30.10.2015

Reality of having a baby at 40

With Katie’s first child, she ended up with a C-section because she was told her baby could not fit through her pelvis (7 lb 13 oz). Of the women who were told that their baby was getting big, 2 out of 3 said their care provider discussed inducing labor because of the suspected big baby, and 1 out of 3 said their care provider talked about planning a C-section because of the big baby. Most of the women whose care providers talked about induction for big baby ended up being induced (67%), and the rest tried to self-induce labor (37%).
When care providers brought up planning a C-section for a suspected big baby, 1 in 3 women ended up having a planned C-section. In the end, care provider concerns about a suspected big baby were the 4th most common reason for an induction (16% of all inductions), and the 5th most common reason for a C-section (9% of all C-sections). Reality #1: Big babies are at higher risk for temporarily getting their shoulders stuck, but difficulty giving birth to shoulders is unpredictable and permanent injuries are rare. Although most cases of shoulder dystocia can be managed by a care provider, it can sometimes result in a nerve injury in the baby called brachial plexus injury. Laura’s 3rd baby, born at home, weighed 10 lb 6 oz– a full 2-3 pounds larger than her first two babies!
Amy, a well-controlled Type I diabetic, had her second baby (8 lb 14 oz) after a very fast 1 hour 25 minute labor. Perhaps most importantly, when a big baby is suspected, women are more likely to experience a harmful change in how their care providers see and manage labor and delivery. Other researchers have found that when a first-time mom is incorrectly suspected of having a big baby, that care providers have less patience with labor and are more likely to recommend a C-section for stalled labor.
Reality #2: Care providers and ultrasound are equally poor at predicting whether a baby will be big at birth. Assumption #3: Induction allows the baby to be born at a smaller weight, which helps avoid shoulder dystocia and reduces the risk of C-section. In summary, the researchers found that: 1) ultrasound estimation of weight was inaccurate, 2) shoulder dystocia and nerve injury were unpredictable, and 3) induction for big baby did not decrease the C-section rate or the risk of shoulder dystocia.


Although the randomized, controlled trials on induction for big baby found that induction did not hurt or help moms or babies, the overall number of women enrolled in those studies was small (less than 400 women). In 2002, researchers combined the results of 9 observational studies that compared women who were induced for big baby and women who went into normal labor on their own (Sanchez-Ramos et al. Assumption #4: Elective C-sections for big baby has benefits that outweigh the potential harms.
Reality #4: Among women who are not diabetic, it would take nearly 3,700 unnecessary C-sections to prevent one baby from having a permanent nerve injury due to shoulder dystocia.
Jillian’s 1st baby experienced a brief shoulder dystocia and so she was talked into a C-section with her second baby because the doctors were afraid of another shoulder dystocia. Although some care providers will recommend an induction for a big baby, many skip this step and go straight to recommending an elective Cesarean.
Ultrasounds and care providers are equally inaccurate at predicting whether or not a baby will be big.
Having a baby is a joyous occasion, but that doesn’t mean the next 18 years come easy. There is a very strange story in the news today about a woman going into a hospital with a life-like, fake baby, dressed in scrubs and trying to enter the maternity ward.
This means that the higher your blood sugar, the more likely you are to have a baby who is large for gestational age (Metzger et al.
More than half of all moms (57%) believed that an induction is medically necessary if a care provider suspects a big baby.
However, we have strong evidence that treatment for gestational diabetes drastically cuts the chance of having a big baby and shoulder dystocia (To read more, click here). A baby does not have to have shoulder dystocia in order to experience a brachial plexus injury. They found 14 studies that looked at ultrasound and its ability to predict that a baby would weigh more than 8 lbs 13 oz.


When a care provider estimates that a baby is going to weigh more than 8 lb 13 oz, the overall accuracy is only 40-53%. In this study, women were included if they were at least 38 weeks, had a suspected big baby (8 lbs 13 oz to 9 lbs 15 oz), did not have gestational diabetes, and had not had a previous C-section. If diabetic women were offered an elective C-section for every baby that is suspected of weighing more than 8 pounds 13 ounces, it would take 489 unnecessary surgeries to prevent one case of permanent nerve damage. Although having a big baby may be a risk factor for severe tears, severe tears are uncommon to begin with, and a big baby is nowhere near as big a risk factor as other things like vacuum and forceps delivery. She did not have any ultrasounds during her pregnancy and so they did not suspect a big baby. Jillian ended up having a successful VBAC with a 7 lbs 12 oz baby– and no shoulder dystocia. It is likely that for most non-diabetic women, the potential harms of an elective C-section for a big baby outweigh the potential benefits.
I’m not here to brag—I’m just stating facts that prove that even though my pregnancies were “uneventful,” I still wasn’t having a good time.
However, women who receive treatment for gestational diabetes cut their chances of having a big baby in half (Landon, Spong et al.
However, it is not clear whether this higher rate of postpartum hemorrhage is due to the big baby itself or the inductions and C-sections that care providers often recommend for a big baby (Fuchs et al.
Women who were suspected of having a big baby (and actually ended up having one) had a triple in the induction rate; more than triple the C-section rate, and a quadrupling of the maternal complication rate, compared to women who were not suspected of having a big baby but who had one anyways. In other words, induction for suspected big baby increased the C-section rate and did not lower the shoulder dystocia rate.



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