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Break down of ACOG guideline for a "big baby"

Posted by on Nov. 5, 2012 at 11:49 AM
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http://www.aafp.org/afp/2001/0701/p169.html


"Weighing the newborn after delivery is the only way to accurately diagnose macrosomia [big baby], because the prenatal diagnostic methods (assessment of maternal risk factors, clinical examination and ultrasonographic measurement of the fetus) remain imprecise." This means that there is NO WAY of knowing how much baby will weigh until he or she is weighed after birth!

"Nonetheless, the results of these reports, along with published cost-effectiveness data, do not support prophylactic cesarean delivery for suspected fetal macrosomia with estimated weights of less than 5,000 g (11 lb), although some authors agree that cesarean delivery in these situations should be considered." This means, c-section should not even come up for discussion, unless the is estimated to weigh more than eleven pounds and it is debatable whether a c-section for a estimated baby over eleven is even beneficial.

"Suspected fetal macrosomia is not an indication for induction of labor, because induction does not improve maternal or fetal outcomes." Inducing should not happen, becuase it is not safer for mom or baby. 

"Labor and vaginal delivery are not contraindicated for women with estimated fetal weights up to 5,000 g in the absence of maternal diabetes." A baby estimated to be ELEVEN pounds or less is not a reason to deliver vaginally. 

"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." It is safe to have a trial of labor and if it doesn't work THEN take action. 

"Suspected fetal macrosomia is not a contraindication to attempted vaginal birth after a previous cesarean delivery." You can still VBAC with a "big baby"!



by on Nov. 5, 2012 at 11:49 AM
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Replies (1-10):
aussiechic
by on Nov. 6, 2012 at 8:44 AM

 question.  I'm a Non insulin dependant diabetic. How would the following apply to me?

"Labor and vaginal delivery are not contraindicated for women with estimated fetal weights up to 5,000 g in the absence of maternal diabetes." A baby estimated to be ELEVEN pounds or less is not a reason to deliver vaginally.

I"m COncerned that the doc will try to induce me.  SHe has already mentiooned induction at 39 weeks for me.  I'm 28 weeks now. :/  Baby only weighs 2lb 11 ozs right now and is in the 72 percentile. So far, bp is good and blood sugars are well controled with NO Medications. :/

louzannalady
by Group Owner on Nov. 6, 2012 at 8:55 AM

I am during research on this. There are two points: one induction for suspected fetal macromsomia and early induction for the diabetes issue. Maybe, someone else will know. What type of diabetes do you have- one or two? I am not well-versed in diabetes, so I will need to read up. 

Quoting aussiechic:

 question.  I'm a Non insulin dependant diabetic. How would the following apply to me?

"Labor and vaginal delivery are not contraindicated for women with estimated fetal weights up to 5,000 g in the absence of maternal diabetes." A baby estimated to be ELEVEN pounds or less is not a reason to deliver vaginally.

I"m COncerned that the doc will try to induce me.  SHe has already mentiooned induction at 39 weeks for me.  I'm 28 weeks now. :/  Baby only weighs 2lb 11 ozs right now and is in the 72 percentile. So far, bp is good and blood sugars are well controled with NO Medications. :/


aussiechic
by on Nov. 6, 2012 at 9:06 AM

 type 2.   When not pregnant i take metformin.  My MFM doc took me off of that at 13 weeks.  So far my sugars are well controlled with diet.  I guess i could understand if my sugars were critically high, but they are never above 160 even on days i'm sick.  Baby looks great.  THey are so happy with me that they decided they don't want to see me for 4 weeks.  ( I had been seeing them every 2 weeks for prior loss due to incompetent cervix).  Ugh.  I just want a natural birth that happens on it's own.  when we lost our son at 20 weeks last year they offered me an epidural for that!  say what?!  I was shocked.  and this go around, my MFM looked shocked when i told her I don't want an epi this go around... she said, "why not? I had one".  I don't care what she had. Its my body.  Not to mention, the doc said to me ..." we'll talk about inducing you at 39 weeks becuase we want to have a vaginal delivery". that's what i was told.

Quoting louzannalady:

I am during research on this. There are two points: one induction for suspected fetal macromsomia and early induction for the diabetes issue. Maybe, someone else will know. What type of diabetes do you have- one or two? I am not well-versed in diabetes, so I will need to read up. 

Quoting aussiechic:

 question.  I'm a Non insulin dependant diabetic. How would the following apply to me?

"Labor and vaginal delivery are not contraindicated for women with estimated fetal weights up to 5,000 g in the absence of maternal diabetes." A baby estimated to be ELEVEN pounds or less is not a reason to deliver vaginally.

