Posted by My OB said WHAT?!?.
Jan
3
Posted by My OB said WHAT?!?.
“It’s A Good Thing I Didn’t Know He Was Going To Be That Big Or I Would Never Have Let You Labor At All.”
“It’s a good thing I didn’t know he was going to be that big or I would never have let you labor at all.” – OB to woman who birthed a 11 1/2 pound baby unmedicated and vaginally with only 15 minutes of pushing.
There are 55 comments to this post.
Doc, do you have any idea how stupid you sound? Let me explain it to you, what you just said is that iT is a good thing you didn’t know how big my baby was because then you would have done something that would have injured me in a vain attempt to save me from myself which would have been stupid because by the natural course of events I was fine! Now don’t you feel dumb? Stop saying these things, stop being afraid of shadows and learn to roll with the punches. Thank you!
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Details Reply:
January 3rd, 2012 at 11:46 am (Quote)
Another thing that really bugs me about this one is the idea that labor is bad. The fact is that during labor certain hormones are released that prepare the baby to breath. The best procedure for a CBAC is to wait for labor so you know the baby is done and gets some of those labor hormones. Scheduling is bad for babies.
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Laura Reply:
January 5th, 2012 at 2:11 pm (Quote)
Of course if they waited for labor with me, baby would NOT be a c-section unless s/he got stuck, probably. (Of course…if there’s no medical need for a c-section, that would be for the best. If one was medically necessary, though…it could be a problem.)
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Bonnie B Matheson had this to say,
Jan 3, 2012 @ 5:01 am (Quote)
And it is a VERY good thing that this very wise mother responded by putting this VERY stupid doctor’s equally stupid comment on this site for us all to laugh at and remember.
Thank goodness the mother simply pushed the baby out without extra Ultrasounds or all sorts of interventions due to baby too big superstitions.
That is what they are: Supstitions!
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Teri had this to say,
Jan 3, 2012 @ 5:18 am (Quote)
Not to defend stupid Doctors but I actually don’t think this is a stupid comment. If the comment had been “If I’d known he was going to be so big…” It’d be different but the OB is almosts admitting that would have been a bad idea.
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Kathy Reply:
January 3rd, 2012 at 6:04 am (Quote)
IMO, what you said, and what he said are the same thing.
If this were said in a “Wow, I would have been totally wrong for doing that do you, I’m so glad I didn’t know so you go the best birth possible,” it would have been a “Thoughtful Thursday” comment. My guess is this was said in a “Wow, I dodged a bullet here! This kid could have had SD, so I better be careful I don’t let another one of these 11lbers slip by me again!
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Aron Reply:
January 3rd, 2012 at 3:17 pm (Quote)
Besides the basic fear this doctor seems to project about big babies, I think part of the reason this comment is so frustrating is the “I would never have LET you….” statement. The care provider can always recommend a course of action, but s/he doesn’t have the authority to disallow a competent adult to refuse a recommended treatment. That’s the essence of a patient’s right to INFORMED consent (or refusal). It’s also the crux of why obstetrics is one of the most controversial of medical specialties: too few care providers are held accountable for upholding informed consent and providing truly evidence-based care instead of CYA-based care.
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Heather P had this to say,
Jan 3, 2012 @ 6:02 am (Quote)
This is exactly why I refuse late ultrasounds to check on size.
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Tee Reply:
January 3rd, 2012 at 5:59 pm (Quote)
You’re a smart woman, Heather P! Most midwives can judge a baby’s size simply by palpation but… as sad as it is to say… many OB’s can’t do that.
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WellBegun Reply:
January 3rd, 2012 at 6:43 pm (Quote)
GOOD midwives also understand the limitations of that technique and don’t go fearmongering. 
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Lisa had this to say,
Jan 3, 2012 @ 7:03 am (Quote)
Sorry doc, but regardless of how big the baby is, you can’t make me do anything. How about instead of freaking out you say something like “it’s good to know that all big babies don’t need medical intervention and you’re an amazing mama for doing this all on your own”.
