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Big baby: Is Induction of labor necessary?

Posted by on Feb. 5, 2009 at 11:12 AM
  • 46 Replies

Big baby: Is induction of labor necessary?

by Henci Goer

What's involved in inducing labor?
Many obstetricians and some midwives recommend inducing labor if you are near or at full-term, and they think the baby is larger than average -- macrosomia, literally, "big body." Typically, they use an estimation that the baby weighs or will soon weigh 4,000 grams (8 lbs. 13 oz.) as the threshold. Inducing labor usually involves the following:

•·         Prostaglandin treatment if the cervix is still long, firm, and thick: Prostaglandins are a family of compounds, two of which are known to soften a cervix that isn't ready for labor. These same two can also stimulate contractions. Prostaglandin E2 is inserted into the vagina either in gel form (Prepidil) or in a tampon (Cervidil). Prostaglandin E1 (Cytotec) comes only as a pill because it is not formulated for the purpose of inducing labor. A piece of the pill may be inserted vaginally or the pill may be given orally.

•·         Breaking the bag of waters (amniotomy or artificial rupture of membranes): During a vaginal exam, the birth attendant snags and tears the membranes using an instrument that resembles a crochet hook with a small sharp tooth under the curled tip.

•·         Oxytocin (Pitocin or "Pit"): Pitocin is given intravenously via a pump that controls the dose.

Why would practitioners want to induce labor for suspected big baby?
The theory goes that inducing labor will prevent:

•·         Cesareans, due to the baby growing too large to fit through the pelvis.

•·         Shoulder dystocia, a situation where the head is born, but the shoulders hang up behind the pubic bone.

•·         Birth injuries, namely, broken collar bone, or injury to a complex of nerves controlling the shoulder and arm (brachial plexus injury). Birth injuries often, though not necessarily, occur in conjunction with shoulder dystocia.

However, studies consistently show that inducing labor for suspected big baby accomplishes none of the above (2-3,5,7,9-10,15-16). These studies include two trials, randomly assigning women thought to have big babies either to induction or to await spontaneous labor (7,15). Random assignment trials produce the strongest evidence because they eliminate bias by ensuring that the two groups are truly similar.

Why doesn't inducing labor help?
Whether a woman carrying a big baby has a cesarean depends largely on her caregiver's management, not her pelvis. In proof of this, the cesarean rate for babies weighing 4,000 grams or more was three percent in 1958 in Great Britain (4). These days, U.S. obstetricians may perform cesareans on as many as half of women with babies of this size (11,16).

The practitioner's belief that women cannot safely birth big babies vaginally, or cannot birth them vaginally at all, will lead to cesarean sections. Several studies illustrate this factor at work. Studies have found that:

•·         C-section rates for mothers having big babies can vary enormously among individual practitioners. One study reported that having a private obstetrician tripled the odds of cesarean compared with having a resident or a midwife (2). Another found rates among obstetricians ranging from less than five percent to one-third (14).

•·         Doctors may be likely to order planned cesareans for women suspected of carrying big babies. This was true for one-third of the women in one study (3).

•·         When obstetricians believe that women are carrying a big baby, far more of them may have cesareans than when doctors don't think the baby is that big, but it actually is. A study reported that half the women whose babies had estimated birth weights of 4,000 grams or more had cesareans versus less than one-third of women with lower estimated birth weights but whose babies were just as big (16).

•·         The reverse is also true. When ultrasound predicts a big baby, women may be just as likely to have a cesarean when the ultrasound is wrong than when it is right. In yet another study, roughly half the women predicted to have babies with birth weights in the top ten percent had cesareans regardless of whether their babies actually weighed in this range (11).

•·         Doctors may not give women a fair chance to labor when they think the baby is big. A study found that when obstetricians thought the baby would weigh 4,200 grams (9 lbs. 4 oz.) or more, half the cesareans for poor progress were performed in early labor (16). When they didn't think the baby was that big, although it was, they performed cesareans for poor progress in early labor less than twenty percent of the time.

Inducing labor for a suspected big baby increases the odds of c-section compared with starting labor on your own. Most, though not all, studies conclude this (2,5,9-10,16). This could be the belief that women can't, or shouldn't, birth big babies vaginally coming into play. It could also be the fact that labor induction, even with pretreatment to prepare the cervix, is more likely to end in a cesarean in first-time mothers than starting labor spontaneously.

While shoulder dystocia and birth injuries are more likely in bigger babies, they occur in non-macrosomic babies and occur rarely even in big babies. For this reason, a policy of induction could have little effect on outcomes even if it reduced the incidence of these problems. To give you an idea of the numbers, an analysis of nearly 15,000 births reported shoulder dystocia rates of twelve percent in non-diabetic mothers of babies weighing 4,000 grams or more and one percent in babies weighing less than this. A similar analysis of birth injuries in nearly 20,000 babies found that less than two percent of babies weighing 4,000 grams or more experienced a birth injury as did less than half a percent of smaller babies (8).

