Childbirth Connection angered that estimated fetal weights are merely estimates

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The Childbirth Connection is the leading lobbying organization for the natural childbirth industry. Their apparent goal is greater employment for the women they represent: midwives, doulas and childbirth educators. The heart of their marketing strategy is to promote distrust of modern obstetrics and obstetricians. As I noted almost exactly one year ago today, getting your information on birth from the Childbirth Connection is like getting your information on solar power from Big Oil. The conflict of interest is gargantuan.

Better maimed than Cesarean shamed.

Their latest effort to promote distrust of obstetricians is embodied in two recent articles, When a Big Baby Isn’t So Big in the NYTimes, and, Are Women Being Tricked Into Having C-sections? by Beth Greenfield, who often serves as a conduit for the natural childbirth industry, in Yahoo Parenting.

From the Yahoo piece:

[R]esearchers … found that a significant number of women are being erroneously told that they would be having big babies. And the study, published in Maternal and Child Health Journal in December and based on the data of 1,900 women surveyed by Childbirth Connection, further showed that mothers who believed they were having big babies were nearly five times more likely schedule a C-section — even though the large majority of their babies wound up weighing less than 8 pounds 13 ounces …

“Estimating weight is still an imprecise science. But the study is really more about communication than anything else,” one of the researchers, Eugene R. Declercq, a professor at Boston University School of Public Health, tells Yahoo Parenting. Figuring that a baby will be big, rather than too small (and then at greater risk of problems), he notes, “should be conveyed as good news, with no question about it being able to be delivered vaginally.” But based on the study’s findings, that’s not what’s happening, as a doctor telling a mom-to-be that her baby will be big “has a profound effect, and contributes to undermining women’s confidence they can deliver the baby,” Declercq told the New York Times.”

See! See! It shows you that obstetricians don’t know what they are talking about. It shows you that they just want to trick women into C-sections. How dare obstetricians fail to inform the public that an estimated fetal weight is merely an estimate? How was anyone to know?

The articles make it sound like this is some sort of shocking discovery, but obstetricians are well aware of the fact that estimate fetal weights are … gasp … estimates. Moreover, we are also aware the the accuracy of estimated fetal weights declines as the baby gets bigger. In the third trimester, EFW is accurate only to within +/- 2 pounds. A baby with an EFW of 9 pounds may weigh as little as 7 pounds, but it is EQUALLY likely that it weighs as much as 11 pounds.

There’s a simple reason why EFW is an estimate. It’s the equivalent of weighing a child with a tape measure. If you were told a child’s age, height, head size and abdominal circumference, you could probably come up with a pretty good estimate of its weight. That’s essentially the same information that ultrasonographers use to calculate the EFW.

Why does fetal weight matter anyway?

Here’s why: the baby’s very life may depend on it.

In another recent study that examined the relationship between increasing birth weight and perinatal mortality among 5,049,104 liveborns in the United States between 1995-2000, a nadir was observed at approximately 3,900 g and a sharp rise occurred for newborns with higher weights (see the image below). Thus, depending on many factors, the optimal birth-weight range to minimize the risk of fetal and maternal morbidity and mortality is between 3000-4000 g.

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We know that very large babies have a much greater risk of paralyzed arms (Erb’s palsy), brain damage and death. We know that our best methods of estimating fetal weight can be off by two pounds in EITHER direction. What’s the solution?

The obvious solution is to develop more accurate ways of estimating fetal weight. In the meantime, we have to make do with what we have in attempting to prevent injury and death.

But that’s not how the folks at the Childbirth Connection see it. What are they doing to develop new, more accurate methods of measure fetal weight? Absolutely nothing. They don’t want to improve existing technology because … never forget this … their goal is NOT to make childbirth safer; their goal is to make vaginal birth more common, and their go-to tactic is to demonize obstetrics and obstetricians.

Listening to the Childbirth Connection declaim on the risks of technology is like listening to Big Oil declaim on the risks of solar power. There is a massive conflict of interest. But in the case of the Childbirth Connection and obstetricians, there is also an extraordinary conflict of VALUES: the Childbirth Connection values process whereas obstetricians have a laser-like focus on outcome.

That’s why obstetricians are constantly working to improve the accuracy of their technology while the natural childbirth industry, represented by the Childbirth Connection, resorts to demonizing it. The Childbirth Connection want you to hire a midwife and a doula to preside over your unmedicated vaginal birth. If that means taking a chance that your baby will end up injured, brain damaged, or dead, so be it.

As far as the Childbirth Connection is concerned, better maimed than Cesarean shamed.

  • momofone

    Anecdotal, but my son’s weight was estimated to be 9 lbs, 2 ozs. There was some calcification visible on the ultrasound, and I was at 38 weeks, 3 days with a Bishop score of zero. My OB knew that I wanted to avoid c-section if possible (because of all the awful things I’d heard about the agonizing recovery), and offered the option of induction with the understanding that he expected I would end up (possibly) laboring and still needing section, or doing a c-section that day (he didn’t recommend waiting due to the calcification). We went with c-section. All that to say that though my son actually weighed 7 lbs, 15 ozs, the placenta was much more calcified than was visible on the ultrasound. I shudder to think what could have happened if we had had some stubborn insistence on waiting, and if the inaccurate weight estimate (hard to say it’s inaccurate, being an estimate) helped spur his safe delivery, we couldn’t be happier about it.

  • meglo91

    My sister in law has now had 2 babies via planned c, both because they were estimated to be over 9.5 lbs at 37 weeks. Baby 1 came out and was 9 lbs, 15 ozs at 39 weeks. His sister recently arrived and was 10 lbs, 4 ozs at 39 weeks! No gestational diabetes. My SIL is not overweight and neither she nor my BIL are very large people. They just make ENORMOUS babies. She was and is glad for fetal weight and size estimation, and for planned c-sections. Because while she MAY have been able to have the babies vaginally, the likelihood that they would have wrecked her pelvic muscles and genitals on the way out is pretty high.

    • Sue

      Yep – and that’s what it’s all about. As Dr Amy often says, preventive medicine.

  • Grace Adieu

    My son was 3.3kg, about half a kilogram less than estimated. But his head circumference was 39cm. Surely if the estimated weight is an over-estimate then it’s at least likely that one of the parameters is larger than usual, which can complicate delivery even if the baby’s weight isn’t particularly great? After all, estimated weight is itself a proxy for the baby’s actual dimensions.

    • Who?

      My friend’s kids were all smaller than anticipated, and all turned out to be unusually round around the middle-like their father.

    • Allie P

      Good point. My kids were all shaped like lawn darts. Scrawny and long with ENORMOUS heads. None of their little hats that came with their baby onesies fit.

    • Erin

      I had a scan at 35 weeks because I was losing weight.. was told that the baby looked perfect sized & everything looked great. They wouldn’t give me a weight estimate but we worked it out as being 8 pounds by 40 weeks.

      He was born 4 weeks later weighing six pounds nine ounces but by c-section because his rather large for his size head refused to descend from mid pelvis. The Consultant Pediatrician overseeing his stay in NICU (waters broken for 81 hours) took one look at his head and told me I was a very lucky girl. I subsequently discovered that it’s a family trait of my husband’s.. oddly enough they never mentioned it before and my Mother in law needed 81 stitches for her first, my eldest sister-in-law ended up with a fourth degree tear and his middle sister had surgery for a prolapse and to fix her labour induced incontinence.

      Needless to say any babies I may yet have will be born by repeat c-section as I don’t fancy having the equivalent of a patchwork quilt down there.

      • AirPlant

        eighty. one. stitches.
        That number is not even within the statistical spread of what I would expect to come from childbirth.

