Jan 10

“You Need To Be Induced Or Have A Cesarean Section…”

“You need to be induced or have a cesarean section because your baby is going to be big, at least 10 pounds.” – OB at 37 week prenatal.

58 people dislike these words.

There are 40 comments to this post.

Jane had this to say, Jan 10, 2012 @ 4:27 am (Quote)

Hey, Doc?

{citation needed} for estimation of size of baby.
{citation needed} for benefits of inducing early for suspected large size

Thanks! I know that as an evidence-based practitioner, you probably have these studies on file in your office, so I’ll just wait right here while you go get them. Take your time. I brought a book.

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Honey Reply:
January 10th, 2012 at 8:47 am Honey(Quote)

http://xkcd.com/285/

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Margaret had this to say, Jan 10, 2012 @ 5:05 am (Quote)

Been there, done that.

I’ll take my labors with huge babies over a Pit induction or major surgery any day.

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Nica Reply:
January 10th, 2012 at 7:01 am Nica(Quote)

BTDT as well and ended up with an uneventful vaginal birth of a 9 lb, 12 oz baby. Thank GOD my OB had a “wait and see” attitude. I think pretty much any other OB in my area (metro NYC) couldn’t slice me open fast enough.

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Bonita Reply:
January 10th, 2012 at 2:25 pm Bonita(Quote)

Same here. My first was a pit induction and she was 9lbs 2oz. I then had two homebirths: 10lbs 4oz and 10lbs 6oz respectvely and both of them were much easier than my 9lber!

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Details had this to say, Jan 10, 2012 @ 5:17 am (Quote)

Induction or C-section – they are both the same to me. Doesn’t matter – pick one! Yes, this is a professional I want to trust! Doesn’t know the differnce between those two *rolls eyes.

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steph had this to say, Jan 10, 2012 @ 5:42 am (Quote)

Just had a friend give birth to an 11 pound 9 ouncer without so much as one single tear or stitch. Both mom and baby are healthy and happy. No diabetes. I’ll take my chances…thanks doc.

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Heather P had this to say, Jan 10, 2012 @ 5:45 am (Quote)

Based on what exactly? Your measuring tape? A late ultrasound? (notoriously inaccurate) Your crystal ball? Your magic 8 ball?

I think I’ll just wait for labor to start rather than risk a preemie.

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Doug Reply:
January 10th, 2012 at 7:17 am Doug(Quote)

I have a magic 8 ball with answers in it from Freud. Maybe that’s what he was using?

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adrienne had this to say, Jan 10, 2012 @ 6:52 am (Quote)

can you guarantee me a 10 lb baby? ok, good. I was getting a bit tired of pushing out 11 1/2 pounders anyway.

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Mary had this to say, Jan 10, 2012 @ 7:30 am (Quote)

This exact thing happened to a friend of mine at her 34 week prenatal. The doctor told her that based on the ultrasound he was already 6 pounds, and that if she hadn’t gone into labor at 39 weeks he would section her.

I told her that late U/S were up to 3 pounds off when estimating size in the 3rd trimester and that I hoped they weren’t going to put her through major surgery for what turned out to be a 7 1/2 pound baby.

39 weeks came around. No labor. She consented to the section.
Her son was born weighing 7 pounds, 8 ounces.

Oh so huge!

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Dawn R Reply:
January 10th, 2012 at 9:28 am Dawn R(Quote)

Similar thing happened to me. He tried from 36 weeks to get me to induce because my baby was getting too big. He was born vaginally at 42 weeks weighing just shy of 8lbs.

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C.Pratt Reply:
January 10th, 2012 at 10:29 am C.Pratt(Quote)

These stories just break my heart

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Dawn R Reply:
January 10th, 2012 at 4:35 pm Dawn R(Quote)

Oh, I stood my ground, but I also knew that he would’ve tried to force an induction had I not gone into labor when I did. I gave birth 2 days before my 42 week appointment. I’m so glad I did too! I just wish I hadn’t used an OB and hospital because they pushed the EPI on me almost as soon as I arrived and I ended up with the PIT which I was totally against. I’m 30 weeks with #2 right now and I’m going through a CNM and birth center this time

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Andrea Reply:
January 10th, 2012 at 12:17 pm Andrea(Quote)

What was her reaction? Did she come out thinking that the doc was still right to recommend the c-section, or was she pissed?

