Thursday, August 5, 2010

Big Baby

In light of being pregnant again and previously given birth to a 9lb 8oz baby, I found this topic extremely interesting as I didn't realize how different view points could be. I ran across this briefing/study/data/whatever you want to call it and found A LOT of the info on here VERY thought provoking.

It's really really long, so I'll sum it up on the topics I'm going to talk about.
1)A baby born with weight below the 10%tile and above the 90%tile is considered 'abnormal'. Baby's between the 10% and 90%tile are between 7lbs 3oz and 9lbs 6oz. VERY broad range! No Liam really wasn't all that massive as some thought (mainly the OB who made it very clear while sewing me up that he was such a HUGE baby, I politely asked her to stop and after a glance at the other OB and nurse didn't say anything else)

2)Ultra-sound is NO BETTER at guessing baby weight than your care provider palpating on your belly. Personally, I would venture to say that Midwives are better at guessing baby size based on feeling on mom's belly because they don't use ultrasounds unless medically necessary, and as we all know (even ACOG) finding out the baby's size IS NOT a medical necessity, so it's therefore IT'S NOT recommended to have an ultrasound for this reason alone. EVERY HEALTH ORGANIZATION STATES THAT DUE TO THE LACK OF KNOWLEDGE OF THE EFFECTS OF ULTRASOUND, THEY SHOULD ONLY BE USED WHEN MEDICALLY NEEDED. (Yes, this means, not just because you got a positive test, not because you are 20 weeks, not because you are 37 weeks, etc) But this can be a whole other post.

3)When studied, estimating baby size by ultrasound, estimations are off by less than 10% of the baby's weight a little less than 60% of the time. This is HUGE! Basically, if your ultrasound says that you have an 81/2lb baby, there is a 60% chance your baby is actually between 7lb 10oz and 9lb 6oz. And there is a 40% chance the ultrasound is off by more than that, in either direction.

Why is all this important?
Well, today, there is a HUGE 'BIG BABY' scare out there for pregnant women, and I think it's sad that women are scared at anytime in their pregnancy, and I think further, care providers (including some Midwives) push to 'get the baby out' sooner rather than later, so a mom makes an emotional decision based on fear of 'not being able to birth her baby' and consents to either early induction and/or cesarean. Why are these things bad? Well, again that's another whole blog.

Can a woman's body build a baby too big for her to birth?
Yes, in some cases, yes. For instance if she has polio, rickets, dwarfism, extreme pelvic injuries that leaves her pelvis severely traumatized or scared, then her pelvis may be too small to birth her baby. Most women don't have these. OR if a woman has a really really really crappy diet, which commonly leads to gestational diabetes (as these moms typically have bigger than average babies). By this I mean, eating pints of ice cream a day, not eating veggies for fruits practically ever, surviving off of coca-cola and bacon and sugar for the entire pregnancy, you get the point.

What reasons does a care provider have to be afraid of a 'big baby'?
Well, they say shoulder dystocia. This is where once the baby's head is past the pelvic outlet, one of the shoulders get stuck, and since most women in a hospital have an epidural, the maneuvers to get baby out are limited and usually it's pretty invasive for baby to get baby out. Here's the kicker, only 50% of shoulder dystocia cases are with babies larger than 8lbs 15oz.! So just because your baby is big(ger) doesn't mean you will have this problem. In fact, you are just as likely to have this problem with a baby smaller than 8lb 15oz.

Why do care providers think an 8lb-9lb baby is 'abnormal' when it's really NOT?
Well, years ago, like when our moms were pregnant, a 8lb baby was quite normal, even a close to 9lb baby. We women haven't changed in that short time and neither has the size of our babies, so one must think that it's the thinking of the care providers. Today there are MANY MANY more early inductions and cesareans before a women goes into labor herself. The reasons vary, and most are not reasonable. So if babies are being born EARLIER, their sizes are going to be SMALLER. Now, this varies from practice to practice, so, one care provider may say 'oh yeah a 8-9lb baby is normal' while another says 'I've never seen one that big! 6-7lb is normal!'. I bet the second CP has a very high induction and cesarean rate, or just really unhealthy moms.

