Big baby #2, need some advice

Diabetes and Pregnancy Trying to Get Pregnant
1

Hi everyone,

I'm 38 weeks pregnant with baby #2. I had a c-section with #1 due to her size (she was 9 lb 13 oz, but the estimated weight was 10 lb 13 oz). I have been in excellent control with this pregnancy (last A1c was 4.5), but at my last ultrasound at 36 weeks, the baby's EFW was 8 lb 3 oz, with her belly measuring bigger than her head.

After that 36 week ultrasound, one of my docs basically told me there was no way she would recommend a VBAC, due to the risk of shoulder dystocia, even if I were to go into labor early. So we scheduled a c-section for 39 weeks.

Well, I saw one of my other OBs the other day (I love both of them, by the way), and he was much more optimistic that I might still be able to have a VBAC, if I go into labor any time soon.

OB #1 is saying that the risk of a shoulder dystocia is just too high, and OB #2 is saying that as long as the baby is estimated to be under 4500g (just under 10 lb), if would be safe to try labor, and then if it is not progressing well, go for a c-section.

I had to make this decision while in labor with my first baby and ended up having a fairly traumatic c-section experience under general anesthesia, largely due to the fact that there was no clear plan in place when I went into labor. So I really want to avoid that situation this time and try to make up my mind as to what I feel comfortable with now, as I could go into labor at any time (baby #1 was born at 37 wks, 4 days).

Has anyone else had to agonize over this? Am I just being silly and should I just go for the safe decision and have a c-section even if I go into labor?

Just hoping for some shared experiences or maybe just some words of support. I feel kind of exhausted from trying to research and think and talk about this. I realize that another c-section would be a fine outcome, I just have always wanted to have the experience of a vaginal birth, and I just firmly believe that it is better for the baby and the mother, in general.

Thoughts? Thanks!

Elizabeth

2

I just had my first baby, who was also a c-section and I feel like it was a pretty traumatic experience for me. My blood sugars were perfect (A1Cs in the low 5s my whole pregnancy), but my OBs induced me at 39 weeks. They told me that they rarely let diabetics go past 38 weeks and I was pushing it by waiting until 39. I've come to learn that new ACOG guidelines say that 39 weeks is full term now, not 37 as it previously was, and I wish I had known that before. I would've pushed them to let me wait longer. The induction (which was pretty traumatic in and of itself) failed and I never dilated past a 6. I ended up with a c-section, just with an epidural, but it was still not what I wanted and I believe it was all unnecessary. I had a horrible recovery and my baby never latched well and my milk never came in, despite the fact that I pumped my brains out, and tried all the drugs and herbs that were supposed to increase my supply. I really believe my baby and my body were not ready to go into labor and that I was pressured into being induced and ultimately a c-section, because they were afraid my baby would be big or be still-born, even though she never measured big and never showed any signs of distress, ever.

I feel like a lot of OBs pressure diabetic women into having inductions and c-sections just because historically, diabetic women have big babies. Things are so different now, and OBs need to catch up. I think that as long as your baby is doing fine (no signs of distress), you're doing fine, and the baby isn't measuring huge, you should not be pressured into anything you don't want. 8 lbs is a normal sized baby, and plenty of women give birth to bigger babies vaginally and they are just fine. Also, late term ultrasounds are notoriously bad at estimating a baby's weight, so take them with a grain of salt. Unless there is a clear medical reason, there's no reason you shouldn't be able to try for a VBAC. In fact, I think the new ACOG guidlines even say that a VBAC is preferred if there's not medical reason for another c-section.

Fight for what you want. You know your own body, and you have a mommy's intuition. Trust your doctors, but don't let them make you not trust yourself and the amazing control you've had through your pregnancy. Ask tons of questions, especially if they are pressuring you into something that doesn't feel right. And then, make a plan for every scenario. If you try for a VBAC, have a plan in place in case you need a c-section. If you decide to have a planned c-section, make a plan for what you want to have happen in the operating room and recovery room.

You're not being silly at all. It is exhausting trying to learn and know what the right thing to do is. Please know that there are other people out there who totally understand, and fully support you and whatever decision you make! Feel free to message me if you have any questions or just need support! Good luck! I hope everything goes well for you and your baby!

3

Oh dear, I'm sorry to hear you had a difficult experience as well. Thank you so much for sharing your experience and being so supportive.

You're right that 8 lb is a normal sized baby, but that was at 36 weeks--so she is likely to be over 9 at this point… and she has been measuring big all along. The ACOG guidelines say that for a diabetic mother with a baby estimated to be 4500g or bigger, a c-section should be offered because of the risk of a shoulder dystocia.

I think what almost makes this harder is that my doctors aren't really pressuring me to have a c-section--in fact, one of them is very supportive of VBAC if the baby is under 4500g. However, they have both been very clear about the increased risk of shoulder dystocia, which obviously could be traumatic at best and even cause permanent damage to the baby.