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Mary Reply:
January 10th, 2012 at 1:31 pm Mary(Quote)

At first she was ok with it, but then quickly came to realize she was railroaded and denied what was going to be her only birth experience. She ended up realizing why all of us cautioned her against a c-section based solely on size. I feel badly for her. I can’t even imagine how it must feel to realize your doctor sold you a bill of goods and scared you into major surgery.

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Mandie had this to say, Jan 10, 2012 @ 8:41 am (Quote)

Yeah, one of the reasons I stopped going to an OB, “your baby is going to be huge…” Still comes out fine thanyouverymuch. 10lb 6oz at home.

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jaed had this to say, Jan 10, 2012 @ 9:29 am (Quote)

I honestly don’t know what the obsession is with “right-sizing” all babies. There is normal variation in birth weight. There’s supposed to be.

I notice they’re not nearly as frantic about babies near the small end of normal – not until the size gets truly worryingly small – even though obviously very small babies, or babies who have been erroneously dated as older than they really are, are at risk in a way that “suspected large babies” [what a creepy phrase] are not.

So what is the deal? Is it part of the “obeeeesity-epidemic” hysteria (you can never be too thin, even if you’re minus three weeks old!)? Or what?

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Jane Reply:
January 10th, 2012 at 10:07 am Jane(Quote)

You’ve got a point there. If the average at-term baby is 7 pounds 12 ounces, then they should be freaking out over a six pound baby the same way they are about a nine baby, right? Except everyone’s totally calm about that.

Same with post-dates. There’s a bell curve of outcomes that peaks at around the due-date and then trails off, but it also trails upward on the early side. THey flip out that your baby is going to die at 41 weeks, but they’re totally blase about 39 weeks.

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Rebecca Reply:
January 10th, 2012 at 10:19 am Rebecca(Quote)

Well, they are fine with it until the baby is born. Then its all about how you need to supplement and “your baby is only 35th percentile” and threatening a diagnosis of FTT despite staying on the same curve during the childs whole life.

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jaed Reply:
January 10th, 2012 at 10:44 am jaed(Quote)

I wonder whether the two are related. Long gestation is associated with larger babies, and there’s much more panic about long gestation than short, so a big baby triggers the same reactions… maybe.

40 weeks isn’t even average, let alone a deadline past which babies die. The average is over a week more for first-time mothers, and a few days more for multiparas. And yet “not quite average gestation time” is treated as “Time to panic and get out the scalpel”.

My theory about that is that, as with so much about medically managed birth, prematurity ensures control by the doctor. If you let a mother go into labor normally, you aren’t in control. If you induce her, you are in control… but that requires doing it earlier than she’d normally start laboring. And the earlier you do it, the less likely she’ll go into labor spontaneously (thus robbing you of control).

So we see doctors wanting to induce earlier and earlier, and sometimes using the fear of “suspected large baby” [creepy] as the excuse. (They can get away with it, too, since NICU has improved so much. A malpractice case is only going to happen if they actually manage to kill or permanently brain-damage someone – not if they cause serious problems short of that.)

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Rebecca Reply:
January 10th, 2012 at 4:21 pm Rebecca(Quote)

That sounds very conspiracist theory to me. I think it is different. I think it is fear, fear of malpractice. They think they can medically manage away risk. I don’t think that’s working out the way they want it to.

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jaed Reply:
January 10th, 2012 at 9:10 pm jaed(Quote)

I don’t think it’s a conspiracy, just to clarify. An attitude, a way of approaching birth. Things that are in control are perceived of as less risky. This is more emotional than anything else. OBs are surgeons, and surgeons are trained that they are completely responsible for what happens and that everything revolves around their judgment and their convenience. (This attitude actually makes sense for, say, cardiac surgeons. For OBs attending normal childbirth, it’s out of place. But it’s still trained into them.)

