this person’s experience, that it is often worth going into labor instead of just scheduling surgery.
The Best Ways To Avoid A Cesarean Section
The best way to avoid cesarean section especially if the baby is larger than average, is to
- Go into labor spontaneously. Not only should a woman not be induced without a true medical indication, but she not try to induce herself with natural methods. Just WAIT for labor to begin.
- Rest in early labor-have a glass of wine and take a nap, Move in active labor-walk up and down your stairs, do figure 8’s while sitting on the exercise ball, squat in the shower.
- Avoid the epidural or at least delay as long as you can – a woman needs to be able to push very effectively if the baby is bigger. Epidurals not only take away sensation, but they paralyze the pelvic floor. Consider turning if off for the 2nd stage of labor before exhausting yourself pushing without effect.
Cesarean sections are necessary at times to safely deliver a large baby but it really can be game day decision. You do not know what you (and your pelvis) can do until you try!