        • Erin

          I know my sister-in-law was a large baby who was delivered back to back but I admit I almost choked when she told me. I like to think they were very very small stitches because anything else is too horrible to contemplate but she said the midwives wanted her to complain about the Doctor who cut her and they got someone else to sew her up so I’m guessing they weren’t that small.

          • AirPlant

            I am involuntarily crossing my legs for dear life right now. I expect that to go on for the next forever.

          • Charybdis

            There. Are. NO. Words. Is there even enough tissue down there to hold 81 stitches? Where would one even start to sort that out?

      • cookiebaker

        My kids have huge heads, too. (>90th percentile). I tore horribly with the first one, they never told me the degree, but I tore up, down and internally. It took forever for her to sew me up (without pain meds.) I have a lot of issues with that OB, but I will say her patchwork was spot on. I’ve never had any incontinence issues and I went on to have 5 more babies and never tore again.

        My 5th had the biggest head. I can’t remember exactly what it was at birth, but by 8 weeks, he’d gone off the upper end of the growth chart. I was starting to worry about it, but now he’s down to the 99th percentile at 19 months and has been hovering there for about a year now.

  • guest

    I only weighed 8 pounds, 7 ounces when I was born, but apparently my head was larger than average. I don’t have all the details on my mother’s labor, but the end result was that I was born via forceps (the doctor later told my mother that it should have been a c-section) and my mother’s tailbone was broken at some point during the process. She says she couldn’t sit down comfortably for a year. They didn’t do estimated fetal weights back then, but oh please tell me again how a baby weighing less than “8 pounds, thirteen ounces” isn’t “big” enough to merit a c-section.

    (There’s no reason to believe my mother or her doctor were influenced by NCB, and of course many women have birth babies larger than me with no problem, but I’m tired of people hating on c-sections. You try not being able to sit down comfortably for A YEAR.)

    • Daleth

      How horrible. Not sitting down for a year is bad enough in itself, but imagine it as a new mother, when you’ve got to feed your baby many times a day.

      • guest

        Yeah, apparently it was rough for a bit (but isn’t always with the first kid?). She was also attempting to breastfeed, but that lasted only two weeks.

  • Amy

    Here’s what I don’t get. A lot of these people immediately demonize YOU because you’re no longer a licensed, practicing obstetrician. But if you WERE practicing, they’d accuse you of wanting to drum up more business for yourself and your colleagues. Your being retired pretty much precludes a conflict of interest on your part. You benefit in no way personally from more women eschewing homebirth and/or trusting their university-trained care providers in the hospital.

    • Amazed

      Oh a good deal many of them don’t even KNOW Dr Amy isn’t practicing, else they wouldn’t have babbled about her wanting to make more money and do more c-sections…

    • Brooke

      Not if she’s working on a book. She’s intentionally trying to stir up controversy mainly among mom’s who feel guilty not educate women about risks or improve OB care.

      • DelphiniumFalcon

        Oh look, you’re still here.

        Since ignoring you doesn’t work, I’ll bring up the music.

        https://youtu.be/NoXLu9Rz70g

      • Montserrat Blanco

        Well, Brooke, first of all, even knowing that you are not going to answer this comment:
        – Where did you get the 5% CS rate as ideal from?
        – What is exactly your point about the PROBIT study not being valid? Please, with statistics analysis.

        I do not see how Dr. Tuteur is trying to stir up controversy among moms that feel guilty. I really do not see it, so, could you please elaborate? Thank you.

        • Gatita

          <3 <3 <3

      • Sarah

        I bet her book will be properly punctuated.

      • Karen in SC

        Dr. Amy posts every day and has been for years! The nature of her blog has not changed in that time.

      • Charybdis

        Nope, sorry. The moms who feel guilty, as you say, are made to feel that way by the NCB, EBF, AP, IBCLC, LC, CPM, BFHI propaganda brigade and the tripe they push as dogma. “Breastfeed more! More, MORE, I TELL YOU”, “Trust birth, trust your body and your ancient Mama wisdom”, “Blah, blah, blah, microbiome, blah, blah, interventions are evil, blah, blah, blah, CS’s are of Satan and his OB minions, pain relief is not necessary, change position, have a snack, take a walk, scream, er VOCALIZE a bit, the umbilical cord cannot choke your baby, he is not breathing yet, castor oil, lactation cookies and tea, herbs, etc…If a woman is ego-stroked and told only what she wants to hear, then she cannot make a truly informed decision about having a baby.
        Dr. Amy provides the scientific evidence, backed up by actual legitimate research to women. It is obviously different than what the woo crowd offers and they don’t like that as it encourages women to make decisions that are approved by the woo crowd.

      • Allie P

        She’s not trying to educate people about risks? What blog are YOU reading?

      • Megan

        So what was her motivation in all the years prior to her book?

      • Amy

        I got a troll reply! I feel so honored!

        Actually, no, it doesn’t work that way when you look at the record. Dr. Amy has been at this for ten years. I’ve been reading the whole time. In fact, I was directed here by angry crunchies on the ICAN list– I used to be one of them until they turned on me for not being crunchy enough. For years she LOST money on her blogs. So ten years later, she’s publishing a book related to her blog work? How is that worse than The Pioneer Woman’s show and cookbooks, Mercola’s and Dr. Oz’s myriad quack “cures” they peddle, or all of the DIY home bloggers who write sponsored post after sponsored post telling you how to use the product sponsoring them?

        And if you actually look at her lifestyle and background, it’s clear that she’s NOT in it for the money. She’s a Harvard grad married to another Harvard grad. He’s a lawyer. They live in a more affluent community, but it is NOT the richest/snootiest community in the area by a long long way. One thing you realize pretty quickly spending time around doctors and other highly-educated professionals is that by and large, while doctors make good money, people who are “in it for the money” go almost exclusively into investment banking, business consulting, or venture capital. In other fields, well-paying jobs are nice but often require more work than they’re worth. The payoff in terms of years of training and crappy work shifts mean that medicine just isn’t easy money in any way. And to be honest, all of the doctors I know who ARE richer than upper-middle-class got there because they invested in real estate or something similar.

        • The Bofa on the Sofa

          I think from now on, I am going to respond to all of Brooke’s comments like the Onion does when it does those question and answers, where the answer is just some text from a random source unrelated to the question.

          So in response to Brooke, I will just post random bits from The Lost Princess of Oz by L Frank Baum.

          Yeah, it’s trolling but one good troll deserves another

    • Amy Tuteur, MD

      I consider it a great advantage that I’m no longer practicing so no one can accuse me of a conflict of interest in promoting obstetrics.

  • Kelly

    Anecdotally, but all three of my third trimester ultrasounds were accurate within an oz or two.

  • Allie P

    I had a six and three quarters pounder and a seven and a half pounder, the larger one, with the larger head, first. both long and lean, and I had an episiotomy with the first. Those aren’t big babies, but I wouldn’t have wanted them any bigger!

  • EmbraceYourInnerCrone

    Coincidentally:

    https://www.yahoo.com/parenting/2-foot-tall-newborn-tips-scales-at-more-than-12-175647567.html

    The newborn weighed in at an impressive 12 pounds, 8 ounces — and measured a full 2 feet tall. He was not due until 18 January and his mom apparently tried to deliver vaginal but that did not work, yay for C-sections

    • The Bofa on the Sofa

      What? She grew a baby too big to be born naturally?

      • EmbraceYourInnerCrone

        Well he could have been born naturally I suppose, but probably not and still be alive, with his brain cells intact…

        I guess her first weigh 10 lbs according to the article

      • AirPlant

        I would argue that she grew a toddler.

        • Medwife

          That is the exact weight of my 14 week old baby. The mind boggles.

          ETA: 12#8! Not 19.

          • Kelly

            My first daughter was only 18lbs at a year old. That poor mother. How did she even carry that baby?