Further diminishing any potential benefit, few cases of shoulder dystocia result in injury. In one study, of 825 cases of shoulder dystocia in infants weighing 4,000 grams or more, only thirty-six, four percent, experienced five minute Apgar scores less than 7, a broken bone, or a brachial plexus injury. Of these thirty-six complications, eight were a broken bone. Breaking a bone is not serious because bones heal. Subtracting the eight instances of fracture, only three percent of babies with shoulder dystocia were at risk for long-term consequences. Even so, more than nine out of ten babies with brachial plexus injuries will completely recover as will eighty-eight percent of infants with five minute Apgars of 7 or less (12-13).

What are the potential problems with inducing labor?
While conferring no benefits, inducing labor increases the likelihood of overly strong contractions, fetal distress and, as documented above, probably cesarean section (6).

How might having an induced labor affect your birth experience and postpartum recovery? Having labor induced will medicalize your experience, in that you will need an IV and continuous electronic fetal monitoring . You will likely be confined to bed for most or all of the labor. Contractions will probably be more painful, so if you wanted to avoid pain medication, this will make it more difficult to achieve that goal. An epidural will help eliminate the pain, but introduces a long list of potential problems of its own. You may run a additional risk of the labor ending in a cesarean, with all that entails in complications, pain, and recovery time.

 

Women should not feel guilty if they are unable to breastfeed, but they should feel guilty if they are unwilling to do so, and they should be intellectually honest enough to know the difference. - Elizabeth Gene

by on Feb. 5, 2009 at 11:12 AM
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Replies (1-10):
mommy2be33009
by on Feb. 5, 2009 at 11:13 AM

Bump

I want to read this but don't have time right now...

momof2cuteboys
by on Feb. 5, 2009 at 11:21 AM

 I'll be induced a week early due to measuring big and the fact that my babies have all been big.  The largest 8 lbs 12 oz and I recieved a 4th degree tear because he was too big for me.  So since I measure 3 wks ahead and with my history my ob and I decided that this was the best option for me.  Plus the 8lb 12 oz child was induced the day before his due date ... because of other complications.. and it was an easier labor in general than with my first that I went on my own... but I'm an odd duck apparently.

cali4niachef
by on Feb. 5, 2009 at 11:26 AM

Tears are mostly associated with epidurals and laying on your back, of course the size of the baby is relevant to some degree. I had a 2nd degree tear with both of my boys, they were 7lbs 11oz and 7lbs 4oz. 

The doctor can aide in preventing tearing by applying a warm compress to your perineum while pushing and use oil to massage it. Water births are excellent in supporting the perineum thus having a really low chance of perennial damage.

Quoting momof2cuteboys:

 I'll be induced a week early due to measuring big and the fact that my babies have all been big.  The largest 8 lbs 12 oz and I recieved a 4th degree tear because he was too big for me.  So since I measure 3 wks ahead and with my history my ob and I decided that this was the best option for me.  Plus the 8lb 12 oz child was induced the day before his due date ... because of other complications.. and it was an easier labor in general than with my first that I went on my own... but I'm an odd duck apparently.


"If you don't know your options, you don't have any." - Diana Korte, A Good Birth, A Safe Birth

Curllyq
by on Feb. 5, 2009 at 11:33 AM

ITA.  My cousin had a 4th degree tear with her first drugged labor.  The second was bigger and she didn't have an epidural and took her time pushing and she didn't even have a little skid mark.  Another cousin is 115 pounds and had 3 10-lb babies.  Large babies aren't a threat, doctors who don't know about delivering them are.

Quoting cali4niachef:

Tears are mostly associated with epidurals and laying on your back, of course the size of the baby is relevant to some degree. I had a 2nd degree tear with both of my boys, they were 7lbs 11oz and 7lbs 4oz. 

The doctor can aide in preventing tearing by applying a warm compress to your perineum while pushing and use oil to massage it. Water births are excellent in supporting the perineum thus having a really low chance of perennial damage.

Quoting momof2cuteboys:

 I'll be induced a week early due to measuring big and the fact that my babies have all been big.  The largest 8 lbs 12 oz and I recieved a 4th degree tear because he was too big for me.  So since I measure 3 wks ahead and with my history my ob and I decided that this was the best option for me.  Plus the 8lb 12 oz child was induced the day before his due date ... because of other complications.. and it was an easier labor in general than with my first that I went on my own... but I'm an odd duck apparently.



