We’re in a very common practice now that if your baby is estimated to be ‘big’, you’ll be recommended induction. So does big baby = induction?
Not if you don’t want to. Keep reading to find out why this doesn't have to happen!
Not to mention NICE (National Institute of Clinical Excellence) actively advise against recommending induction for estimated big baby alone. Basically, the worry of a big baby is possible shoulder dystocia (where the shoulder gets stuck behind the pubic bone). But there are lots of things that factor in to shoulder dystocia, and you can't really predict it. As well as that, shoulder dystocia is usually easy to overcome - midwives are extremely well trained and this is where their training comes in to play. Even with that, we're still experiencing a lot of health professionals recommending induction of labour for a 'big baby'.
Resarchers admit that "it is not clear whether it is better for women with big babies to have their labour induced or wait for labour to begin naturally" (Warwick Clinical Trials Unit)
I want to do a very big caveat here that I am not shaming induction or those that choose induction. If you are happy with your decision, you bloody go for it. This is for those that are not sure whether induction would be the right choice for them in this situation. Induction is not a big bad word, and it can absolutely be the right choice for many people. And induction can be extremely positive (and this is where the hypnobirthing tools are so important and helpful. I just hope this helps to understand the facts behind this and you can make the decision whether induction is the right choice to you or not.
Induction is something I cover a lot in my courses, even though it is your choice whether to accept induction or not, 30-40% of birthers are having an induction.
Let’s unpick a little and discuss why this recommendation is problematic, shall we?
Scan sizes are complete guesses. There’s between 10-20% leeway either side. So an estimated 4kg baby could be 3.2kg but could also be 4.8kg. Big difference. 30% of the time, they’re even more wrong than this - that's a big decision to induce labour based off of a total guess weight that is highly likely to be wrong. The only accurate way of measuring baby's weight is once they're born.
What’s ironic is that the actual process of induction increases the risk of shoulder dystocia.. funny that. The thing they are trying to avoid is increased by what they're suggested. In my hypnobirthing and antenatal courses, we talk openly a lot about what induction is, the process and risks and benefits - because you likely won't get told this in any of your appointments.
Half of shoulder dystocia happens with a baby under 4kg, and half happened over 4kg. So it can happen to any baby and lots of things may impact it. As we've already discussed, induction increases its chances.. other things do to. Size doesn’t determine that.
The fear of care providers cause more issues than the actual size of baby. There’s been many occasions where a surprise big baby comes and all went great. Everyone seems to say 'wow, thank god everything went smooth that time'. There’s also been many times where they have estimated a big baby, and lots of issues happen in labour and a smaller baby comes out. It’s like it’s the fear of the health professional, making them do more interventions and panic very quickly rather than the medical issue - Rachel Reed (Midwife Thinking) has a fantastic blog post about 'The Risk of Care Provider Fear' which I highly recommend).
Big babies can sometimes be easier to birth, as long as the birther is upright. This is because the baby is heavier, so is pressing down on the cervix, causing dilation to happen, and the weight of baby pulls itself down through the birth canal and out. I've spoken to many parents who have birthed multiple babies and a common theme is that their biggest baby was the easiest to birth.
Your induction won’t change your baby’s weight. It’s not suddenly going to be smaller because of it. It’ll still be the same size, and it’s still caused fear for you and your provider. What it might change, is your birth experience.
There is a 94% chance of your ‘big baby’ NOT having shoulder dystocia. That’s a very big chance. If you told me I had a 94% chance of winning the lottery this weekend, you bet I’m going to be buying a ticket! And by the way, even with shoulder dystocia, this is where the midwives years of training come into practice, because they know what to do and how to resolve this, quickly and efficiently.
A big baby isn’t a medical concern or problem. It’s just a baby. That's it.
Have you been told you need to have an induction due to the size of your baby?
We have to remember, that induction isn't just a nice way for you to meet your baby a little sooner. There are real risks to induction, which is why it is important for you to weigh up the benefits of induction against the risks, so you're making an informed choice. Induction is not without risks. And if anyone tells you it is without risks, I would be extremely wary of trusting their information...
Remember that induction is always your choice. Ask for the evidence, the facts and go with your instinct. It’s your birth, not theirs. Check out when my next courses are to give you confidence for your birth.
My biggest advice with growth scans and being offered interventions based on an estimated weight, is not to make a decision based on the estimated size of your baby alone. Look at other risk factors, other things that might impact your birth, not just the estimated size of your baby, because those decisions can dramatically impact your birth.
Concern of a big baby usually knocks the confidence of the birther, but rarely helps the birth
and safety of the baby.
Don't leave your birth to chance. It's an event that you'll remember for years and years to come, make it your birth, where you'll feel confident, calm and most importantly, in control.
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