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Break down of ACOG guideline for a "big baby"

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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
Replies (11-14):
TTC2Long
by on Nov. 6, 2012 at 11:40 AM
1 mom liked this
Thanks for posting!
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louzannalady
by Group Owner on Nov. 6, 2012 at 11:58 AM

Here are two links one of my Mommas in another group came up with. She is a nurse and said she was having issues coming up with more studies on this, but came to the same conclusion we have: when all is going well, leave it alone and only intervene if something is coming up. Again, each case and pregnancy is different, so I would speak with my provider. If she is recommending an induction, just have her prove that it is needed. The burden of proof to intervene is on her- the burden of proof to leave things alone and monitor them is not on you.*hug* I hope this helps.  

http://www.nejm.org/doi/full/10.1056/nejmoa042973#t=articleMethods

http://care.diabetesjournals.org/content/30/Supplement_2/S251.full

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

 


rachelrothchild
by on Nov. 7, 2012 at 2:03 PM
1 mom liked this

Yay, some good info I can share with friends :)

louzannalady
by Group Owner on Nov. 7, 2012 at 2:07 PM

Quoting rachelrothchild:

Yay, some good info I can share with friends :)

Awesome! : ) I love to hear that! : )

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