What are the main complications with delivery of macrosomic baby?
I am 36.5 weeks & my baby is already measuring to be 9.5-10lbs. I had an amnio yesterday and the baby's lungs are not quite mature enough for an induction. Both of my boys were born, vaginal deliveries, at 36.5 weeks weighing 7lbs 1 oz and 7lbs 11oz w/ stays in the NICU due to lungs. I do not have gestational diabetes & doctors don't see anything wrong with the baby other than genetics has made him large for gestational age. I have read about some of the complications w/ macrosomic deliveries and I am scared that somehow my baby or myself might die or suffer from major complications. Should I try vaginal or just opt for c section?
b_corwen2009-06-12T14:25:28Z
Favorite Answer
http://www.plus-size-pregnancy.org/Prena... Many OBs are fixated on the supposed "dangers" of a big baby (officially known as macrosomia). Definitions of what constitutes a "big" baby differ, but most research chooses one of the following three cutoffs: 4000 g (just under 9 lbs.), 4500 g (9 lbs. 14 oz.), or 5000 g (about 11 lbs.). The average size for babies is somewhere around 7 and a half pounds, but babies vary widely around that and are still born just fine. Although most research considers babies above 4000g to be macrosomic, the American College of Obstetricians and Gynecologists considers 4500g to be a better cutoff for macrosomia.
Although the risks for shoulder dystocia (baby getting stuck at the shoulders) and birth injuries are increased somewhat among big babies, in actuality MOST big babies are born vaginally without any problems. But because a few big babies have problems, and because doctors tend to get sued over these types of cases often, they fixate on whether the baby is big or not, in hopes of preventing shoulder dystocia and birth trauma.
This worry leads to one of the most dubious uses of ultrasound----an ultrasound for estimating fetal weight. This practice is very controversial. Research clearly shows that ultrasounds for estimating fetal weight are often quite inaccurate, and especially so at the extremes of size (extra-small or extra-large). Doing ultrasounds for estimating fetal weight is a very questionable policy, but many providers routinely do it anyhow.
The accuracy of ultrasound for detecting macrosomia seems to run generally from 50% to 65% or so, very low accuracy to be the basis for so much intervention. For example, Pollack et al. (1992) found that only 64% of the babies estimated to be macrosomic (big) actually were. Levine et al. (1992) found that HALF of the ultrasound predictions of fetal weight were incorrect. Delpapa and Mueller-Heubach (1991) found that 77% of ultrasound fetal weight predictions exceeded actual birthweight and only 48% were even within 500g (about one pound) of the actual birth weight. Furthermore, 23% were more than 1 pound overestimated, and 50% of the babies predicted to be macrosomic weren't macrosomic at all.
Notice that predicting macrosomia through estimated fetal weight is as accurate or only slightly more accurate than tossing a coin! It is not very good science. Yet doctors routinely continue to order ultrasounds to estimate fetal size, particularly in large women. And these incorrect predictions continue to result in huge amounts of intervention, which have major health implications.
For example, when the baby is predicted to be 'big,' the doctors often induce labor early in the mistaken belief that this will be more likely to result in vaginal birth and to avoid birth injuries. Or they strongly pressure women (especially big women) to have an elective cesarean, which brings its own set of substantial risks, both for this pregnancy and any future pregnancy the woman may have. Unfortunately, research shows that early induction and/or elective cesarean for macrosomia are NOT justified in non-diabetic women, and may be questionable in some diabetic women too.
In many cases, induction strongly raises the chance of a cesarean (instead of lowering it), and may increase the risk for birth trauma as well. Levine (1992) found that inducing for macrosomia increased the cesarean rate from 32% to 53%, and Weeks (1995) found that inducing increased cesarean rates from 30% to 52%. Leaphart (1997) found that inducing for macrosomia increased the cesarean rate from 17% to 36% in a facility with a generally low cesarean rate, and Combs (1993) found that inducing for macrosomia increased the cesarean rate from 31% to 57%!
Even when inducing early did not increase the cesarean rate (Gonen 1997), it did not improve fetal outcome or lower the rate of shoulder dystocia. In fact, in some studies, inducing early actually increased the rate of shoulder dystocia (Combs 1993, Jazayeri 1999, Nesbitt 1998). So although most OBs have been taught that early induction for macrosomia will decrease the chances for cesarean and lower the risks for birth injuries, research actually shows that the opposite is true.