I"m COncerned that the doc will try to induce me.  SHe has already mentiooned induction at 39 weeks for me.  I'm 28 weeks now. :/  Baby only weighs 2lb 11 ozs right now and is in the 72 percentile. So far, bp is good and blood sugars are well controled with NO Medications. :/


 

louzannalady
by Group Owner on Nov. 6, 2012 at 9:32 AM

I have a question. I have a great group of women on Facebook, some are from here. A lot of midwives and doulas who would have great resources. Would you be okay if I posted the info you gave me and get their input? Or, if you want to join, feel free and ask there directly. I just want to get you the best answer possible! *hug* 

http://www.facebook.com/groups/519580908070092/

Quoting aussiechic:

 type 2.   When not pregnant i take metformin.  My MFM doc took me off of that at 13 weeks.  So far my sugars are well controlled with diet.  I guess i could understand if my sugars were critically high, but they are never above 160 even on days i'm sick.  Baby looks great.  THey are so happy with me that they decided they don't want to see me for 4 weeks.  ( I had been seeing them every 2 weeks for prior loss due to incompetent cervix).  Ugh.  I just want a natural birth that happens on it's own.  when we lost our son at 20 weeks last year they offered me an epidural for that!  say what?!  I was shocked.  and this go around, my MFM looked shocked when i told her I don't want an epi this go around... she said, "why not? I had one".  I don't care what she had. Its my body.  Not to mention, the doc said to me ..." we'll talk about inducing you at 39 weeks becuase we want to have a vaginal delivery". that's what i was told.

Quoting louzannalady:

I am during research on this. There are two points: one induction for suspected fetal macromsomia and early induction for the diabetes issue. Maybe, someone else will know. What type of diabetes do you have- one or two? I am not well-versed in diabetes, so I will need to read up. 

Quoting aussiechic:

 question.  I'm a Non insulin dependant diabetic. How would the following apply to me?

"Labor and vaginal delivery are not contraindicated for women with estimated fetal weights up to 5,000 g in the absence of maternal diabetes." A baby estimated to be ELEVEN pounds or less is not a reason to deliver vaginally.

I"m COncerned that the doc will try to induce me.  SHe has already mentiooned induction at 39 weeks for me.  I'm 28 weeks now. :/  Baby only weighs 2lb 11 ozs right now and is in the 72 percentile. So far, bp is good and blood sugars are well controled with NO Medications. :/


 


louzannalady
by Group Owner on Nov. 6, 2012 at 9:38 AM

This is what I posted in a couple of other groups, because I have been wondering about early induction in relationship to diabetes. It was very general. I did not post it in the Informed Births Facebook group, in case people read here and read there.

This is not for me. But, what are the risks and benefits of inducing at 39 weeks for Type 2, non-insulin depend, diet controlled diabetic? Is this really a thing that an early induction is a good idea? I know, the worry is for "big baby" or there other concerns? Any studies or links looking at induction at 39 weeks versus expectant management? Thanks, Ladies! : ) 

Quoting aussiechic:

 type 2.   When not pregnant i take metformin.  My MFM doc took me off of that at 13 weeks.  So far my sugars are well controlled with diet.  I guess i could understand if my sugars were critically high, but they are never above 160 even on days i'm sick.  Baby looks great.  THey are so happy with me that they decided they don't want to see me for 4 weeks.  ( I had been seeing them every 2 weeks for prior loss due to incompetent cervix).  Ugh.  I just want a natural birth that happens on it's own.  when we lost our son at 20 weeks last year they offered me an epidural for that!  say what?!  I was shocked.  and this go around, my MFM looked shocked when i told her I don't want an epi this go around... she said, "why not? I had one".  I don't care what she had. Its my body.  Not to mention, the doc said to me ..." we'll talk about inducing you at 39 weeks becuase we want to have a vaginal delivery". that's what i was told.

Quoting louzannalady:

I am during research on this. There are two points: one induction for suspected fetal macromsomia and early induction for the diabetes issue. Maybe, someone else will know. What type of diabetes do you have- one or two? I am not well-versed in diabetes, so I will need to read up. 

Quoting aussiechic:

 question.  I'm a Non insulin dependant diabetic. How would the following apply to me?

"Labor and vaginal delivery are not contraindicated for women with estimated fetal weights up to 5,000 g in the absence of maternal diabetes." A baby estimated to be ELEVEN pounds or less is not a reason to deliver vaginally.

I"m COncerned that the doc will try to induce me.  SHe has already mentiooned induction at 39 weeks for me.  I'm 28 weeks now. :/  Baby only weighs 2lb 11 ozs right now and is in the 72 percentile. So far, bp is good and blood sugars are well controled with NO Medications. :/


 


aussiechic
by on Nov. 6, 2012 at 10:13 AM

 thanks! absolutely! the more input i have the better.  I just don't want to be "run over" when i go into labor beucase it's not progessing like they would like and i don't want unnecessary drugs. :/  I don't want an induction if it's not needed.