    • Commander30

      I keep finding myself going back to this list… http://www.baby2see.com/large_babies.html

      But, of course, a mother won’t grow a baby too large to be born vaginally! A 19 lb newborn is just a “variation of normal!” (chokes on sarcasm)

      • BeatriceC

        When my youngest was in the NICU a baby was admitted that was in the 15 pound range. I forget the exact weight, but this kid really did look like a toddler, especially next to all the 1-5 pound babies that surrounded him. Then the parents came in, and apparently the baby was just the right size for them. The father was at least 6’8″ and the mom was well over 6 feet, though shorter than her husband. They were both broad shouldered and stocky. I have no idea whey the baby was admitted to the unit, but he wasn’t there for very long; a couple days at most.

        • demodocus

          Both my MIL’s babies were taken away for meconium. both overdue, one weighed nearly 10 and the other 1 oz shy of 11. She did not have GD with the “smaller” boy. Granted, we’re talking 35-40 years ago now. She’s the short one on both sides of the family at 5’9″.
          I’m really glad her first grandchild was 8 1/2 pounds (and 21 inches long); wish me luck on the second grandchild…

        • The Bofa on the Sofa

          Heck, when my first was born, he was 6 lbs. The baby that was born in the c-section that was in the OR right before was 11 lbs. They were laying next to each other in the nursery, and it was like, whoa! The other guy was basically twice as big.

    • Gene

      We grow BIG babies in our family. On both my side and my spouses. My MIL is not even 5′ tall and my spouse was 10lbs. There are tales of 12-13 pounders being born in farmhouses in the early 1900’s. All vaginally. Apparently, we have “birthin’ hips”. But damn!

      • DelphiniumFalcon

        Apparently my husband side of the family does too. I mean my sister was 9 pounds and something oz but if I remember right I think Mom was beginning to show signs of gestational diabetes. My sister was also two weeks early. o_o

        My brother in law was 10 or 11 lbs, I don’t remember. Anything larger than 9 pounds makes me go “Ahhhhh!” And if I’m remembering right my MIL said she didn’t have gestational diabetes.

        I’ll admit it. I’m a little scared.

        Also OT, but I started CNA classes Tuesday! Yay!

        • Who?

          I’m pretty small-barely 160cm, slender build-and had two biggish bubs (3.8 and 3.9kgs, which is 8 pounds 6 and 8 oz respectively), both very long-55cm (sorry no idea what that is in old money-more than one third of my body length though, however you are counting). And they both came out in six-ish hours, small tear with the first, second just slid out.

          I was back in my jeans within 10 days both times.

          My husband is not a big person either. Both kids are now small average sized adults.

          It’s not over until it’s over, and you can’t tell how it’s gone (or going to go) until it’s over. I was days away from a section for breech with the second, but she tired of being upright.

      • cookiebaker

        I was lucky enough to be blessed with birthing hips. At the first internal exam with one of my kids, my OB told me I could have a 15lb baby, but she quickly followed with, “Let’s not, though!” The biggest of my babies was only 7lbs, 4oz. With that baby, my OB called the pediatrician in to do the exam/apgars before I started pushing and the ped started to leave saying she doesn’t come in until the baby is crowning. My OB stopped her and asked her to please stay because in her experience this will go very fast. About 30 seconds later, there was a healthy baby boy.

    • PeggySue

      HOLY CRAP!

    • BeatriceC

      Yikes! I thought I was a big baby. I was 10 pounds, 12 ounces. My poor mother weighed only 90 pounds prior to getting pregnant with me. I wound up being delivered by c-section after hours of labor and no progress. My head was just too big to fully engage and labor stalled. My parents have vastly different body types. My mother’s family are all very skinny (think Twiggy, but with nice, proportional curves) and my father’s family are all built like linebackers. I took after my father’s family.

      • Amazed

        When my mom left the hospital with brand new me, she weighed 120 pounds. I have a picture of us that day. She’s in a sundress as if she’s going from the hospital straight to the beach. No belly or something. After her giant baby, most of the weight had followed.
        It was not a pretty sight. Body looked OK. That’s what some lucky women look like after giving birth, one would think… until they saw her face. She was very ill for months.
        Not pretty. Sure as hell not healthy. But hey, we’re both here. Yay vacuum!
        When the Intruder arrived, he was the biggest baby in the unit, with his mighty 10 pounders. Nurses cooed over him – so big, so lovely. Then, they met my dad (towering hugely over my mom) and they were like, aha.

  • She

    A woman on babycenter was complaining that her OB was suggesting early induction because it looked like the baby was going to be big. She was angry and suspicious that he just wanted more money or convenience for himself. Women were chiming in about their successful vaginal deliveries of huge babies. I felt it was my duty to point out that if that baby is too big, it’s going to be more than a minor inconvenience. Number one, you want a healthy mom and baby. After that, it’s nice to be able to have fond memories of the day your baby was born. You don’t want PTSD or months of therapy trying to get over a traumatic birth. If you’re lucky enough to know in advance that you have a good chance of a difficult birth, take it seriously. FFS.

    • Madtowngirl

      I seriously want to meet one of these OBs that does a c-section out of convenience. Don’t c-sections, by nature of the fact that they are surgery, increase the risk of something happening that could bring about a lawsuit? Don’t get me wrong, I’m not saying they are unsafe but why would a doctor want to scrub in for an “uneccessary” surgery when a baby could be safely delivered vaginally?

      • Tiffany Aching

        The “doctors schedule c sections for convenience” also seem kind of fishy to me. First, it doesn’t take into account that “more convenient” might also mean “more adapted to the contingencies of the real world”, like the availability of anesthesiologists, etc., and I guess that sometimes a birth that could have taken its natural course in perfect, ideal conditions (with an anesthesiologist readily available, and a NICU at hand) becomes a c-section because in the real world, with the means available, it is safer. And the character of the money-grubbing OB-GYN who can’t wait to slice women open makes it look like what sociologist Stanley Cohen calls a moral panic, OB’s being the folks devils that spread the evil of an over-medicalized birth among the society (https://en.wikipedia.org/wiki/Moral_panic#)

        • Who?

          And what in the world is wrong with scheduling what the naysayers all proclaim is major surgery for a time when everyone in the room to work has slept, eaten and been to the loo?

  • MaineJen

    *Estimated* fetal weight.
    *Certified Professional Midwife*

    They seem to have trouble with word comprehension in general, don’t they?

    • DelphiniumFalcon

      So why can someone call themselves a Certified Professional Midwife because they saw a show on TV but if someone else calls themselves a Certified Nursing Assistant and they really aren’t all hell breaks loose? Just wondering.

  • mostlyclueless

    If medicine doesn’t work every time, it doesn’t work!

    I know someone whose doctor said she’d have a big baby, and she didn’t! Estimating fetal weight through ultrasonography must NEVER work!

    I know someone who died of cancer after getting chemotherapy, so chemotherapy NEVER works!

    • demodocus

      Real conversation i had today
      “Birthing in a pool sounds so wonderful and natural.”
      Me: “Natural? No one but middle class suburban women in the developed world have babies in a pool.”
      Them: “Well, giving birth on your back isn’t natural either.”
      I managed to not roll my eyes

      • namaste863

        Personally, I’m in favor of inventing a way to have the kiddo beamed out by Scotty.

        • Allie P

          I’ve been saying that for years. I have no idea why Kirk’s mom didn’t do that in the reboot.

          • Roadstergal

            I bet there’s an NCB movement in the Star Trek universe. Sure, you could have your baby painlessly and safely beamed out, but Real Moms still give birth vaginally and without pain relief. Only the uneducated Bajorans get tricked into beam-out births by over-interventionist doctors. After all, everyone knows that next-gen fetal imaging is off by 0.005 grams, and that means it’s just an estimate.

          • DelphiniumFalcon

            Or when the kid is half Ktarian and their cranial ridges get lodged in the uterus!

