GIVING BIRTH TO A 'BIG BABY'

Pregnant mother holding stomach Doula Oklahoma

HOW BIG ARE BIG BABIES?

A big baby or a baby with Macrosomnia is defined as a baby with a birth weight that is more than 8lbs 13oz(1). 89.6% of babies are born weighing 8lbs 13oz or less. This means that even though macrosomia is somewhat uncommon, it’s still frequently suspected.ย 

HOW IS A BIG BABY DIAGNOSED?

Big babies are most often diagnosed by using ultrasound during pregnancy. Yet, ultrasound weight predictions are pretty inaccurate! ๐—จ๐—น๐˜๐—ฟ๐—ฎ๐˜€๐—ผ๐˜‚๐—ป๐—ฑ๐˜€ ๐—ต๐—ฎ๐˜ƒ๐—ฒ ๐—ฏ๐—ฒ๐—ฒ๐—ป ๐—ณ๐—ผ๐˜‚๐—ป๐—ฑ ๐˜๐—ผ ๐—ข๐—ฉ๐—˜๐—ฅ ๐—ฒ๐˜€๐˜๐—ถ๐—บ๐—ฎ๐˜๐—ฒ ๐—ฎ ๐—ฏ๐—ฎ๐—ฏ๐˜†โ€™๐˜€ ๐˜„๐—ถ๐—ด๐—ต๐˜ ๐Ÿณ๐Ÿฌ% ๐—ผ๐—ณ ๐˜๐—ต๐—ฒ ๐˜๐—ถ๐—บ๐—ฒ. As an Oklahoma City Birth Doula, I have heard from several mothers who were told they were going to have a โ€˜big babyโ€™ because of the ultrasound predictions. Their babies all ended up less than 8lbs. Care providers can also diagnose โ€˜big babiesโ€™ but their accuracy is only 37%.

Because of the inaccuracies of ultrasound, ๐Ÿญ/๐Ÿฏ ๐˜„๐—ผ๐—บ๐—ฒ๐—ป ๐—ฎ๐—ฟ๐—ฒ ๐˜๐—ผ๐—น๐—ฑ ๐˜๐—ต๐—ฎ๐˜ ๐˜๐—ต๐—ฒ๐—ถ๐—ฟ ๐—ฏ๐—ฎ๐—ฏ๐˜† ๐˜„๐—ถ๐—น๐—น ๐—ฏ๐—ฒ ๐—ฏ๐—ถ๐—ด. One of the big reasons for the inaccurate fetal weight prediction is because different sonographers can use different equations to predict birth weight. The equation that has had the most accuracy is when the babyโ€™s abdominal measurement is used.

Technology can NOT accurately predict a big baby.

FACTORS LINKED TO BIG BABIES

There are some risk factors that are linked to Marcosmnia. These factors are genetics, male babies, diabetes, higher weight gain, older maternal age, higher BMI prior to pregnancy, and a previous history of big babies.

SUSPECTED BIG BABIES

Why is it so important to know that fetal ultrasound weight predictions are so inaccurate?

Because there are ๐—บ๐—ผ๐—ฟ๐—ฒ ๐—ฟ๐—ถ๐˜€๐—ธ๐˜€ ๐—ณ๐—ผ๐—ฟ ๐—ฏ๐—ฎ๐—ฏ๐—ถ๐—ฒ๐˜€ who are ๐—ฆ๐˜‚๐˜€๐—ฝ๐—ฒ๐—ฐ๐˜๐—ฒ๐—ฑ ๐—ผ๐—ณ ๐—ฏ๐—ฒ๐—ถ๐—ป๐—ด ๐—ฎ ๐—ฏ๐—ถ๐—ด ๐—ฏ๐—ฎ๐—ฏ๐˜† ๐˜๐—ต๐—ฎ๐—ป ๐—ฏ๐—ฎ๐—ฏ๐—ถ๐—ฒ๐˜€ ๐˜„๐—ต๐—ผ ๐—ฎ๐—ฟ๐—ฒ ๐—”๐—–๐—ง๐—จ๐—”๐—Ÿ๐—Ÿ๐—ฌ ๐—•๐—œ๐—š! Remember, ๐Ÿญ/๐Ÿฏ ๐˜„๐—ผ๐—บ๐—ฒ๐—ป ๐—ฎ๐—ฟ๐—ฒ ๐˜๐—ผ๐—น๐—ฑ ๐˜๐—ต๐—ฎ๐˜ ๐˜๐—ต๐—ฒ๐—ถ๐—ฟ ๐—ฏ๐—ฎ๐—ฏ๐˜† ๐˜„๐—ถ๐—น๐—น ๐—ฏ๐—ฒ ๐—ฏ๐—ถ๐—ด. When babies are suspected to be big, they have higher rates of โ€˜stalledโ€™ labor, higher induction rates, and ๐Ÿฎ-๐Ÿฏ๐˜… ๐—ต๐—ถ๐—ด๐—ต๐—ฒ๐—ฟ ๐—ฐ๐—ฒ๐˜€๐—ฎ๐—ฟ๐—ฒ๐—ฎ๐—ป ๐˜€๐—ฒ๐—ฐ๐˜๐—ถ๐—ผ๐—ป ๐—ฟ๐—ฎ๐˜๐—ฒ compared to babies who are born big without the prior diagnoses or suspicion!