Lilypie Breastfeeding Ticker I'm a natural-birthing, public breastfeeding, attachment parenting, co-sleeping advocating, future home-birthing, cloth-diapering, mom of 2 boys - 10/06 and 3/08. One is circumcised, one isn't, ask me why! (and don't mutilate your poor baby's penis:( ) I tandem nurse.
I'm an open book when it comes to my pregnancies and births. There's nothing you can ask that I won't answer.
usmc1171
by on Feb. 5, 2009 at 11:38 AM

Very well said, Nature does not give us babies that are too large for us, at a point in every woman's body there is a limit and when that limit is hit the baby wont keep growing! otherwise we could all be birthing toddlers! lol So no I do NOT AGREE with being induced early for that reason, it is bad for baby and for the mom..... dont be afraid to stand up for your rights and be informed.....

Quoting Curllyq:

ITA.  My cousin had a 4th degree tear with her first drugged labor.  The second was bigger and she didn't have an epidural and took her time pushing and she didn't even have a little skid mark.  Another cousin is 115 pounds and had 3 10-lb babies.  Large babies aren't a threat, doctors who don't know about delivering them are.

Quoting cali4niachef:

Tears are mostly associated with epidurals and laying on your back, of course the size of the baby is relevant to some degree. I had a 2nd degree tear with both of my boys, they were 7lbs 11oz and 7lbs 4oz. 

The doctor can aide in preventing tearing by applying a warm compress to your perineum while pushing and use oil to massage it. Water births are excellent in supporting the perineum thus having a really low chance of perennial damage.

Quoting momof2cuteboys:

 I'll be induced a week early due to measuring big and the fact that my babies have all been big.  The largest 8 lbs 12 oz and I recieved a 4th degree tear because he was too big for me.  So since I measure 3 wks ahead and with my history my ob and I decided that this was the best option for me.  Plus the 8lb 12 oz child was induced the day before his due date ... because of other complications.. and it was an easier labor in general than with my first that I went on my own... but I'm an odd duck apparently.

 


 




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Konalove
by on Feb. 5, 2009 at 11:48 AM

8.12 isn't a huge baby. Its a healthy baby, but doesn't fall under the HUGE baby catagory.

Quoting momof2cuteboys:

 I'll be induced a week early due to measuring big and the fact that my babies have all been big.  The largest 8 lbs 12 oz and I recieved a 4th degree tear because he was too big for me.  So since I measure 3 wks ahead and with my history my ob and I decided that this was the best option for me.  Plus the 8lb 12 oz child was induced the day before his due date ... because of other complications.. and it was an easier labor in general than with my first that I went on my own... but I'm an odd duck apparently.


cali4niachef
by on Feb. 5, 2009 at 11:48 AM

I couldn't have said it better!

Quoting Curllyq:

ITA.  My cousin had a 4th degree tear with her first drugged labor.  The second was bigger and she didn't have an epidural and took her time pushing and she didn't even have a little skid mark.  Another cousin is 115 pounds and had 3 10-lb babies.  Large babies aren't a threat, doctors who don't know about delivering them are.

Quoting cali4niachef:

Tears are mostly associated with epidurals and laying on your back, of course the size of the baby is relevant to some degree. I had a 2nd degree tear with both of my boys, they were 7lbs 11oz and 7lbs 4oz. 

The doctor can aide in preventing tearing by applying a warm compress to your perineum while pushing and use oil to massage it. Water births are excellent in supporting the perineum thus having a really low chance of perennial damage.

Quoting momof2cuteboys:

 I'll be induced a week early due to measuring big and the fact that my babies have all been big.  The largest 8 lbs 12 oz and I recieved a 4th degree tear because he was too big for me.  So since I measure 3 wks ahead and with my history my ob and I decided that this was the best option for me.  Plus the 8lb 12 oz child was induced the day before his due date ... because of other complications.. and it was an easier labor in general than with my first that I went on my own... but I'm an odd duck apparently.

 



jupiter84
by on Feb. 5, 2009 at 7:06 PM

Bump

jennie710
by on Feb. 5, 2009 at 7:13 PM

My son was 9 lbs 7 oz.  I barely tore at all, it almost didn't even need any stiches... Granted, I had a midwife and she helped to prevent tearing.  Regaurdless, he came when he was ready and nobody thought he'd be that big, but it was not a problem at all and I am not that big...

 

krystaldawn_21
by Bronze Member on Feb. 5, 2009 at 7:30 PM

I know a lady that gave birth to an 11 pound baby and she didn't tear.Now thats a big baby!LOL.My son was tiny.He was 5 pounds 3 ounces but I didn't get to deliver him vaginally due to complications but I will be trying for a VBAC with this baby and no stupid epidural either!

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