            Samantha Wildman took the easy way out. Can you imagine the Warrior Mama points she would have scored by vaginally delivering a baby with head spikes?! All lost because they wanted to avoid something like massive internal bleeding!

          • guest

            I think they did do that in the Voyager finale. Few people know because everyone hates Voyager.

          • Allie P

            Everyone hated voyager? I did not know that.

          • guest

            Apparently. I am the only person I know who liked it.

          • demodocus

            That was my sister’s favorite incarnation.

          • Roadstergal

            I remember watching the pilot the night it aired with a big group at Bryn Mawr, which is a great place to watch a Star Trek pilot with a female captain who looks and sounds a fair bit like Katherine Hepburn. It got Agony-Booth-worthy awfully quickly, though. 🙁

            I have to admit, my favorite by far was Deep Space Nine.

          • Roadstergal

            …and I like Enterprise in my MST3K parts.

          • demodocus

            Ah, mystery science theater… My best friend and I had fun doing this to both the Blade movie and the Daredevil movie.

          • Squillo

            Kate Mulgrew. I believe she actually played Katharine Hepburn in a one-woman show.

    • DelphiniumFalcon

      *puts on tinfoil hat*

      Yeah! Just like evolution is a “theory” so that means science doesn’t even know if it’s real!!!11

      *takes off tinfoil hat*

      That was painful to type.

    • Who?

      Certainty to the point of madness is the mark of the quack. Well one of them anyway.

      ‘Bleach enemas for your autistic child didn’t work? So you must have done them wrong or didn’t believe enough.’

      ‘Coffee enemas didn’t cure your cancer? You must have done them wrong or didn’t believe enough.’

      With the alt crowd it is never the ‘treatment’ that fails, it is always the recipient or their caregiver. You will never hear an alt provider say ‘we did all we could, but the patient died’.

  • StephanieA

    What do you all think of inducing at 40 weeks instead of 41? I had my son at 38 weeks so I’m hoping I don’t have to worry about this, but in case I do, the standard is to induce at 41 weeks. Part of me doesn’t feel totally comfortable with this; 41 weekers don’t always tolerate labor well and their placentas don’t look the greatest. Plus at that point the baby is full term and I don’t any benefit to going overdue.

    • Commander30

      I was induced at 40w1d with mine, but it was due to low amniotic fluid levels and not due to my request. Honestly, I’m not sure if I could request or not–I just never asked my OB. Some people in the mom group I’m in on Facebook have said that they’ve asked their OB’s about requesting an induction without an underlying medical reason and they were fine with it. It probably depends on your doctor, though. My induction went fine and if I do have another baby (jury’s still out on that one), I’d probably ask about the possibility of scheduling induction before any potential complications pop up.

    • Michele

      I’m not a medical anything, but I told my OB I was not willing to go past 40 weeks with #2 (#1 was 41 weeks) in part due to the increasing risks.

      ETA: #2 Ended up being a repeat C-section scheduled for 39 1/2 weeks. But if I’d wanted to try a VBAC my OB was in agreement that 40 weeks was the latest we wanted to go.

    • tariqata

      I had a conversation with my midwife immediately after my son was born (just after 41 weeks – I was scheduled for an induction but he decided it was time to finally get a move a few days before instead), and it amounted to: next time, particularly if you’re already dilating, unless you really like the possibility an unscheduled homebirth, let’s induce at 40 weeks and make sure your labour happens in a controlled setting if it goes as fast as this one did. I wouldn’t have been comfortable inducing at 40 weeks this time around, even though I was pretty sure of my dates, but in hindsight it probably would have been better, and if things proceed similarly for any future kids, that’s the route I’ll go.

    • meglo91

      I’m 26 weeks pregnant with #3, and I will absolutely be having a conversation with my OB about inducing at 40 weeks. I doubt I’ll get pushback given that my blood pressure tends to spike to crazy levels at the end of pregnancy, so I’m sure I’ll be induced somewhere between 37-39 weeks, but just in case — 40 weeks is as long as I feel comfortable going. Nothing good happens past that point.

    • prudentplanner

      My 40 week induction (2nd baby) was amazing!!! I say go for it.
      – – ‘they thought’ i was 41 weeks, but I know when ‘It’ happened. I was easily able to convince them to induce.

      • StephanieA

        My dates are pretty spot on thanks to a first trimester ultrasound (which fit exactly to when I thought I ovulated). I don’t have any risk factors for induction, so I’m kind of nervous to suggest an elective one.

    • Allie P

      Nothing good happens after forty weeks. I had two inductions, one at 40+5, one at 39+5. I was damn sure of conception dates both times. My babies were born quickly and with little drama.

    • Ceridwen

      My first came at 40+2 and we were planning to induce no later than 41 if she hadn’t. In that case I wasn’t really wanting to go to induction because my cervix was not at all ripe and I was hoping to avoid a long, drawn out labor. Jokes on me. Labor started up naturally but was more than 40 hours long. Turns out natural labor that starts on an unripe cervix is pretty prone to taking forever too.

      With my second, due to not having family nearby and needing to plan out childcare for my daughter, combined with the evidence that between 39 and 41 weeks is the best time for baby to be born, I asked for an elective induction at 39 weeks. My cervix was borderline. Total labor was 5 1/2 hours from the time pit started until the baby was out and was nearly textbook. Baby turned out to be more than a pound larger than his sister, despite being born at 39+4 (and I was very certain of dates both times as I track ovulation *and* had several early ultrasounds for bleeding). Glad we didn’t wait longer.

      My OB was completely on board for it and we had an excellent discussion about the recent research on the topic when I brought up wanting to induce.

      • Medwife

        Second babies are so awesome. (Generally.)

        • araikwao

          Except when they are melon-headed and born by vbac….*shudder*

        • Eater of Worlds

          My mother’s first was 6 hours of labor, total, born 6 weeks early and was over 5.5 pounds. Her second was nearly 30 hours of labor, a few days overdue and 6.5 pounds. Both were exactly the same length, 19 inches. Doc felt that was as big a baby as her uterus could stretch for, which is why we were the same length when born but one was born so early. He was big for being 6 weeks early. His father was nearly 13 pounds, his grandfather was 13 pounds (in the 20s) and his own son was 11 pounds.

    • Gene

      Depends on the OB and/or hospital. My LGA induction at 39/5 got my OB in trouble (hospital did not allow “elective” inductions prior to 40w). My last OB/hospital was happy to induce anytime after 39w.

  • Commander30

    I don’t get this argument. Even if their prediction of a big baby was wrong and you had an “unnecessary” C-section, what’s the big deal? Better to prepare for a bad outcome and find that the preparation wasn’t necessary than to believe everything’s fine and then suddenly find yourself in a bad situation that you hadn’t prepared for.

    But then again, I have nothing against C-sections. I actually went through most of my pregnancy hoping that my baby would be breech so that I had a “reason” for one–the uncertainty of labor made me uneasy! (I ended up getting induced, so I had a little time to prepare and had somewhat of a timeline (a sketchy one is better than none at all), and had a pretty straight-forward vaginal birth, so best of both worlds, I guess?)

    • AirPlant

      I am secret hoping that my imaginary future children will be breech. My mom says her planned sections were the shit and I would LOVE to be able to have that much control over the birthing process. Barring that an elective 39 week induction is a thing I can talk an OB into right?

      • demodocus

        Find myself half wishing i could.

      • LaMont

        My imaginary future birth plans are also very much related to my mom’s experience but in a far less rational way (I want to have a life experience I can get mom-advice about!). I say hit up mom on advice about getting a planned section like she did!!

        • AirPlant

          My mom’s planned sections were medically indicated so no such luck. A girl can dream though.