๐—จ๐—น๐˜๐—ฟ๐—ฎ๐˜€๐—ผ๐˜‚๐—ป๐—ฑ๐˜€ ๐—ต๐—ฎ๐˜ƒ๐—ฒ ๐—ฏ๐—ฒ๐—ฒ๐—ป ๐—ณ๐—ผ๐˜‚๐—ป๐—ฑ ๐˜๐—ผ ๐—ข๐—ฉ๐—˜๐—ฅ ๐—ฒ๐˜€๐˜๐—ถ๐—บ๐—ฎ๐˜๐—ฒ ๐—ฎ ๐—ฏ๐—ฎ๐—ฏ๐˜†โ€™๐˜€ ๐˜„๐—ถ๐—ด๐—ต๐˜ ๐Ÿณ๐Ÿฌ% ๐—ผ๐—ณ ๐˜๐—ต๐—ฒ ๐˜๐—ถ๐—บ๐—ฒ

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Yet, Nondiabetic women only have aย 7.6%ย chance of having a big baby(5)! How crazy is it that SO many birthing people are told that their baby is going to be large when such a small amount actually have large babies? Studies have found that only 1.3% of babies are born weighing more than 9lbs 15oz.

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IS HAVING A BIG BABY DANGEROUS?

Most of the concern around big babies is that people have become cultured to believe birthing a big baby is more dangerous for the birthing person and baby. Letโ€™s talk about each potential risk.

Still Birth
Some care providers will stress that big babies have a higher chance of being born stillborn. The evidence does not show this. It is actually the babies on the small extreme that are more likely to be stillborn(4).

Shoulder Dystocia
Shoulder dystocia is the prolonged delivery of a babyโ€™s head to the delivery of their shoulders. While diabetic mothers are more likely to have shoulder dystocia, there is no possible way to predict shoulder dystocia. Statistically, only 0.65% of babies who are born weighing treated than 8lbs 13oz experience shoulder dystocia. The risk of these babies receiving nerve damage from shoulder dystocia is 0.009%.

Birth Fractures
It is rare for a baby, even a big baby, to experience birth fractures. Only 0.54% of big babies have fractures during birth compared to 0.08% that smaller babies do(6).

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BIRTH INTERVENTIONS FOR SUSPECTED BIG BABIES

The suspicion of a woman having a big baby doubles her chances of having a cesarean section even though there is no evidence of improved outcomes for mom and baby. It is important to remember that C-sections come with their own risks as well.

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OKC Doula Oklahoma Doula

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When babies are suspected to be big, they have higher rates of โ€˜stalledโ€™ labor, higher induction rates, and ๐Ÿฎ-๐Ÿฏ๐˜… ๐—ต๐—ถ๐—ด๐—ต๐—ฒ๐—ฟ ๐—ฐ๐—ฒ๐˜€๐—ฎ๐—ฟ๐—ฒ๐—ฎ๐—ป ๐˜€๐—ฒ๐—ฐ๐˜๐—ถ๐—ผ๐—ป ๐—ฟ๐—ฎ๐˜๐—ฒ compared to babies who are born big without the prior diagnoses or suspicion!

Multiparous women with a previous delivery of a macrosomic infant were at lower risk of maternal complications (3)

Care Providers may use Macrosomnia as a reason for Induction. As of 2018, the American College Of Obstetricians & Gynecologists (ACOG) doesย NOTย recommend induction in cases of macrosomia (2). Although induction is not recommended, care providers of 2/3 of the women who were told they were going to have a big baby discussed induction and/or cesarean section. Can you see how many women are undergoing induction or planned cesarean for macrosomia when ACOG doesnโ€™t recommend it and when big babies cannot be diagnosed by technology?ย Less than half of women whose Care providers counseled them about big babies gave birth vaginally. Letโ€™s remember again that birthing people only have a ๐Ÿต.๐Ÿณ% chance of having a big baby!

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WEIGHING THE RISKS of a Big Baby

As an expecting parent, you can look into the potential risks and weigh your options. Does your baby potentially being big really pose a threat? Do we have any of the risk factors that are linked to big babies? Are the risks of having a big baby higher than the risks of a planned induction or cesarean? To aid you in your decision-making process, I have included several resources below!
If you are needing additional guidance and support, please donโ€™t hesitate to book a free consult with me about providing doula services byย Clicking Here. Want to continue to learn more about your options in pregnancy and birth? Check out my other blog posts Here.

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RESOURCES ABOUT BIG BABIES

  1. Macrosomia Definition
  2. Practice Bulletin No. 173: Fetal Macrosomia
  3. What are the birth implications for a suspected big baby? Evidence-Based Bith Podcast
  4. Maternal and neonatal complications of fetal macrosomia: systematic review and meta-analysis
  5. Birth weight percentile and the risk of term perinatal death
  6. Adverse maternal outcomes associated with fetal macrosomia: what are the risk factors beyond birthweight?
  7. Risk factors for recurrent macrosomia and child outcomes
  8. Shoulder Dystocia Info
  9. โ€œThe effectiveness and costs of elective cesarean delivery for fetal macrosomia diagnosed by ultrasound.โ€

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