How should we be measuring 'normal'?
This is all my opinion, but I do feel it makes a LOT of sense, and I'm going to compare a typical MW practice with a typical OB practice.
MWs focus on healthy living. This includes a diet high in water, protien, fruits, whole grains, veggies, low in sugar and flour, especially white sugar and white flower. They don't really focus on weight gain if a mom is eating healthy. They also focus on exercise and getting some type of workout through out the week to move your body to burn off calories. Even if you weren't exercising before pregnancy, they will most likely tell you it's a great idea to start walking a few days a week around the block to your comfort level. Due to this focus, very few moms become high risk and develop things like eclampsia, gestational diabetes, IUGR, fluid issues, etc. Now, Midwives, (talking specifically about out-of-hospital Midwives) don't induce, wait till the mom goes into labor, don't do cesareans, but most midwives don't consider a 9lb-10lb an issue. Oh, and most MWs don't run into shoulder dystocia as they allow women to birth in pelvic opening positions, and if they do, they simply change the position of the mom and no more invasive intervention is needed.
OB, of what I know and in my experience and in the experience other women have told me, don't do so much diet counseling. Of course they say eat healthy, etc fruits veggies, etc. But they don't typically hold moms accountable and have them actually list out what they ate for a week/month to really see what that mom considers 'healthy'. During prenatal visits, not much is talked about diet, when it is routinely with MWs. The current recommendation is, if you weren't exercising before pregnancy, don't start now. Ok, I understand don't start marathon training, but DO get off the couch and walk at least, especially if you haven't before! OBs typically have a higher rate of eclampsia, gestational diabetes, fluid issues, growth issues, etc due to this lack of focus, which commonly leads to low weight/not the right kind of weight issues in a newborn. OBs obviously do many more cesareans, inductions, etc. So therefore, an OB would see many more smaller babies. This explains why I was told 'WOW! LIAM WAS HUGE!' When really, he was no bigger than most moms' babies were small.

Here are some interesting blurbs from other women who were given the big baby scare, and some turned out much smaller than expected...dangerously small. Keep in mind 'normal' baby size is 7lb3oz-9lb6oz. Smaller babies especially have many more issues than bigger babies.

"For the record, DD was 8lbs 12 oz and 21.5 inches long. About a week before her birth, ultrasound estimated 9lbs 3 oz.....doc was worried about a "big baby...I do however, believe that the "Big Baby" scare is way out of control and that most women will not create a babe that is too big for them. I especially think that women should at least give there bodies a chance to try....they might even be surprised!"

"With DS, my ob did an ultrasound right around 39 weeks. US showed baby 9 pounds plus or minus a pound. She pushed and pushed and finally got me convinced to induce. Since it was my first and this was a newer dr because of a move, I felt like I was doing something wrong by not listening to her. My birth went okay, as in I didn't have a c-section or anything, but I still had a harder labor because of the induction which included pitocin and an epidural. "

"With my first, they induced because they thought he was going to be 11 lbs or more, and they did repeated sonograms to check. He was 8 lbs 10 1/2 ounces at 40 weeks.

My SIL was told that her baby could be induced at 37 weeks, because he was already 7 lbs (according to ultrasound) and that his lungs looked mature, but sure enough, he was 4 lbs 11 ounces and not at all ready when he came out."

"Now if they had something else like the baby is jumping in size (like gaining 5 lbs) and wasn't purely based off of u/s I might support it. Or if they thought the baby was going to be like 14lbs, yeah I can see it. For me personally I just happen to have big babies. ODD was 7lbs 14 oz and she was 2 weeks early (induced because of hbp). Ydd was 9 almost 10 lbs. "

"Oh I forgot to add that my ob pushed and pushed to induce my 9 pound plus or minus baby...3 days later he was 8lb 1oz. Hmmm...really glad I am not seeing her again! "

"Before I delivered ds 2 the midwife kept telling me that my baby was going to be very small. She said I was measuring very small, and the U/S showed him to be 3 pounds at 38 weeks......Um. he was born at 39 weeks weighing 8 lbs 3 ozs and 22 1/2 inches long!!"

"My SIL was sectioned at 37 weeks because they told her the baby was too big and running out of room to grow. She is 230 lbs pre-pregnancy and not a small-framed woman. Baby was 4lb13oz at birth. My sister was "overdue" with her ds and was induced at 41w3d for dr convenience (not size at least). Ultrasound at 40 weeks "showed" baby was about 8 pounds. He was born weighing 6lb3oz. Their guesses and "proof" are so inaccurate. "

BELIEVE IN YOUR BODY! Baby's are really quite squishy and mold very easily (if positioned right) and pelvises are really quite stretchy too (if your in a good position during labor and pushing)

Oh, BTW, ANY care provider that says, baby is getting too big, we should induce, as them what ACOG says. They are the ones that mandate the recommendations that should be followed, and even THEY say inducing or scheduling a cesarean for a baby thought to be macrosomic (over 8lb 15oz) IS TOO RISKY and should NOT be done! I would be hesitant to continue my care with an individual who bases their practice on experience alone and not on recommendations that come from more experienced sources.

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