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BIG Babies…

Birth Preparation

I am posting a big chunk of information on ‘Big Babies’ here and if it is too much (totally get it) keep an eye out for the next few posts where I will break down the info into more sizable chunks .

An increasingly large number of women, due to the common use of ultrasounds, are being told in the 3rd trimester that their baby is ‘big’, ‘large for gestational age or macrocosmic. Ironically most third trimester ultrasounds are done to identify small babies or growth restricted and most at risk of stillbirth.

Many women with babies identified as big are offered induction in hopes of reducing a rare but serious event – shoulder dystocia.

This is problematic because – ultrasounds are notoriously inaccurate, and many women have been told they require induction or caesarean for a “big” baby only to have a perfectly average 3.5kg be born.

There are risks associated with shoulder dystocia, and there are risks associated with induction. It is really hard to compare and give medical advice on the chance of a small but serious event happening (shoulder dystocia) vs less serious but very common (complications of induction being that it is unsuccessful, the baby is born before it is ready, the experience is more painful, depending on how the process is discussed; a lack of autonomy if the woman feels like she didn’t have a say in the recommendation).

Interestingly women who are induced are most likely to have an epidural because of the absence of hormones associated with the physiological process, and yet most shoulder dystocia happens in the context of an epidural and induction. The baby is forced into the pelvis in a way that is harder for them to navigate the pelvis (membranes are often artificially ruptured), and women are less mobile making it more restrictive for the management of shoulder dystocia should it occur. NICE guidelines also suggest that induction for a baby being big doesn’t reduce the risk of shoulder dystocia unless the estimated weight of the baby is over 5.5kg.

It is important to discuss with your healthcare provider their experience in managing shoulder dystocia and what complications are associated with induction. If you are aiming for a physiological birth, you may want to seriously question the recommendation for induction in the absence of other medically confounding variables. If induction is part of your birth plan and an informed decision-making process, then that might be the right choice.

Routine 3rd-trimester ultrasounds will identify more pregnancies with macrosomia but will not have any clinically significant effect on predicting shoulder dystocia (Moraitis et al., 2020)

When comparing the outcomes of a group of women who had a suspected big baby with a group of babies born the same size, the group where the big baby was suspected had higher morbidity rates (shoulder dystocia, slow progress in labour, perineal trauma, etc.). The research about complications relating to big babies suggests that it is the intervention carried out when a baby is assumed to be big – other than the actual size of the baby – that mainly contributes to complications” (Reed 2019b)

RCOG 2012 guidelines state that “induction of labour does not prevent shoulder dystocia in non-diabetic mothers with a suspected LGA baby” and the NICE (2008a) says “in the absence of any other indications induction of labour should not be carried out simply because a health professional suspects a baby is larger.”

by Ashlee Anslow
Endorsed Midwife/Registered Nurse
The Birthing Tree Midwifery Pty Ltd
0423 974 289
[email protected]

A shout out to Graphic Node for the image – thankyou #bigbabies #gestationalage#macrocosmic #thebirthingtree #midwife #withwoman #Midwifery #privatemidwife


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