I do think the way malpractice works plays into it though. It’s hard to imagine an OB being successfully sued for doing a C-section. Even if the baby is very premature, if it survives without permanent damage, it makes for a difficult court case. If doctors policed their own, doing that would put your license in danger, but doctors generally close ranks so that’s not a worry in practice.

Then the underlying attitude of need for control plays into the fear of lawsuits – they synergize to create this situation.

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Michelle Potter Reply:
January 11th, 2012 at 5:56 am Michelle Potter(Quote)

Exactly. This is EXACTLY what I think it is. Anything that is not completely within the doctor’s control produces a gut-reaction of fear.

Everything in their training tells them that DOING SOMETHING is better than not. If they induce or c-section, they feel they are DOING SOMETHING to “make sure” the birth goes “correctly,” whereas a natural birth is unpredictable and so much of it is out of their hands. That’s terrifying for them. If the baby is born at 38 weeks, then they have the baby in their hands and they can DO SOMETHING to “make sure” that the baby is healthy, even if it means DOING SOMETHING in the NICU. OTOH, if you don’t give birth until 42 weeks, they have a whole extra month to worry themselves sick that something is going wrong, or about to go wrong, and they can’t DO SOMETHING until that baby is out.

It’s not a conspiracy. It’s logical, rational training that works perfectly when dealing with a tumor. It just doesn’t make sense when dealing with a normal, healthy birth.

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Kim had this to say, Jan 10, 2012 @ 10:21 am (Quote)

Oh yes, because ultrasounds are accurate to the ounce and can predict the future

My sister in law had a baby in December. An ultrasound at 40 weeks predicted a 10 lb baby. Good thing she had a doc that didn’t pressure her to induce. She gave birth to a perfectly beautiful 8lb baby girl at 42 weeks!

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Nica Reply:
January 10th, 2012 at 2:05 pm Nica(Quote)

I went in for a growth u/s at 38 wks. Peri estimated the baby at 8.5 lbs. I went into labor spontaneously at 39.5 weeks and baby was 9 lb, 12 oz. Unless my son had some spectactular growth that last week and a half, I think the u/s and peri were just a bit off!

I think I’m going to just skip any late-term u/s with the child I’m currently carrying. With the LARGE margin of error they have, I think they’re esssentially worthless and a waste of my time and money.

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IF Survivor had this to say, Jan 10, 2012 @ 12:48 pm (Quote)

This happened to my SIL. Right at 39 weeks she was induced. She actually got to push for 3 hours before they pulled the c-section card. Then when the baby was only 7lbs 13oz, they told her that was just “too big” for her. I’m sure none of you are surprised to hear that the baby ended up in the NICU. My SIL still believes that he was “ready” to be born, that “nothing” could have prevented his NICU stay and that she’s just not capable of vaginal childbirth. It breaks my heart. The only real good that came out of her experience (besides a sweet nephew of course) was that my husband became a huge believer in home birth.

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Melissa C Reply:
January 10th, 2012 at 12:54 pm Melissa C(Quote)

Off topic, but my husband agreed to a home birth after seeing what they did to my sister in the hospital. Sucks that she had to suffer for me to get a safe healthy birth.

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IF Survivor Reply:
February 4th, 2012 at 10:28 am IF Survivor(Quote)

That’s pretty much the way I feel too. My DH used to look at me like a was over-reacting when I read him stories out of Pushed, but when we walked away from the hospital that night I could tell that his whole world had changed.

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Gemma Reply:
January 10th, 2012 at 1:29 pm Gemma(Quote)

When I requested detail from the deliveries of my older 2 girls I was told the reason that the deliveries had been so ‘hard’ were because they were just too big for my body.
DD1 was 7lb 7oz
DD2 was 7lb 5 oz (a week early)

I started thinking maybe I was broken until I had a wonderful homebirth in water to a 9lb 5oz beautiful baba!

So much for broken :-/

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IF Survivor Reply:
February 4th, 2012 at 10:26 am IF Survivor(Quote)

Definitely not broken. ((HUGS)) and congratulations on your homebirth!