I will have another growth ultrasound on Tuesday, but I could go into labor before then, of course. I'm still not sure what I will do in that case--I assume they would do an ultrasound at that point to get an updated weight estimate. I guess I will just have to wait and see what happens.

Thanks again for your support.

4

Several thoughts:

Her belly has very little to so with shoulder dystocia. Bellies compress pretty easily. And 8’3" at this stage isn’t that big.

I see no safety reason not to try for a VBAC. As you said, you can always opt for a C-s if it doesn’t work out.

That said… I opted for a repeat c-section with my second. The first was an emergency C-section due to non-progression. It wasn’t pleasant at all. You know how that goes, though. So, for my second, I could choose to stay with my OB who does NOT do VBACs, or find a new one who does. I decided to stick with her and do a repeat section because:

  1. I felt comfortable with her and most of her practices.
  2. I felt I had a low chance of succeeding with a VBAC.
  3. I did NOT want to go through labor plus surgery again. OMG!!! Awful!

I in NO WAY want to discourage you from trying. I think someone with more determination than me would have a far better shot. But I faired sooooooooo much better with a planned procedure compared to emergency! The first time was a slowwwwwwww, painful, and exceptionally bloody recovery. The second time, planned, went by the textbook, with so little pain that I only took Motrin even in the hospital, after the first day. My biggest personal complaint was nausea from the anesthesia, which I had the first time around too.

But it isn’t without risk. My son apparently inhaled amniotic fluid while being pulled out and had problems expelling it, which landed him in the NICU on oxygen for almost 24 hours. His pediatrician said this is mostly unique to c-sections. Babies normally expel most of the fluid on the way out of the birth canal.

My final contribution: you’re the boss, not the doc. If you want to VBAC, then tell him to schedule the VBAC. Period.

5

Hey there,
Thanks for your thoughts and support.

The belly measurement is only important because they can't measure the shoulders on ultrasound, and a big belly usually means big shoulders. I agree, 8 lbs is not that big at term, but that was at 36 weeks, and babies grow quickly at the end, so I'm assuming she's much bigger now.

You are right that I could try for a VBAC, and then if my labor isn't progressing, opt for the c-section. The problem, apparently, is that your labor can progress fine and the baby's head can be born but then the shoulders get stuck and it's suddenly an emergency.

I do kind of feel that I would have a slim chance of succeeding with a VBAC, but on the other hand part of me feels like if I can try safely, that's what I want. Again this is all contingent upon me going into labor on my own. Neither my OB team nor I would feel it would make much sense to try induction, as that is most likely to end in a c-section anyway, especially with an early term big baby.

My daughter also had trouble breathing after my c-section and was in the NICU for a few days. She was also on oxygen at first and not allowed anything by mouth for the first day, which was difficult. So I'd love to avoid all that--it's just that if a VBAC means I end up with a baby with permanent (or even temporary) nerve damage from a shoulder dystocia, I sure won't be very happy with that either…

Now that it's Sunday afternoon, it's looking much less likely that I'll go into labor before Tuesday, when I have another growth ultrasound. So I'm going to see what that says and then try to make a decision.

Thanks again for your thoughts. And it is really, really reassuring to hear that you had such a good (or as good as possible) experience with your planned c-section, other than your son's NICU stay.

6

I was induced with #1 at 37w 2 d. The induction went very well and he was born within 6 hours of me actually going into labor. However, he was 9 lbs 4 oz and had shoulder dystocia. I ended up with a 3rd degree tear and he spent 6 days in the NICU. By the grace of God, he has no mental or physical complications from any of it.

My #2 was born on 9/13/13 at 35w 5d and weighed in at 8 lbs 7 oz. Week by week he weighed in within 3 oz of his older brother. Based on my previous birth, we opted for a c-section from the first trimester. Because #2 was early (his heart rate was extremely low at my 35 week scan) he had an extended stay at the NICU (15 days).

Recovery-wise, it was a lateral. Vaginal delivery with tearing is similar to a c-section...it's just that the pain is in a different area. I was able to bf my first for 14 months until we chose to wean. I have even more milk with #2 and have donated 3 times already.

If I had to do it all over again, I would not change a thing. I have two healthy boys in my arms. I agree with the other ladies that this is your choice to make. Good luck in the last few weeks!

7

"your labor can progress fine and the baby's head can be born but then the shoulders get stuck and it's suddenly an emergency"

This was the argument that the OB-GYN used to convince me to opt for a planned c-section. I don't regret it, but I feel exactly the same way that you do. With #2, I am hoping for a VBAC, but my OB-GYN said that only condition for a VBAC would be if the head and belly measurements are smaller next time around.

