We’ll start with saying that whilst we will shout from the roof tops over and over again that there’s no need to have an induction for a suspected big baby alone (ie. No other issues relating to that such as uncontrolled diabetes or previous pelvic injury), we are ALL about choice here at TBU HQ. If you think that an induction or caesarean is the right choice for you to birth your baby then we want to support you 100% in that. However, the chances are you’re here because your gut says that that isn’t what you want and you want to find out if you must go with what’s being suggested. No. You do not have to go with ANY recommendation at all. You are in charge.
So when we look at that that offer of induction, what is that hoping to relieve us from? Well, anyone will tell you that the suggestion is that we are aiming to reduce the chance of ‘baby getting stuck’ aka ‘shoulder dystocia’. This is when the baby becomes wedged at the shoulders upon birthing and finds it difficult to come out. Now this happens to varying degrees. MOST of the time it is a simple ‘oops baby may be a little stuck there, could you just try moving your leg a bit? Oh fab, there’s baby, no big deal!’. Other times, this can require a little more hands on support from a care provider. This is something that all midwives and obstetricians are trained in and know how to deal with. Shoulder dystocia in the vast majority of cases doesn’t result in any long term issues We will link to some great blog posts with more information on shoulder dystocia at the end of this.
So let’s look at some the reasons why you might want to think twice about an induction for baby’s estimated size alone.
1.An induction will not reduce your baby’s size
Bizarre that isn’t it? An induction doesn’t take away any of the ‘risks’ of birthing a big baby but it does add all the risks of induction. When we think about being offered an induction due to the size of our baby, it’s put across as if they’re too big to be birthed. What your care provider means is ‘I’d like to manage the shit out of this birth please’. This difference is worth noting, ‘I’d like to’ and ‘you have to’ are VERY different. What is worth noting is that maternity services are highly litigated. Our NHS here in the UK pays out far more compensation for the area of maternity than any other area. This is because, rightly so, if an adverse outcome is thought to have been avoidable, parents want to hold someone accountable. The issue with this though, is that in these cases, you are more likely to be held accountable for what you didn’t do rather than what you did. So if a care provider doesn’t recommend an induction and anything happens to parent or baby, often times people will think, well why didn’t you induce me before this happened? Whether that is relevant or not. Inductions for things such as estimated size, ticked boxes such as high BMI, IVF conception or due dates alone are more often about avoiding future litigation than the actual safety of the parent or child. We know that this makes it bloody hard to make decisions about your birth though. That’s kinda where people like us come in, sharing evidence and stats rather than fear based policies.
2. An induction may increase the instance of shoulder dystocia
So does an induction make shoulder dystocia less likely then? No. We’re afraid it doesn’t! In fact, since our bodies actually are more efficient when left to their own devices, induction actually increases the instances of shoulder dystocia, whether a baby is suspected to be large at all. Things like baby’s position have such a big impact on how efficiently they are born, this could be the reason why the baby hasn’t bee born spontaneously on it;’s own yet, the body may be attempting to get baby into a more optimal position before kick starting labour. Inductions themselves often involve a lot of waiting around with limited movement before active labour begins (and often after it has too). This can mean that a baby that isn’t in that optimal position has limited to chance to move into one. When we take a baby that is not quite in position and ready for labour, and induce labour, potentially ruptured waters so that a position change is even less likely and limit the movement of the parent through things such as continuous monitoring. We aren’t helping where we think we are helping. When an induction is given for an estimated big baby and shoulder dystocia, forceps or caesarean occurs, everyone often says ‘see? Baby was too big to be born at home/ spontaneously/ vaginally etc. Thank goodness we were here’. This is how these things are perpetuated, not enough people are talking about how the induction has often contributed to the issues that have occurred and the person who has given birth is likely to now carry a mistrust of their body which is likely to be unfounded.
3. Shoulder dystocia occurs just as often with small babies as large
This one can be a real kick in the teeth to find out if you are going to appointments with your crew providers and being led to believe that your suspected big baby is going to cause issues in you birth. Those who’s baby’s are not suspected to be on the large side are not facing the same level of scare mongering, the same offers of intervention or the same mistrust in their body’s ability to birth their baby. The fact is, a persons position when birthing, being able to use gravity, listening to their body and utilising the foetal ejection reflex are all things that can reduce the chance of shoulder dystocia. When a small baby encounters shoulder dystocia, we will often blame the position, when a large baby encounters it, we blame the size. There’s so much more to it than size!
