Pregnancy and you blog

Delivering a big baby: What's the big deal?

By Julie A. Lamppa, C.N.M., R.N. March 2, 2016

As a midwife who helps women during childbirth, I am not going to lie. If you ask me if I would rather catch a big baby or a small baby (loose definitions here), I am going to say small. Or medium. Admittedly, the process of birth just seems to be easier if the "passenger" is small, rather than large. I would have to bet that pregnant women feel the same way. I have never, ever in my life heard, "I sure hope this baby is going to be 10 pounds!"

Before I go further, I want to remind you that your body has an amazing ability to birth. Women successfully have large babies all of the time. In the past three years, my niece has pushed out two adorable giants, who weighed 9 pounds, 6 ounces (4,252 grams) and 10 pounds, 11 ounces (4,848 grams) respectively. Impressive.

So what's the big deal about giving birth to a big baby? The term "fetal macrosomia" is used after birth to describe a newborn who's significantly larger than average. A baby with fetal macrosomia has a birth weight of more than 8 pounds, 13 ounces (4,000 grams), regardless of his or her gestational age. Possible maternal complications of fetal macrosomia include stalled labor, genital tract lacerations and potentially serious bleeding after delivery.

However, some risks might not be related to actual fetal size, but to health care providers' impressions of fetal size. A recent study showed that when providers suspect a baby might be getting big, they are more likely to intervene, such as by medically inducing labor. Upon hearing that their babies might be getting big, women in the study were also more likely to request a C-section. And yet the majority of the babies suspected to be big weighed less than 4,000 grams. That means many labors were managed differently for no reason. I admit to being a guilty party in what this study shows and I am trying to change.

Unfortunately, there are no accurate ways to assess fetal weight, especially late in pregnancy. I have seen fetal weight be off by 2 pounds (907 grams), whether the estimate was done by ultrasound or the hands of an experienced provider.

I hope we can all agree that unnecessary interventions should not be a part of the normal birth process. My new goal is to remember the inaccuracy of estimating fetal weight and forge ahead — trusting in the process of birth.

Have you given birth to a baby who was suspected to be large? Was your labor affected? Please share your thoughts and experiences.

March 02, 2016