Even simply the PREDICTION of macrosomia by estimated fetal weight significantly changes the way the doctor perceives and handles the labor, and strongly increases the rate of induction and/or cesarean. Weeks (1995) studied the effect of the label of predicted macrosomia. Those women who had been predicted to have big babies had a 42% induction rate, and a 52% cesarean rate! Yet the big babies in the study who were NOT predicted to be big had only a 27% induction rate and a 30% cesarean rate. There was no difference in size between groups; the only difference between groups was the PREDICTION of a big baby. The authors concluded, " Ultrasonography and labor induction for patients at risk for fetal macrosomia should be discouraged."
So, let's start with this - ultrasounds and fundal heights are EXTREMELY unreliable near the end for measuring fetal size, no ifs ands or buts, unreliable.
Even if the baby is 9 lbs 15 oz, that's not macrosomatic, 10lbs and up is. Even if the baby is 10lbs most mothers can deliver a 10lb baby vaginally, it's when they have large shoulders that it's a problem - and that, well, that is usually due to gestational diabetes not from being big.
So the one problem with macrosomatic babies is shoulder dystocia, where the shoulder gets stuck on the pelvic bone and that can be a true emergency as it's stressful for the baby to be in the birth canal for too long and their oxygen supply can be compromised at that point. Sometimes the fetus has to have it's shoulder broken to be delivered, this is preferable to death of course, sometimes there is nerve damage. A broken shoulder is nothing, it heals rapidly in a newborn and should not mean further problems.
If you delivered a normal weight infant, you more then likely can do a 10lb baby - I know I did, normal pushing and a 10lb 5 oz, he had no shoulder dystocia becuase I had no gestational diabetes. Let your body give it a try, you'll have a healthier baby if you have at least a trail of labor with this one.
The main complications of a large baby are shoulder dystocia, his head is too big too fit through the pelvis, you'll need more time to labor and deliver the baby which if your membranes are broken, can make you and baby higher risk of infection. As far as I am concerned you should try a vaginal delivery. C-section is major surgery which requires a substantial amount of recovery time. With two boys running around you won't have that time. You and baby are pretty safe scince you will be giving birth in a hospital around trained nurses and doctors. They will wheel you into the O.R. at the slightest hint of of trouble. Unless of course you would rather get a c-section for what ever reason, try to give birth vaginally. Good Luck!
I was afraid of the c-section because of what people (who never had one!) said about it here, how it is major surgery etc., but it wasnt' bad at all. At no point did I have more than soreness, by the time I left the hospital on day 5 I was moving better than I had for the last few weeks of my pregnancy. By 6 weeks I was moving fine, just not lifting heavy things, and by 12 weeks it is like nothing ever happened. Yes, I have a horizontal scar in a place no one sees and I don't even notice. I held the babies the same hour they were born, milk came in on day 5. C-sections are very safe for the mother and for the baby as long as it is not an "emergency c-section". The fact that C-sections are used for emergencies and high risk cases throw the stats for it out of whack. If anything is currently in the process of going wrong, then they do the c-section, and when things then don't work out it is a c-section statistic. A scheduled c-section is safer than vaginal birth with all other factors being equal. That is the reason doctor's often prefer the c-section. However no one gets to walk home the next day like some women get to do after a vaginal birth either, and it does cost a LOT of money! My mom had huge problems with vaginal deliveries, both of them. She was in the hospital for weeks after both due to complications from it. The choice is yours, but c-section can definitely be much easier than vaginal. The pain killers they give you for a c-section means you don't ever have to be in real pain. Sore to mild pain yes, but not real pain. The pain is more akin to 3rd trimester soreness and aches.
RE: What are the main complications with delivery of macrosomic baby? I am 36.5 weeks & my baby is already measuring to be 9.5-10lbs. I had an amnio yesterday and the baby's lungs are not quite mature enough for an induction. Both of my boys were born, vaginal deliveries, at 36.5 weeks weighing 7lbs 1 oz and 7lbs 11oz w/ stays in the NICU due to lungs. I do...