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Mama Wrench had this to say,
Jan 3, 2012 @ 10:20 am (Quote)
Dear Doc, gravity is an amazing thing. It keeps planets aligned, it keeps the oceans and tides steady, it allows the moon to wax and wane. Gravity enables STARS to be born — let it do the same for “big” babies. Stop turning moms into upside-down beetles and I guarantee 80% of those “macrosomatic” babies will fall right out.
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jaed Reply:
January 3rd, 2012 at 10:43 am (Quote)
I don’t really think it’s gravity so much as leverage and pressure on the pelvis. Not so much the upside-down part (for the convenience of the doctor “performing the procedure” of birth) as the fact that having your weight on your tailbone tends to close up part of the pelvic opening.
I think hanging by the feet from the ceiling [I hereby dub this "the bat position"] would actually be better for birth, physio-mechanically, than the customary “dead beetle”. I’m having trouble thinking of a birth position that *wouldn’t* be better, actually…
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BeckyJ Reply:
January 3rd, 2012 at 11:14 am (Quote)
Actually, this is kind of true. I watched a youtube video of a chimp(and I know their anatomy is a little different, but still) give birth basically upside down.
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Jane Reply:
January 3rd, 2012 at 11:26 am (Quote)
4th birth I was in a labor tub rocked back almost onto my shoulders, pushing uphill, feet and hands braced on the side of the tub. Baby was out in one push.
So I agree with you: hanging from the ceiling, at least your pelvic bones would be free to flex and slide.
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Let me guess, the next time doc will say “since your last baby was so big, let’s schedule you for a c-section”
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C.Pratt Reply:
January 3rd, 2012 at 1:07 pm (Quote)
As well as double GD testing and a whole other slew of extra measures.
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Bonita Reply:
January 3rd, 2012 at 1:19 pm (Quote)
OH yes! Let’s not forget the fact that she MUST have had GD in order to have a baby that big! They just didn’t catch it! *sigh*
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Michelle Potter Reply:
January 3rd, 2012 at 3:19 pm (Quote)
I have a question about this. I am always hearing about how GD causes “big” babies, but what does “big” mean? Does it actually mean “fat”? I mean, on the one hand, can diabetes cause changes to a baby’s skeletal structure? On the other hand, can doctors not tell the difference between “big” and “fat”?
I am asking because, according to my Great Aunt Sue, my grandfather was 11 pounds at birth and “all skin and bones.” As an adult he was very tall and broad-shouldered (muscular, but never fat), so this isn’t surprising. Similarly, two of my sons were nearly 9 pounds, but skinny. It makes me think that a baby’s weight doesn’t mean all that much.
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Missy Reply:
January 3rd, 2012 at 3:38 pm (Quote)
Same here. My two daughters were both near 9 lbs. but very long and skinny.
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Jenny Islander Reply:
January 3rd, 2012 at 6:47 pm (Quote)
I refused the sugar-sickup-drink test for my last. He was born 9 lb. 11 oz. with broad shoulders and long, powerful legs (kicked like a mule). He is at the 85th percentile for both height and weight, most of it muscle, and performs feats of strength that amaze child development specialists. He is healthy as a horse too. If I had let them do the tests and the late ultrasounds and such, I bet that he would have been declared “too big” and subjected to unnecessary and counterproductive interventions. See, I am unmistakably big and fat.
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Lisa Reply:
January 3rd, 2012 at 10:15 pm (Quote)
Unfortunately for OB’s, the actual research shows that “GD” doesn’t make much difference to baby size. “Other factors such as race, age, parity, sex, and especially maternal weight, far outweighed glucose intolerance in determining birth weight. Hunter and Keirse observed that GD mothers had a 3-fold risk of giving birth to a baby weighing over 4500 g compared with normoglycemic women. However, a woman weighing over 90 kg had a 26-fold risk of having a baby this heavy compared with normal weight women (Hunter and Keirse 1989). Oats and colleagues could not find a significant association between glucose levels and birth weight until birth weight exceeded the 90th percentile. Even then, 77 percent of women had normal glucose tolerance (Oats et al. 1980).” from http://www.gentlebirth.org/archives/gdhgoer.html
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we were successful and you would not have allowed it? my head hurts! makes no sense!