4. Fear of a big baby causes more complications than big babies themselves
This sounds ludicrous that the way someone feels about a baby’s size could have such an impact but if you’re familiar with the concept of hypnobirthing, you’ll know that actually, how we feel about our birth and our ability to do so, has such a major impact on our hormones that we can slow the process of birth when we don’t feel safe and confident in our abilities. That isn’t all though, it is not all on those of us birthing, far from it! In actually fact, a care provider suspecting a large baby causes the most interventions. From unplanned caesareans to severe tears, episiotomy and assisted deliveries, a care provider is more like to suggest an intervention to someone who’s baby is suspected to be on the larger side for things as simple as a fluctuation in baby’s heart rate or a labour that isn’t progressing as fast as they would like, even if there are no signs of any issues whatsoever.
A care provider’s mistrust can be what causes the cascade of interventions over the actual size of the baby. We can see this proven in a study from 2008 where a group of women who’s babies were suspected to be big were compared to a group of women who’s babies were large unexpectedly, the findings were that the group of women who’s babies were suspected to be big, had more instances of caesarean or induction (3x more) and more instances of postpartum haemorrhage and severe tears. However, there was no difference in the instances of shoulder dystocia, the thing that we’re told we will be able to avoid by scheduling our babies birth. Make it make sense.
5. Big babies are birthed without issues all the time.
Your pelvis is getting ready to birth your baby whatever size your baby is. You are producing relaxin, which may well be causing you to have aches and pains as your body is feeling less stable and may cause you to overextend etc. This is the reason that we are advised not to do heavy lifting in pregnancy. Our bodies are getting all wobbly and stretchy so that they can allow our baby to pass through the pelvis as it needs to! These bodies of ours are so smart! They’re getting ready from as soon as we are pregnant! 94% of big babies will not experience shoulder dystocia either. So it is really worth bearing that in mind and preparing positively for the birth we want to have rather than wasting our pregnancy feeling scared about the small chance of something occurring (which as we mentioned above, could have happened if they were small anyway!).
6. Nobody knows how big your baby actually is until it’s born.
Despite discussions of centiles and estimated weights and ‘oh this is a big baby’ etc. Nobody bloody knows! Any discussion about baby’s size is based on guess work! Whilst we are sent for scans and then the results of them are used as a basis for planning all sorts of things, these scans are just an estimate based on measurements being taken of a baby suspended in fluid, within another persons body (so not the easiest thing to measure!) which are then used to create an estimate based on averages. Growth scans are proven to be inaccurate and studies have shown them to be up to 15% out either way. To perhaps explain better, if a baby is estimated to be 8lbs 13oz, this could mean that they are anywhere from 7lbs 5oz to 10lbs 4oz. That’s a huge size range! That’s basically a stab in the bloody dark! Consider this when you are basing your birth choices in this. If you change your plan and have an experience that you were not looking to have, how will you feel if your baby comes out bang on average size?
Bonus fact for this point- studies have proven that when we compare size estimates given by the mother themselves, an educated guess from a birth professional or a growth scan, the thing that comes out in top most often, the MOST accurate estimate is the mothers guess! So do YOU think your baby is enormous?
7. Your birth experience is important!
YOU are important! We’ll say it again and again! You are the person who will live through your birth experience and you will always reflect on this experience for the rest of your life. It isn’t just a means to an end but the way in which you will transition into parenthood. If you want to birth in a certain way, that is to be respected. Your instinct is so important and you will never put your baby in danger. If you feel home is the place you will feel safest and you want to be supported by multiple birth partners in an environment you feel safe and supported in, then you deserve for that to be how it happens. If you would rather avoid induction because you feel strongly that your experience is going to be better waiting for labour to start spontaneously (and this is supported by evidence also) then you should absolutely be able to choose that rather than have anyone try to convince you otherwise with fear.
The stats etc around birthing big babies are super reassuring, if you are someone who is reassured by evidence and statistics etc, we will always recommend doing some research. Here are some links to blogs that will help you to get more informed on this topic-
Here’s what stacey had to say this week-
“Knowledge is so powerful. I thought going into my first birth I’d be alright as I’m a medical professional in the NHS. I’m learning so much more and feel so much more empowered now with the hypnobirthing pack with my third child and I so wish I did it with my first. I know I would’ve had a way better experience if I did. 🙌”