      • CSN0116

        I had two elective cesareans. Good stuff. Not at all difficult to arrange. Most doctors I have had contact with fiercely support a woman’s right to choose. Then again, I see a male doctor who has repeatedly gone on record as saying, “I don’t understand. I won’t try to understand. Therefore, I empathize and listen to my female patients.” I really like him 😀

      • Spooby

        My OB easily agreed to my request for a primary elective c-section. She was happy to do so as long as it was at 39 weeks, I told her I didn’t plan on having more than 1-2 children, and I was informed of the risks/benefits. Don’t be afraid to advocate for you and your future baby’s well being. If your OB refuses, find another OB who will listen and treat you with compassion. They’re are plenty of them out there, at least in the States.

    • Allie P

      In the Topsy turvy world of natural childbirth, any c section that wasn’t a traumatic emergency in which the baby would have died if not for quick surgical extraction is “unnecessary”.

      • LaMont

        I just realized this is a weird overlap with how I feel about the anti-choice “life of the mother” exception for abortion restrictions. How much risk does a mother have to be in before you’ll allow the hated surgical procedure to proceed? For an abortion, does a woman have to be 100% dead without it? Is 50% high enough? Does she get to make that call by her discretion and willingness to risk her life or is it going to be written in the law somewhere? In the c-section argument as in the abortion argument, I think that logically, pregnancy is 100% the medical condition of the woman to be navigated by her choices. Starting from the endpoint of “no abortion” or “no c-section” does not make sense, and granting “exceptions” is *nonsense* because it sets up a situation where women are justifying themselves when they should NOT have to.

        • LaMont

          Oh, also, the fact that people get *credit* for being moderate when they favor exceptions BOILS MY BLOOD. They’d make women legally state (or prove?!?!) that they have life-threatening complications, or that they were raped, before accessing medical care? How is that compassionate or moderate? Or even sane, given that they consider this act a murder? Like, murder is okay in certain unprovable instances? Give me a break, they make *no* sense, b/c their starting point of “ban this procedure” makes no sense.

          • They don’t actually think it’s murder. Not if they’ve thought it through. Like you said, if they really believed it was murder, then a rape exception would be saying that it’s OK to murder an innocent person because of a separate crime committed against another person. It makes no sense and is in no way compatible with any meaningful definition of “pro-life.” So I figure the ones who have spent any time thinking about it don’t really think it’s murder, but they keep saying so because it’s such an effective talking point for people who haven’t, and are unlikely to, think very deeply about the implications of their stated positions.

            For similar reasons I also don’t think they really believe that s fertilized egg is s person. And thank goodness for that – if you really believed *that,* at the very least you’d have to open an investigation into every miscarriage.

            The “pro-life” position doesn’t stand up to the slightest scrutiny in my opinion.

          • LaMont

            Oh yeah they’d have to investigate miscarriages, investigate every menstrual cycle just in case a fertilized egg gets washed out before it implants, require pregnancy tests before women can go into bars or buy alcohol at supermarkets. As I said to a friend, the only positive in this dystopian hellscape is no more fodder for “I Didn’t Know I Was Pregnant.” You’d always have to know…

          • guest

            If they thought it was murder they’d be advocating for life imprisonment for any woman who had an abortion. But they don’t.

          • Who?

            If there’s one thing the so called ‘pro life’ crowd can recognise, it is a slippery slope.

          • demodocus

            My aunt was livid because aparently in her state someone was trying to make a law to investigate every miscarriage, and they called her. She’s had 5 or 6 miscarriages, as late as 5 months along. She didn’t even have her living child until she was 42, 20 years after the last of her nieces and nephews were born.
            (Grandpa was ecstatic, since not only was Aunty having a baby that year, so were my sister and my formerly youngest cousin. Gramma loves to tell about going into a baby store with him and watching him order 3 of this or that.)

          • The Computer Ate My Nym

            If the “pro-life” movement really believed that embryos were people, they’d be lobbying for research into the causes of miscarriage. Because up to 80% of conceptions end in miscarriage, usually before the woman knows she’s pregnant, and if you really believe that embryos are babies then to ignore that while opposing abortion is to ignore a pandemic because the occasional murder occurs. It just makes no sense at all.

          • Roadstergal

            “They don’t actually think it’s murder.”

            The Slacktivist makes that case often, nothing that every time a doctor is murdered, the ‘thought leaders’ say, “Oh, that’s a tragedy, we don’t mean for people to do that at all!” If they really believed abortion was murder, they’d consider doctor-murder a necessary evil, just like the doctor-murderers obviously do. “Oh, we didn’t mean for you to take our hyperbole _seriously_!”

        • The Computer Ate My Nym

          Well, in Ireland apparently a 100% chance of death is not enough to allow the procedure. I think there was a similar case in El Salvador: a woman with a basically 100% chance of death if the pregnancy continued to term. They eventually allowed her to have a c-section at something like 20 weeks with the pretense that there was a chance of saving the (I think, ancephalic) 20 weeker.

    • guest

      Well, I understand being a little disappointed that you had a surgery that it turns out you didn’t need. That doesn’t negate the fact that it’s better to be safe than sorry, but it IS major surgery and I think I would have been disappointed if after it was over it turned out that it wasn’t necessary. In my case, we’ll never know if it was necessary or not, and I’m fine with that. My daughter wasn’t tolerating contractions well. *Maybe* she would have made it through unscathed, but maybe not – there’s no way to know. But if I KNEW it was unnecessary afterwards, I’d be disappointed. I’d do the same thing in the same circumstances again, but I’d still be disappointed that I went through the pain and disfiguration unnecessarily.

      • Montserrat Blanco

        I certainly would not. I can barely imagine the other way around, thinking that you would have been able to make your baby healthy by consenting to a CS instead of pushing for a vaginal birth… I can barely imagine how that might feel and it is not nice at all.

        • guest

          And that is why I will always choose safe over sorry. But I can still feel disappointed that in hindsight it wasn’t necessary without betraying science and best practices.

          • DelphiniumFalcon

            The way I look at it and why I won’t be disappointed that c-section may have been unessecary in hind sight is a benefit/risk ratio.

            Vaginal birth has a higher risk for the baby and less risk for the mother in a lot of situations. Not always, which is why mothers die in childbirth but birth is comparatively much more dangerous for the baby.

            A c-section on the other hand is a much higher risk to the mother due to the inherent risks of abdominal surgery but far safer for the baby in most cases.

            If the risks are hypothetically even between myself and the baby, I will put the risk on myself every time. My body is more resilient than that of an infant. My risk is more on the lines of pain and recovery while the risks to the baby are far more dire such as nerve or brain damage.

            With that in mind I’ve already made up my mind that because I have a higher chance of having a better outcome for my baby if something goes wrong with a c-section, I’ll take that risk over a potentially easier time for me but a higher risk of injury to my baby.

            If it’s true (and I’m not really convinced) that c-section babies are at higher risk for asthma then that’s the trade off I make. Asthma is treatable. Nerve and brain damage generally aren’t. Death especially isn’t.

            So I can’t really be disappointed and think it’s unnecessary when I will always think it’s necessary to place a relatively minor risk on myself.

          • demodocus

            and its not like there aren’t plenty of asthmatics born vaginally.

          • PeggySue

            Raises hand. One here!

          • DelphiniumFalcon

            Yeah, like my husband! My husband was born without an epidural even! Because my poor mother in law didn’t know they existed while they were stationed in Guam. Poor woman. That was one of the first things she took advantage of when little brother in law was born back in the states.

            And yet my husband had a very bad case of what is more reactive airway disease than actual asthma until it finally started to improve in his late teens.

          • demodocus

            I was also born the traditional way, without medication. And I’m asthmatic. Just like my father. It’s almost like there’s a genetic component.
            (As I’ve said before, my mom had a really high tolerance for pain, and considering the blizzard, we were rather lucky to get to the hospital on time.)