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Jane Reply:
January 3rd, 2012 at 1:41 pm (Quote)
It’s an emotional thing. If a doctor stops and says, “Maybe I’ve been wrong all these years. Maybe women CAN deliver nine pound babies with no problem,” then the doctor has to look in the mirror and say, “I performed unnecessary abdominal surgery on hundreds of women.”
That creates a cognitive dissonance in the doctor: The doctor wants to believe on the one hand that s/he is a good doctor, and then on the other hand the doctor realizes that good doctors do not perform unnecessary surgeries or procedures on the patients who trust them.
Many doctors will resolve the cognitive dissonance by saying “That safe birth was a fluke. Even if it’s a 99% chance of the baby getting stuck and dying, one in a hundred will make it through. Good medicine says you cut those babies out.” Or they’ll say, “This is just an anecdote. The plural of anecdote isn’t data.” And that way their emotions are protected, but protected at the cost of their patients. 
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Judith Reply:
January 3rd, 2012 at 1:58 pm (Quote)
Jane, you are so right! that is why even when it was proven that doing xrays on pregnant women was causing harm , it took decades to change the practice. have you read the book titled”Mistakes were made, but not by me”? it discusses this phenomenon in different professions-invaluable reference.
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Michelle Potter Reply:
January 3rd, 2012 at 3:24 pm (Quote)
I don’t understand what’s so difficult about, “I acted on the best information I had at the time. That’s not shameful. Now I have better information, and I am happy to be a better person for it.”
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Jane Reply:
January 3rd, 2012 at 3:27 pm (Quote)
But in order to reach that spot, someone has to get over the hurdle of “I hurt people in the past,” and that’s a tough thing to do. It requires a lot of emotional maturity and emotional reserves. Not every doctor is going to have that.
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Kristy Reply:
January 3rd, 2012 at 3:48 pm (Quote)
What I don’t get is how much easier it seems to be for *us* to get over that hurdle. I mean… many of us here had ‘go with the flow’ births before we learned more about best practices. And many of us have children who were hurt to one degree or another by those births. Why can we deal with the fact that our lack of knowledge has hurt *our own children* when these doctors have to work their way around the facts and go on hurting women and babies just so they can avoid the fact that they hurt women and babies in the past.
I don’t know about you ladies, but I’m so tired of us mothers having to be the only grown ups in the room so much of the time. That’s it! I’m gonna go be in childish denial about something for the rest of the day… but I think *I’ll* pick something that doesn’t hurt anyone *else*.
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Jane Reply:
January 3rd, 2012 at 3:56 pm (Quote)
Harriet Lerner: The person with the problem is going to be the one who solves the problem.
A doctor who sections 40% of the women in his/her care doesn’t have a problem: the women who get unnecessarily cut have the problem. The doctor who cuts an episiotomy on EVERY woman who delivers is not the one with the problem; the women who get cut are the ones with the problem.
You can argue that the doctor’s problem causes problems for others, but the fact is, the doctor has no problem with the way things are.
But a woman whose child has been hurt has a very big problem, and therefore she solves it. If she can’t solve it for this child, she will solve it for the next one. A woman who has PTSD from her birth has a problem, and she therefore takes steps to solve it during the next birth.
That’s why women are the ones who struggle and go against the common cultural default in order to have safe and satisfying births, whether in the hospital or at home or in birth centers. Because the women are motivated to solve the problem of the American birth systems because they and their children are the ones being harmed by it, and they are the ones with the problem.