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Kate, Ren's mama Reply:
January 10th, 2012 at 3:59 pm Kate, Ren's mama(Quote)

Was she induced because of a suspected big baby? How big did they guess? And was she able to move during labor, or was she pushing on her back? I’m just a nosy nelly and a huge birth geek, but I can’t imagine pushing for three hours and not progressing with a 7lb13oz-er without *some* extenuating circumstances. I’m sorry the hospital failed your SIL then broke her confidence

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IF Survivor Reply:
February 4th, 2012 at 10:24 am IF Survivor(Quote)

I’m sorry I totally forgot about this post! Yes, she was induced due to “big baby.” They were guessing over 10lbs. She was in bed the entire labor and on the epidural for at least 13 hours.

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Nicole had this to say, Jan 10, 2012 @ 2:51 pm (Quote)

I’m so glad I actually have an OB with a brain. At my 37 week ultrasound my daughter supposidly weigh 8lbs 9 oz. My doctor told me I could handle it. Today marks 40 weeks, and there’s been no talk of induction.

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jennifer had this to say, Jan 11, 2012 @ 10:15 am (Quote)

These kind of comments make me appreciate my OB so much! During my 2nd pregnancy, I asked my OB whether the fact that I had a “big” (9 lb. 4 oz.) first baby would change anything about how they would want to manage the 2nd pregnancy. I was testing him, of course – I wasn’t planning on changing anything and would never have agreed to induction or c-section for a supposed big baby, but I just wanted to know how he’d answer. He said, “nope, you had a perfectly healthy pregnancy and a normal vaginal delivery, there’s no reason to do anything differently. In fact, the second delivery is usually much easier even if the baby is bigger because the first one paved the way.” Hurrah! He passed my test. I went into labor on my own a few days past 40 weeks and delivered another 9 pounder. And he was right, it was way easier the second time.

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Rebecca Reply:
January 11th, 2012 at 11:22 am Rebecca(Quote)

Same here. My son was never on track to be a big baby, but I did have a lot of limitations put on my delivery. I’m a diabetic, I’m the mom who posts about losing her son to stillbirth caused by my undiagnosed diabetes. My diabetes is pretty chill normally, but in pregnancy my pancreas basically goes on strike, and my blood pressure goes crazy too.Right from the beginning she made it clear that we should induce at 39 weeks if I hadn’t gone naturally by then, although she greatly preferred that I go naturally, although you can’t just tell your uterus to do that. But that’s the thing. She didn’t tell me she was GOING to induce me, and she really was clear about preferring a natural birth. I assumed I would have to have a c-section due to my issues and prior history, and her reaction was quite clear – that was the LAST thing I should have! I did have to be induced, at 37 weeks thank-you-very-much-elevating-blood-pressure, and she let me go 40 hours from the administration of the pit before we had a section. Turned out to be a smart decision, my son had to be rushed to the NICU, and he would have been worse off if he hadn’t exited my uterus in a rapid and non-squeezed manor.

Not all my doctors were great, we almost sued the attending anesthesiologist on duty my first night, but I feel lucky for my MFM team.

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Lace had this to say, Jan 11, 2012 @ 11:19 am (Quote)

My daughter was estimated to be over 8 lbs. At 34 weeks. She was born at 42 weeks weighing a huge 6 lbs 11.5 oz. She was forced out, but at least it wasn’t because of estimated weight.

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Cassidy had this to say, Jan 30, 2012 @ 7:53 pm (Quote)

My ob didn’t pull the section card but did estimate my son to be 6 1/2 pounds at 34 weeks so I was told to expect a 10 -12 pounder. However when he was born at 38w3d he was 5 lbs 4.2 oz. I dont believe in the estimates anymore. My little man knotted his cord which is why he was so little

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Holly had this to say, Feb 8, 2012 @ 4:25 pm (Quote)

I was told my son would be “too big” and that I needed to be scheduled for a c/s. He was 7.5 pounds according to the ultrasound and I would be needing the c/s within the next few weeks (I was 36+1). The dr wanted to do a VE because I had been having contractions and since I go from 0-12 in a few hours it was “a good idea” to keep an eye on things. I consented, never again! During my VE he stripped my membranes!!! No consent, no asking, no informing.. just did it. The next morning I delivered my 8lbs 4 oz baby vaginally.. even though the dr said I would never deliver a child 7.5 pounds or bigger vaginally!!

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