My planned c-section was a much more pleasant experience than I expected and my recovery was quite easy. So I think that in your position, I would be equally undecided. I guess it is weighting the likelihood of uncertain outcomes:
Best - successful VBAC
next best - planned c-section
worst - emergency c-section

Another possibility would be to go for a planned c-section and see if your doctor will wait until you go into labor and then do the c-section. This was basically what happened to me. We took it day by day (two NST per day plus one ultrasound per day) and when my OB-GYN saw movement begin to slow (but no emergency), she scheduled the c-section for the next day. It turns out that when I went to get prepped for the c-section, I was in active labor. This did not change the decision about the c-section, but I felt good knowing that our son probably would have naturally been born on the same day (i.e. he was ready for the big world). In the end, he was really ready (meconium in amniotic fluid and no vernix left). So the OB-GYN said we probably could have done the c-section a day or two earlier. But he did not need any time in the NICU.

I don't know if you have flexibility in scheduling c-sections in the US, but just thought that I would share how our planned, but not scheduled weeks in advanced c-section worked.

8

Hey Kristin,
That is an interesting idea about trying to wait till I go into labor to have the c-section. I unfortunately had such a bad experience with my first labor-cesearean combo that I am reluctant to go for that, even though in theory I like the idea that the baby would still be coming basically when she was ready and not before. The other thing is that my c-section is scheduled for 39wks, 2 days, and the longest they'd let me go would be 39wks, 6 days, so it's not really much of a difference anyway.

I think I'm leaning toward the c-section… when I read your post, I thought, no--the worst outcome would be a shoulder dystocia and a child with permanent neurological damage… and however small that risk is, I'm not sure I'm willing to take it just so I can have an experience that may or may not end up being better for me or the baby. It does make me very sad to think I'll never be able to have a normal vaginal birth, but that's something I can deal with.

I'll post an update with the estimated weight tomorrow after my ultrasound--in case any of you is waiting with bated breath! :)

9

I hope your appt goes well today! Drive safe in this fun MD weather!

10

Thanks! My husband is going with me--I was having visions of getting stuck on a hill and trying to walk for help at 38 weeks pregnant… eek!

11

Update for those who are interested: the ultrasound today showed exactly the same weight estimate as 2 weeks ago. This of course doesn't mean the baby hasn't grown, only that the last one was over or this one is under or both. However, even if this one is an underestimate, the highest it could really be is still under the 4500g cutoff they use to "offer" a c-section to a woman with diabetes.

My husband and I had a long talk with the OB, and he seemed totally comfortable with me waiting to see if I go into labor and then trying a VBAC, up until my due date. We are going to reschedule the c-section for closer to my due date to give me more time to go into labor on my own.

So that's the story! Please pray for me that I go into labor soon so that this baby is as small as possible when I'm trying to get her out!!! Thanks again to everyone for your support.

12

Hooray for lack of exponential growth -- indeed something to celebrate :)

Will be praying for you!!! Keep us posted when you can!!!

Are you trying methods to naturally induce labor? (not that I know they work, just curious)

13

Thanks, Kristin!

My prenatal yoga DVD claims that yoga squats can induce labor, so I'm going to try to do lots of those. I would try walking a lot except that my hip is bothering me quite a bit, so I guess that's out. Anyone have any proven techniques?

14

Old wives' tales, but sex and hot sauce. but not together :)

15

How are you doing?

16

Ha!

17

Fine, but no labor yet… thanks for asking!

18

An update for those who are interested:

Our second daughter was born December 18th, and we are all doing very well.

My story had an unexpected twist, which was that between 37 and 39 weeks, my amniotic fluid level went down significantly. When I went in for my NST and fluid check at 39 weeks, the fluid level was low enough that the doctor was not comfortable letting me go home. He said I could either spend the night in the hospital getting IV hydration to see if that helped, or we could just do the c-section that evening. Even though it seemed really unlikely that I would go into labor before Friday, when the c-section was scheduled, (he checked and my cervix was totally closed), I wanted to try and give my body more time. So we did the IV hydration, and the next morning, they rechecked the fluid and could barely find any at all. (This is dangerous because it can lead to cord compression). So… I had a c-section later that day. Everything went extremely well, I had very minimal blood loss, and my incision looks amazing.

The baby was 8 lb, 8 oz at birth and had absolutely no problems with her blood sugar or anything else. Aside from her routine checks in the nursery, she was with us the entire time we were in the hospital. She was able to start nursing while I was in the recovery room and has done very well with that from the beginning. (My husband and I were practically in shock at this, as our first daughter was hypoglycemic, had trouble breathing, had to spend her first couple of days in the NICU, and wasn't allowed anything by mouth for the first day).

So… all in all of course I was disappointed that I didn't get to have a VBAC (especially since it seems like it might have been successful, given the baby's weight). But in the end, the decision was taken out of my hands, which in some ways was a blessing. You really can't argue with someone telling you that your baby needs to be delivered because her umbilical cord might get compressed at any moment. This birth experience was so, so, so much better than my first one, in pretty much every way I can think of.

And now we're all just hanging out at home, figuring out what it's like to have a 2-year-old and a newborn! :)

Thanks again for all of the support and words of encouragement! And I hope that reading about my experience might be helpful to someone else out there.

19

Congratulations!

20

That's great to hear! So glad you are all doing well and settling in.