          • guest

            I will always be at least mildly disappointed if I end up with less than the most optimal outcome. And I am allowed to be, because I will still always make the decision to go with the safest choice (even though with a c-section, that already means the final result – whatever it ends up being – won’t be optimal. Sorry, but I’ve had abdominal surgery twice, and it will NEVER be an experience that I don’t wish I didn’t have to have gone through.

          • Medwife

            Get out of here with your dumb feelings that are totally unscientific and non-evidenced based!

            /s

      • Michele

        I get being disappointed, yes, but I don’t understand the devastation some women feel at having what they believe in retrospect to be an unnecessary C-section.

        • guest

          I don’t understand devastation either, but I was not looking forward to birth in any form. No matter how you do it it comes with pain, and I don’t put a high value on pain. I just wanted the babies.

        • Medwife

          I know a woman who had an emergency (as in unscheduled, but not STAT) c/s. An NCB interpretation may have been that it was unnecessary- baby was healthy after all, can’t grow a baby too big to birth, blah blah blah. The woman had disastrous complications during the section and nearly died. She’s still glad the c/s happened. I don’t believe feelings can be wrong, but I would say that her feelings are healthier and are leading her to be a happier person. I would say that I would advise her to have therapy if she was full of regrets and anger at having the section. Feeding into those feelings is just cruel.

      • The Bofa on the Sofa

        Well, I understand being a little disappointed that you had a surgery that it turns out you didn’t need.

        But if I KNEW it was unnecessary afterwards

        How is it determined that the c-section wasn’t needed? I don’t know how anyone can claim that, even after the fact. The only thing I could imagine is that you do it because the baby is thought to be breech, but afterward you find it it isn’t. But that isn’t happening with modern ultrasound (heck, when my wife went in labor with our first, they wheeled in an ultrasound machine to verify that he was still breech before going into OR).

        That a specific c-section was unnecessary is inherently not something that can be determined, because you cannot know that something bad would not have happened if you didn’t do it.

        • guest

          I think most of the time you can’t know, but if you were doing a c-section SOLELY for an estimated big baby and the baby turned out to be much smaller than expected, it would seem to have been unnecessary surgery (not that things unrelated to the size of the baby might not have gone wrong, as there’s always that risk). My point is that I understand the disappointment someone might feel if they feel it wasn’t necessary after all – but I am NOT saying this is a “problem” with current practices. You can’t know ahead of time. But it’s okay to be sad or disappointed AFTER as long as you don’t lose sight of the fact that it was better to be safe than sorry.

          • The Bofa on the Sofa

            I think most of the time you can’t know, but if you were doing a c-section SOLELY for an estimated big baby and the baby turned out to be much smaller than expected, it would seem to have been unnecessary surgery (not that things unrelated to the size of the baby might not have gone wrong, as there’s always that risk).

            And so, you can’t actually know.

            “Risk due to size” is not a binary situation. It’s less risky vs more risky. You choose a c-section when risk gets too high, but even if the risk wasn’t that high, you don’t know that everything would have been ok.

            When doctors recommend c-sections due to large baby, they are taking into account the probability that their estimates are wrong. It’s part of the risk calculation, so even if the baby wasn’t as big as estimated, the risk of it being big was still there.

          • guest

            I’m not saying the risk wasn’t there, you understand that, right? In HINDSIGHT we can see that a baby that was estimated large was actually normal sized. So in HINDSIGHT, a doctor would have recommended a vaginal birth over a c-section for the normal sized fetus. We never have hindsight until it’s over, so I’m not arguing that anything about current practice should change. But we CAN see that the risk was less than estimated after a baby is born and measured, leading a mother to say, “if I had know she was only 7 pounds I wouldn’t have chosen the c-section. It wasn’t necessary.” The converse situation also exists: A woman could choose a c-section and end up with complications that wouldn’t have happened without it (almost always to the mother rather than the baby). This is why we don’t do c-sections as the default.

            I don’t see any problem with this. Most of life operates this way. All I’m saying is that there is nothing surprising or wrong with the FEELING of disappointment, or wishing you could have had that impossible knowledge ahead of time to make a different choice. I don’t like discounting the way things feel, because understanding how science-based practice feels to a patient can help us address concerns and explain why a particular intervention is the best option in any given case. It’s important for bedside manner, basically – and if we can address it before an OB is actually bedside and too busy for explanations, even better.

          • The Bofa on the Sofa

            In HINDSIGHT we can see that a baby that was estimated large was actually normal sized. So in HINDSIGHT, a doctor would have recommended a vaginal birth over a c-section for the normal sized fetus.

            But it still doesn’t make the c-section “unnecessary.” Yes, the doctor may not have recommended the c-section, and the baby may have gotten stuck.

            So completely in hindsight, you CANNOT say the c-section was unnecessary.

          • guest

            Yes, I can and I am saying that it wasn’t necessary. There’s no reason to believe that a complication there were no signs of or risk factors for would have happened in a case where it didn’t in fact happen because a c-section was done. If we think that way, we could say the same thing in the first place: We can’t KNOW that the c-section is the best choice even if the baby looks big, because maybe the mother’s incision will get infected (or some other c-section complication). And that is what we’re fighting against, the NCB idea that c-sections are always bad even with scans and other assessments that suggest they would be the safer choice.

          • Roadstergal

            “if I had know she was only 7 pounds I wouldn’t have chosen the c-section. It wasn’t necessary.”

            *noting the stories above of the ‘small’ babies that tore/stuck/had a lot of trouble coming out*

            *noting the bit in the discussion where dimensions vs weight is noted*

            I’d argue that hindsight is still not 20/20. So the baby’s head was big, big enough to over-estimate fetal weight. So there’s no guarantee that your 7lb-er wouldn’t have gotten stuck or ripped you in a really bad way, so still not automatically ‘unnecessary.’

          • guest

            Not 20/20, but if we want to go down *that* hole we can argue that nothing is every truly certain, and therefore nothing is ever truly knowable. I’m operating in a more practical world where women make choices about c-section based on certain information, and when that information turns out to be wrong, for all intents and purposes we then “know” that the c-section wasn’t necessary. Even though, yes, the vaginal birth that didn’t happen might have caused a maternal stroke that didn’t happen with the c-section, even though there were zero observed risk factors for that, blah blah. For practical purposes, that c-section wasn’t needed, let’s just acknowledge that women can therefore feel bad about that so we can better help them understand that since we can’t know *ahead of time* the c-section was still the best choice.

          • Who?

            The cs in the case you describe is the safest choice-in terms of outcome-for mother and baby. Whether it is the best choice, as you suggest, might in some circumstances require consideration of factors other than immediate health.

            For instance, if someone wanted a big family-say more than 5 children-having a cs as you describe with the first could be something to feel disappointed about. Risking the present baby and mother’s wellbeing for the chance of a future baby isn’t something I understand, though I know it is the way some people consider such things.

            Feeling bad about what can’t be fixed or changed, particularly when it is a result of our own best judgment at the time the decision was made, and when it makes no difference to future plans, is a terrible waste of time and emotion. I’m sorry to hear that sometimes happens, and would put the blame for it right at the feet of anyone who would suggest that vaginal birth is superior to cs.

          • Nick Sanders

            I most certainly disagree. Hindsight cannot tell us that a decision was wrong because the situation was not as it appeared. It can tell us that we made a bad choice because we misinterpreted or ignored the information we did have, or were lax in getting information, but that is different. A good decision is one that best addresses the available information. It remains the best decision to have been made even if that information turns out to have been flawed. If the best instruments available say a baby is big enough that it warrants a cesarian to avoid obstructed labor, finding out after it was born that it was actually smaller doesn’t change that, because there was no way to know. You aren’t arguing for better decision making, you’re arguing for better luck.