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jaed Reply:
January 3rd, 2012 at 5:45 pm (Quote)
I was thinking something similar, about how a birth ending in a caesarean is all upside for the doctor, who:
- gets to do surgery instead of standing around being bored
- is in control of the schedule, something that can’t be done in a normal birth
- can use and be proud of his or her surgical skills
- receives recognition from peers for those skills
- receives gratitude from mothers if the surgery was necessary – or if they don’t realize it was unnecessary. (“Thank you, doctor! You saved my baby!!!” is a very pleasant thing to hear, even if on some level the doctor knows it isn’t true. Even if the doctor in fact endangered mother and baby through negligence or impatience. The mother doesn’t know that, and her gratitude is real and satisfying.)
- more intensive work, but a much shorter time and a larger fee.
For an OB, it’s all upside.
(And mothers, for whom it is not all upside, are taught to obey doctors without question. The only check on it is the rate of death or serious complications for the patients, and that’s gone down steadily as techniques have improved and neonatal ICU has gotten better. Put bluntly, if they’d done so many caesareans and at such a young gestational age decades ago, they would have killed a lot more mothers and babies. The improvement in medical technology has also opened the door to abuse of the procedure because it’s less dangerous now.)
Looked at from that point of view, the frequent abuse of caesarean section isn’t surprising. I’m kind of surprised the rate isn’t even higher. When the person making the decision is the person who gets all the benefits and none of the problems, that’s going to happen.
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v had this to say,
Jan 3, 2012 @ 2:13 pm (Quote)
Congrats on your utter logic fail, Doc! Short of there having been something wrong and the doc trying to comfort the mom with the idea that they just din’t know or would have helped out more (or something…) then this is a complete…argh. It just makes me so angry. Everything was fine, so you wish you had intervened for no reason?? WHAT???
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Bonnie B Matheson had this to say,
Jan 4, 2012 @ 6:09 am (Quote)
This is a REALLY good thread! Jane and Jaed, you both have extraordinarily good points about why doctors “don’t get it” or if they do, they won’t change their practices. Why should they? They are not the ones with the “problem”.
Women must be the ones to stop this sort of thing. Doctors will NEVER be the ones to stop it, unless you run into one who is truly more midwife than physician. (There are a few of those out there)
This discussion reminds me of my 4th child’s birth. It was 1972 and no one gave me much trouble about the child’s weight or suggested any ultra sounds or inductions. No one ever suggested a C-section. But when he was born after about a half hour of pushing, he weighed 10 pounds exactly. I was surprised and so was the doctor because my last two babies were in the 8 lb range.
But the thing is we all just accepted the fact that it was normal to birth the baby vaginally. NO ONE suggested that I might have had a C-section instead. The interesting thing to me was that he was born with a double placenta. My doctor said it was just an anomaly but his partner said I probably had had a second baby that was “absorbed” rather than ever developing into a twin. We will never know for sure. But I still remember the doctor showing me the placenta which had a normal looking cord and then two big normal looking placentas sort attached together, reminding me of elephant ears.
The HORRIBLE part of that birth happened afterwards. They let me hug my baby and then they whisked him off to the nursery for observation. OBSERVATION!!! Like they thought I would not be observing him myself….LOL.
It was NOT funny though. I kept asking when I could see my baby and hold him and nurse him and they said it would be 24 hours before I could have him.
EVEN AS I WRITE this….I have a sick feeling in my stomach. I was so stupid. I LET THEM KEEP MY HEALTHY BABY away from ME. For 24 hours….I did not fight for my baby. I am so ashamed about that, that I hate admitting it.
Knowing what I know now, I would NEVER have let them take him. I would have said “Look if you want to do tests or check on him, let me know and I will BRING him to YOU. But I will NOT give up my baby for 24 hours so you can watch him. NO ONE CAN WATCH HIM BETTER THAN I CAN!”
I Still get chills thinking about it. I STILL remember the feeling of LONGING for my baby. But I was so accustomed to “RULES” and I did not fight them.
There was nothing wrong with my son, by the way. They were afraid of GD I guess. But he was fine. However I am NOT fine with it. I am STILL MAD at myself and at the stupid hospital rules.