Quoting louzannalady:

I have a question. I have a great group of women on Facebook, some are from here. A lot of midwives and doulas who would have great resources. Would you be okay if I posted the info you gave me and get their input? Or, if you want to join, feel free and ask there directly. I just want to get you the best answer possible! *hug* 

http://www.facebook.com/groups/519580908070092/

Quoting aussiechic:

 type 2.   When not pregnant i take metformin.  My MFM doc took me off of that at 13 weeks.  So far my sugars are well controlled with diet.  I guess i could understand if my sugars were critically high, but they are never above 160 even on days i'm sick.  Baby looks great.  THey are so happy with me that they decided they don't want to see me for 4 weeks.  ( I had been seeing them every 2 weeks for prior loss due to incompetent cervix).  Ugh.  I just want a natural birth that happens on it's own.  when we lost our son at 20 weeks last year they offered me an epidural for that!  say what?!  I was shocked.  and this go around, my MFM looked shocked when i told her I don't want an epi this go around... she said, "why not? I had one".  I don't care what she had. Its my body.  Not to mention, the doc said to me ..." we'll talk about inducing you at 39 weeks becuase we want to have a vaginal delivery". that's what i was told.

Quoting louzannalady:

I am during research on this. There are two points: one induction for suspected fetal macromsomia and early induction for the diabetes issue. Maybe, someone else will know. What type of diabetes do you have- one or two? I am not well-versed in diabetes, so I will need to read up. 

Quoting aussiechic:

 question.  I'm a Non insulin dependant diabetic. How would the following apply to me?

"Labor and vaginal delivery are not contraindicated for women with estimated fetal weights up to 5,000 g in the absence of maternal diabetes." A baby estimated to be ELEVEN pounds or less is not a reason to deliver vaginally.

I"m COncerned that the doc will try to induce me.  SHe has already mentiooned induction at 39 weeks for me.  I'm 28 weeks now. :/  Baby only weighs 2lb 11 ozs right now and is in the 72 percentile. So far, bp is good and blood sugars are well controled with NO Medications. :/


 


 

aussiechic
by on Nov. 6, 2012 at 10:28 AM

 I found this on the teh GHC.org website.

Additional Testing/Monitoring
Monitoring Before Delivery The following antenatal tests are not recommended:

    1)Ultrasound to estimate fetal weight
    2)Ketone checking

Timing of Delivery
There is no evidence on which to base the optimal timing for delivery. Expert opinion
     1) For women with good glucose control, induction before 40 weeks is not indicated.
    2) For women on insulin, consider induction at 39 weeks and no later than 41 weeks.

louzannalady
by Group Owner on Nov. 6, 2012 at 10:33 AM
1 mom liked this

Sounds like you found your answer! ; ) That is what my gut says: if baby is doing well and placenta is doing well and mom is doing well and sugar levels are doing well, leave well-enough alone. That is what some of the other mommas are saying, too.

Quoting aussiechic:

 I found this on the teh GHC.org website.

Additional Testing/Monitoring
Monitoring Before Delivery The following antenatal tests are not recommended:

    1)Ultrasound to estimate fetal weight
    2)Ketone checking

Timing of Delivery
There is no evidence on which to base the optimal timing for delivery. Expert opinion
     1) For women with good glucose control, induction before 40 weeks is not indicated.
    2) For women on insulin, consider induction at 39 weeks and no later than 41 weeks.


aussiechic
by on Nov. 6, 2012 at 10:34 AM

 OoOO and i found this on another website.:

If blood glucose levels are close to normal during pregnancy, and there are no other complications, it is ideal for the mother to deliver at term. It is generally recommended that pregnancies complicated by GDM do not go beyond term. There is continuing debate about whether induction of labor or expectant labor is more efficacious, and it is not clear which is better with regard to the outcomes of cesarean delivery incidence, birth injury, or neonatal morbidity and mortality.

here's the link.
CLICK ME

 

louzannalady
by Group Owner on Nov. 6, 2012 at 11:26 AM
1 mom liked this

Great link!!!! : ) I have created a post in additional resources for "Diabetes and Pregnancy" and that is the first link I included! : ) Thank you! : ) 

Quoting aussiechic:

 OoOO and i found this on another website.:

If blood glucose levels are close to normal during pregnancy, and there are no other complications, it is ideal for the mother to deliver at term. It is generally recommended that pregnancies complicated by GDM do not go beyond term. There is continuing debate about whether induction of labor or expectant labor is more efficacious, and it is not clear which is better with regard to the outcomes of cesarean delivery incidence, birth injury, or neonatal morbidity and mortality.

here's the link.
CLICK ME

 


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