  • demodocus

    somewhat OT: a woman today told me that her body knows how to have babies, 4 minutes after telling me all 6 of her kids were premature. She’s irritated that the hospital has a policy of monitoring all pre-term labors in such a manner that she couldn’t squat or use a birthing ball or walk around

    • PeggySue

      Oh how meen.

    • Montserrat Blanco

      If the biggest problem you have with a premature baby is not being able to walk around during labor, please, please, please, change places with me.

      • demodocus

        I think a couple may’ve been in the NICU, but that was very secondary to the conversation.

  • Michele

    I’ve noticed there’s always someone who tells pregnant women that they don’t need to worry, that the estimated weights can be off by a pound or two so their baby surely isn’t as big as their doctor says s/he is. Boy, the looks I get when I join in with “Yeah those estimates aren’t exact, they estimated my first was going to be 9 pounds but he turned out to be over 10 pounds.”

    • Gene

      Same here. I had weekly ultrasounds because my second was big. Estimated weight was 10.5lbs and he ended up being 11lbs. So much for underestimating.

    • Ceridwen

      No ultrasounds in my case, but both my doctor and myself were expecting my son to be roughly in line with his sister’s birthweight. Maybe half a pound larger. He was born almost a week earlier than she was and was 1.25 lbs heavier.

  • Azuran

    Since one of the main mantra of NCB is that your body will never make a baby too big for you to birth it vaginally, it only makes sense they think EFW is only a tool invented by evil OB to trick women into having C-section.

    • EmbraceYourInnerCrone

      Some one should show them the story of Princess Charlotte of Wales, daughter of King George IV, Charlotte, who died at 21 after 3 days in labor with a large baby boy. The baby was finally born(stillborn) and Charlotte bled to death shortly after. Charlotte’s doctor later killed himself.

      • demodocus

        But Sanitation! Doctors! Non-veganism!

        • Roadstergal

          OMG, totally. There was a male doctor around, that screwed up the Natural Feminine Process.

      • Azuran

        They’d probably note that the baby eventually did pass, so it wasn’t too big.

        • AirPlant

          The doctor in the room probably stressed her out. Also we have better nutrition which somehow means that babies won’t get stuck.

      • MaineJen

        I heard one report that said that poor woman pushed for 24 hours to have that baby. I can’t even.

      • Elizabeth A

        Doctor failed to diagnose the transverse lie of the baby, and was hesitant to attempt a version or use forceps, because he was risking the life of two heirs to the throne.

        It was a horrible tragedy, all through,

  • namaste863

    Childbirth Connection, do you have a better idea? Anyone? *crickets chirping*

  • EmbraceYourInnerCrone

    I do not understand these people. If an estimate over-estimates the weight of the baby, yes you may have a C-section that was not strictly “necessary”

    HOWEVER, if the baby is actually bigger then the estimate it can be catastrophic: My nephew’s wife(niece-in-law?) went in for her check at about 38/39 weeks, the baby had been measuring on the big side. Her OB said he’s going to get too big to deliver safely if we let you go until your due date, let’s induce day after tomorrow, first thing. Well as fate would have it she went into labor the same night she had seen the doctor. 10 lb 11oz baby, bad shoulder dystocia, a week in the NICU with the first few days on ventilator and N/G tube.

    They were afraid of permanent damage to his nerves but he appears to have dodged that for now. He is a happy , apparently healthy little boy who will be 1 this spring but we are still not sure there are not problems later. His parent went through a terrifying week and its just luck that it was not worse. I think a C-section would have been a much better idea…

    • Megan

      Yes, they like to pretend that the babies who end up smaller than predicted mean that all CS for estimated big babies are unnecessary. You just can’t know. That’s the problem, and one that they have no tools to fix..

      • guest

        And they’re not just looking for big babies – they’re also looking for small babies. IUGR is no joke.

    • BeatriceC

      Tell your nephew to keep the shoulder dystocia in the back of their minds if anything crops up later. My oldest has been having problems with his left arm for years but we’ve always blamed them on the bone disease. About six months ago we did what the doctor called HFW (huge f***** work up) and found nothing that could fully explain his symptoms. I was reading this comment waiting for the doctor for this morning’s appointment and it got me wondering if maybe the issue had nothing to do with MHE, but went back to his birth. He was born “sunny side up” and had mild shoulder dystocia. I broached the topic with the ortho and it was like a lightbulb went off. His eyes got huge and he scrambled through the kid’s records and said “we may have just found the cause. Everything falls in line when you consider his birth.” The kid is 16.

      • demodocus

        oh my

      • The Bofa on the Sofa

        Tell your nephew to keep the shoulder dystocia in the back of their minds if anything crops up later.

        I have to ask, why?

        Just for something to blame? Or is there something you can do to fix it knowing that it was an SD?

        • Commander30

          I would imagine, if for nothing else, it would be good to eliminate the possibility of other causes.

        • BeatriceC

          It would have saved a lot of trouble and expense of either I or the doctor remembered his birth history when we started the process of trying to diagnose the problem. He has other issues (an osteochondroma on his humerus, narrowing of the spinal column, and previous nerve damage), but none of that adequately explained the symptoms he was having. Taking the birth history into account, combined with the placement of the osteochondroma and the nerve damage, the puzzle pieces fit together. We could have stopped searching for a reason long before we did and the kid would have been spared a lot of uncomfortable imaging exams. Plus I’d be a few thousand bucks less poor.

          • The Bofa on the Sofa

            I still don’t understand. Knowing that it was the result of a SD, how did that help resolve it?

            His problem was not that he had a SD, it was that his arm wasn’t working right or something, right? How did knowing that it was a SD solve that? He still had a problem with his arm that needed to be fixed. Was there something that could be done because it was SD caused?

            Or knowing that it was a SD meant that they gave up trying to do anything about it?

          • BeatriceC

            We’d already mostly given up, but hypothesizing that the SD is a contributing factor and possibly the missing puzzle piece gives an answer. There’s nothing that can be done to fix it. But having an answer alleviates concerns that something else is wrong that we missed. Sometimes the answer really is “there’s nothing we can do”, but it would have been better to come to that conclusion sooner.

            Additionally, it’s just generally better if the doctor is making decisions with all the information available. If it was a problem that could be fixed, it could have gotten fixed much sooner.

          • Charybdis

            It sounds as if there were issues that could not be explained by/attributed to the current diagnoses and they were trying to find what was causing the pesky issues that didn’t fit. It doesn’t sound as if they thought those particular issues could be fixed/addressed by anything; they were just trying to find a reason for the oddball symptoms. Now that they know that the issues are related to a shoulder dystocia during birth affecting the bone disease and how it is manifesting in the young man at this point in time.
            It is more a case of knowing the WHY, even if nothing really can be done about it, so that more time, money, energy, etc is spent trying to determine what the hell is going on.

          • araikwao

            Because brachial plexus palsies have characteristic neurological signs on examination according to the nerves involved. That’s what is potentially injured in a shoulder dystocia, so it just points out that a brachial plexus lesion is part of what’s contributing to BeatriceC’s son’s presentation. There may have been nothing else in his history to explain findings consistent with peripheral nerve damage.

      • EmbraceYourInnerCrone

        Good point. It was a scary shoulder dystocia, my nephew is an EMT and he still gets green around the gills if you ask him about what the OB and team had to do to resolve it. My Sister in law(his mom) is a nurse and said that just makes the waiting worse because you know everything that can go wrong.. I think they have periodic visits to the ortho to make sure everything is working like it should but thank you for the insight, it really is appreciated.

      • Medwife

        Stories like this are why OBs tell me, you have to worry about a birth injury lawsuit for 18 years.