So much of childbirth is CYA and never mind what it does to the mother or baby. Now that I am older and some might say “Wiser”. I am devoting my life to changing things in childbirth. It is a good time for me to do this because my children are grown and my 16 grandchildren have parents who love and care for them so I am not one of those grandmothers tied down by grandmother duties…..I LOVE them but I have time to have my own life. And the thing I want to do most in the world is to keep mothers from having bad birth memories. I want to lower the C-section rate which is appalling. I want to help women educate themselves about how amazing their bodies are. And I want to educate doctors too.
I have heard doctors say. “They never sue you for the Cesarean Section.” And I think that is one place to start. Some women must begin “suing because of the C-section.” Doctors need to think twice before performing one.
At the moment, the system favors the doctor 100%.
Everything that Jane and Jaed said is completely true. And until that changes our hands are figuratively tied.
I WILL NOT QUIT. It is worth the fight. And I have the time and the inclination to try to make a difference.
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Nica Reply:
January 4th, 2012 at 11:50 am (Quote)
It is funny how times have changed. I was born in 1973 and weighed 8 lb, 15 oz. Completely textbook vaginal birth. No one remarked on it other than the fact that I was born at 8:15 am as well. LOL!
When I gave birth to DS in 2009, he weighed in at 9 lb, 12 oz. It was such an anomaly for a child of that size to be born vaginally at the hospital that I had not one, but several, nurses stop by my room to “meet the mom who had the big baby.” I am forever grateful to my wonderful OB who had a “wait and see” attitude with birthing this baby. We just let nature take its course and I had a completely uneventful labor and delivery.
Totally agree with you that it’s all about avoiding litigation and not the best patient outcomes. Ugh.
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jaed Reply:
January 4th, 2012 at 9:29 pm (Quote)
My suspicion is that early caesarean and early induction are so common these days that some providers just aren’t used to seeing many full-term babies (defining “full-term” as “began labor spontaneously” – there’s a movement to define 37 weeks as full term on the grounds that most babies can breathe on their own by then).
For a first-time mother, average time for labor to start for uncomplicated pregnancies and births is about 41/3 weeks, if I remember correctly… and most doctors would consider that “post dates” and be panicking about induction or caesarean long before that point. And remember that’s an average, not a limit: half of uncomplicated, normal pregnancies and births to first-time mothers will start labor normally after that point.
Hence the fear, hence creepy phrases such as “suspected large baby”. What used to be normal is no longer considered normal because medical management of birth has managed many, perhaps most fully mature babies out of the picture. It’s like a collective insanity.
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I posted this, I was the doula. It was a female OB who was talking cesarean before we ever were even in active labor. Mama was amazing, OB was a beast.
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Bonnie B Matheson had this to say,
Jan 5, 2012 @ 3:29 pm (Quote)
I think that the doula who posted this should print out all of our comments and send them to the doctor. She would not like them of course, but just maybe she would learn that there are MANY women who disagree with her. She really should be “re-educated” before being present at any more births.
I am still very inspired by the comments of Jane and Jaed. The problem is women’s not doctors. No one is holding doctors responsible.
It is time to start.
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Wow. My OB said almost word for word the exact same thing to me after I had my 10 lb 7 oz baby girl. Then wanted to do a c-section for my next one because he suspected she was 8.5 lbs. Seriously? I pushed a 10+ pounder out in 20 minutes; What makes you think I’d have a c-section for an 8 pounder?
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You’re right, it’s a very good thing because now you’re going to adjust your understanding of what the female body can accomplish and not routinely induce women for suspected nine-pound babies, right? ….Right? Right?
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Christine Reply:
January 3rd, 2012 at 9:13 am Christine(Quote)
Yes, This!
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Tee Reply:
January 3rd, 2012 at 5:57 pm Tee(Quote)
Okay, Jane, I have to ask. Were you able to type that with a straight face?
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Jane Reply:
January 4th, 2012 at 3:27 am Jane(Quote)
I have a perfect deadpan and can say just about anything with a straight face.
So yes.
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