        • BeatriceC

          I would never go back and sue the OB that delivered him. On the contrary, my OB was a true rock star. He was so calm and collected that I honestly didn’t realize how serious the situation was until the baby was delivered and wasn’t breathing well. Even then, the doctor continued to work diligently with his team, which included a neonatologist and additional nurses that were somehow called in without either me or my husband realizing that anything was out of the ordinary. It was months later before I realized just how serious the whole situation really was (which is good, because it was traumatic enough as it was), and that’s because my OB was so very good at his job and had such an incredible bedside manner. Rather than blaming him for something that was nobody’s fault, I credit him for turning what could have been an even more traumatic and tragic delivery into a smooth operation where both I and the baby came out alive and (mostly) intact.

  • CSN0116

    I had two cesareans followed by two VBA2Cs. As previously stated, ALL endorsed and delivered by a — gasp — male obstetrician in a hospital.

    Here’s the pretty of it: my first vaginal delivery was a nightmare and recovery was longer and hurt worse than the two cesareans combined. That baby was 8 lbs 15 oz. I required an episiotomy (need for which I had all along given my doctor the OK to determine in-the-moment), which resulted in a second/third degree tear, stitches, swelling, and hemorrhoids. I couldn’t sit, stand, lay, walk, or PEE without immense pain for days upon days. The cesarean pain was at least contained to the abdominal area, but not this shit show. Pain was everywhere. With my second VBA2C the baby slid out in two pushes and I could have done a back handspring 5 minutes post-birth, but my vagina had already been – well, use your imagination. She was 8 lbs 11 oz.

    These people would count that VBA2C as some awesome success. Many would even lie to themselves and the public, “raving” over what a great recovery they had, because “a vaginal recovery beats a cesarean any day!”.

    Bullshit.

    • Megan

      I thought it funny that they used 8lbs 13 oz. for their cutoff to describe “big” babies. I know plenty of women who have had difficulty delivering a baby that size. I know my pelvis probably would. It isn’t all about size and you just can’t know how it’s going to go until it does (or doesn’t). We do the best we can with the tools we have. For instance, I have a pretty good idea that this baby I’m carrying is big. At just shy of 28 weeks I could palpate my belly and tell the difference between head and butt and she feels big to me. My 20 week scan showed her as measuring a week ahead. My last baby was 7 lbs. 6 oz…at 37 weeks (and no, I did not then, and do not now, have GDM, just a husband with a family full of big babies)! So if towards the end of my pregnancy an EFW shows a huge baby, I will take the CS. Who cares if it ends up that it’s wrong? There are plenty worse things than a term elective CS.

      • moto_librarian

        I got a cervical laceration and a 2nd degree tear from delivering a 6 lb., 4 oz. baby.

        • Kelly

          I tore from a 5lb 15 oz kid with my first one. She also had a head in the 70 percentile. It really just depends on so many factors.

      • Commander30

        I was 8 lbs 11oz, and I don’t think my mother would say I was anything but a big baby. She needed a double episiotomy to get me out after a day and a half of labor, and the whole ordeal gave her PTSD. I’ve said it before, but when pregnant with my younger brother, my mom was completely relieved to learn he was breech and that she had a legitimate reason to have a C-section. I’m sure she would have much preferred to have me by C-section as well.

        • Roadstergal

          It’s obvious that to these people, nothing – _nothing_ – is worse than a C-section. Yes, your mum had a traumatic experience that gave her PTSD and vaginal damage, but a C-section would have been worse.

          That’s the only reasonable conclusion from their stance. OB: “When in doubt, C-section, because nothing is worse than a damaged (or dead) baby and/or mom.” CC: “When in doubt, don’t do a C-section, because nothing is worse than a C-section.”

          • BeatriceC

            My first pregnancy ended in the vaginal delivery of twins at 18 weeks from unstoppable labor. My second pregnancy is my oldest living child and he was an 8 pound 8 ounce 36 weeker. He had mind shoulder dystocia and was born with a heartbeat of 40 beats per minute and very shallow breathing (later to be discovered was caused by a collapsed lung). My doctor didn’t hesitate to do an episiotomy and took care to repair it neatly, so the damage to me was minimal and not too difficult to recover from, though I still can’t sneeze without peeing myself. That experience was traumatic enough that I absolutely refused to deliver vaginally again. I still had to deliver another late term miscarriage vaginally, but once my second surviving child got past the age of viability I was very adamant that he would be a section. When they couldn’t stop the ptl at 32 weeks, they were still trying to convince me that it would be different because he was estimated to be only 3.5 pounds (5 lbs, 4 oz for the record… Back to those estimates being estimates and all), but I still refused. There was no way I was taking that chance again and had an easy, stress free delivery. Well, as stress free as a pre term delivery can be, anyway. That kid did quite well in the NICU. The Ginger Giant, they called him, because he was so huge compared to the other babies and had a mess of bright orange hair.

      • SL27

        My first was 8 lbs 7 oz, before her due date, and it is the reason my care providers and I are seriously considering an induction at 39 weeks for this pregnancy. I am praying I am favorable at my appointment on Monday so we can schedule it.

        • Janie4

          Not a mom, but I was 8 lbs, nine ounces at 38 weeks, and my sister was nearly eight (I was to say 7 lbs 10) but something like 21 inches long at 38 weeks. There have been three babies in my family who were ten lbs. Some families have large babies.

      • Dr Kitty

        I’m 5′ tall. I wear jeans from the kids section.
        I have a wonky, misshapen pelvis which is literally bolted to my spine.
        Whatever the opposite of childbearing hips are, that is what I have.
        My OB in my first pregnancy told me he didn’t think I could deliver a baby over 7lbs. Since he will deliver Twins and breeches vaginally, and is the guy you call for complicated deliveries, I had full trust in his judgement. At no point was it ever anything other than my call. “We can always give it a try if you want”, however, is not a ringing endorsement.

        At 38w EFW was 7lbs, my cervix was long and closed, baby’s head was high and free and my due date was 4days after a major holiday.

        Booking an elective CS at 39w was a no brainier.
        In his words “doesn’t look like baby can get into your pelvis, never mind out of it”.

        She was 6lbs 3oz and I don’t regret that decision, nor the ERCS with her 6lb 5oz brother for a second.

        So what if I *could* have had normal deliveries?
        I *could* have had CPD and obstructed labour and failed instrumental deliveries. No thanks.

      • Toni35

        My first was 8lb 4oz, 21 inches. Had an episiotomy that extended, so yeah, recovery was a bitch.

        My second was 9 lb 2oz, 21 inches. Tore a little (2 stitches). Pretty easy recovery.

        Third was 8lb 5oz, 21 inches. No tearing… That was my “could have done a back handspring 5 minutes post birth” baby.

        Fourth was 7lb 1 oz, 19 inches (she was born on her due date, the others were all two weeks late). Much to my surprise, tearing was similar to my 9 pounder (4 stitches).

        Not sure what to make of it all, other than the first time is a bitch and it seems to get easier after that, but even a small baby can do the kind of damage a larger baby can do. Depends on a lot of factors.

    • araikwao

      Yes!! The “pain everywhere” part vs confined to the abdomen. Exactly what I complained about during the 4 weeks it to for me to walk normally again after vbac with my 9lb 4oz boy. It took about the same amount of time after my elective-turned-emergency c-section with breech baby #1, but at least that was just wound and abdo wall pain. And they actually wanted to give me analgesia the first time, too.

  • Charybdis

    My OB estimated DS at around 6 1/2 pounds. He actually weighed 5 lbs, 15 oz at birth and he was 18 inches long. I had a CS. Could I have managed vaginally? Probably, even though my OB and a second one in the practice thought my pelvis was too flat(?) for vaginal delivery. They were willing to let me have a trial of labor if I wanted. I didn’t see the point of going through god knows how many hours of labor and pushing to wind up with a CS in the end, being exhausted and worn out from labor. So I opted for the scheduled CS. Win-win for everyone.

    • CSN0116

      Love me some cesareans! 🙂