Tough decision - Elective C or not ?
paul williams
looks very large.
Consultant has given us the choice :-
1. Elective C-section at 39 weeks.
2. Induce at 40 weeks.
Option 1 seems OK but consultant highlighted the risks involved with
any C-section.
Option 2 seems better if natural birth is possible. However, theres a
higher risk of emergency C-section which is obviously worse.
Are there any stats on how many Elective C-sections have problems ?
What about stats on how many large babies get forced down the
emergency C anyway? What about the extra risks of an emergency C
compared to an elective?
Also, my wifes decided on an epidural anyway in the event of normal
birth. Does'nt this provide problems with larger babies anyway? I'e'
forceps or ventouse delivery? Not what we want either....
Confused Father....
Mary Ann Tuli
paul williams wrote:
> Wifes now 36 weeks but baby is measuring up to 40 weeks already so it
> looks very large.
>
> Consultant has given us the choice :-
>
> 1. Elective C-section at 39 weeks.
> 2. Induce at 40 weeks.
What exactly is the problem with the baby being large...I mean is there
some medical risk to Mum or baby? Is the baby actually really large, or
the bump (fluid etc).
> Option 1 seems OK but consultant highlighted the risks involved with
> any C-section.
>
> Option 2 seems better if natural birth is possible. However, theres a
> higher risk of emergency C-section which is obviously worse.
I really have not looked into either of these myself, but my personal
feeling if it were me would be to aim for the most natural birth.
With an induction you will still probably have a natural birth.
> Are there any stats on how many Elective C-sections have problems ?
I don't know those. You should be able to get stats. for your hospital
from the Web (I can't remember the site I'm afraid) which will be much
more relevant to you. Or you can ask the hosptial directly.
> What about stats on how many large babies get forced down the
> emergency C anyway? What about the extra risks of an emergency C
> compared to an elective?
Again, I am not sure about this.
> Also, my wifes decided on an epidural anyway in the event of normal
> birth. Does'nt this provide problems with larger babies anyway? I'e'
> forceps or ventouse delivery? Not what we want either....
An epidural does increase the risk of other interventions. The size of
the baby does not indicate how painful labour will be. Just because she
might be having a big baby does not mean that her body will be unable to
cope. In only rare cases does a woman carry a baby she is unable to
birth. I would advise going into labour with a more open mind. I've
known people who vowed to take every drug they could and were terrified
beforehand, only to have a totally drug free birth and other who vowed
NOT to take a thing, but ended up with everything.
Mary Ann
Cheryl
wrote:
If you aren't sure about what's going on, do some research. Your
consultant seems to believe that measuring large automatically means
large baby but this isn't always the case. It could just be that your
baby is lying at a funny angle, or is stretched out, or is long, or
any of a number of other possibilities. A large baby isn't
necessarily harder to birth, it's the size of the head and the width
of the shoulders that can make the difference and both of those are
hard to determine before a trial of labour.
As far as the choices you've been given, I don't know much about
elective caesareans but an interesting study done in Australia might
be worth looking at:
>http://www.acegraphics.com.au/articles/sally01.html>
This shows what can happen with any interventions in labour and is
based on a study of low-risk patients who selected either private
obstetrician care or public hospital midwife care.
--
Cheryl
Mum to DS#1 (11 Mar 99), DS#2 (4 Oct 00)
and DD (30 Jul 02)
nicky
"paul williams" <paul...@hotmail.com> wrote in message
news:3839a34f.03092...@posting.google.com...
> Wifes now 36 weeks but baby is measuring up to 40 weeks already so it
> looks very large.
I measured 4-5 weeks bigger through the last trimester and was also
predicted a large baby especially as my second baby had been 8lbs 11 oz
...Thomas was 7lbs 11oz !! Perfectly average weight. I hope the hospital
aren't basing their judgement on this being a big baby solely on the fundal
measurement. In any case unless the baby is an absolute whopper is there any
reason to think hat your wife wouldn't be able to deliver vaginally, ie does
she have a very narrow pelvis?
Nicky
Linz
> looks very large.
What do they mean by "measuring up to 40 weeks"? Some 40 week babies are
7lbs, others are 10lbs!
> Consultant has given us the choice :-
>
> 1. Elective C-section at 39 weeks.
> 2. Induce at 40 weeks.
>
> Option 1 seems OK but consultant highlighted the risks involved with
> any C-section.
And runs the risk that baby isn't actually 'cooked' at that stage.
> Option 2 seems better if natural birth is possible. However, theres a
> higher risk of emergency C-section which is obviously worse.
>
> Are there any stats on how many Elective C-sections have problems ?
>
> What about stats on how many large babies get forced down the
> emergency C anyway? What about the extra risks of an emergency C
> compared to an elective?
Are they actually saying baby is big? How big are they thinking? How
have they been measuring? Are they sure it's not that there's a lot of
fluid?
> Also, my wifes decided on an epidural anyway in the event of normal
> birth. Does'nt this provide problems with larger babies anyway? I'e'
> forceps or ventouse delivery? Not what we want either....
I think that one of the important things to look at isn't necessarily
size of the baby, but size of the head. A big baby is going to have lots
of squishy fat which shouldn't cause too many problems. A big head, on
the other hand, my be harder to birth.
Your consultant has obviously been willing so far to discuss pros and
cons, ask for more information if you can, in order to make your
decision an informed one.
And good luck with the birth, whatever your wife and you choose!
Sue
that ultrasound weights are typically off and just an estimate. I have heard
of women being told that their babies are measuring 10 lbs and they are born
at 7 lbs. Measurements based on ultrasounds are just an estimate too. Are
you sure about the dates? Dates can go two weeks either way so I wouldn't
put too much emphasis on what the ultrasound is saying. Based on that
knowledge alone, I would not induce nor have a C-section. Women's bodies are
made to have children, trust your wife's body to deliver the baby (unless
there is medical problems or baby is in huge distress). Your wife should
probably educate herself more on delivery and perhaps find different
techniques that will get her through labor.
--
Sue
mom to three girls
paul williams <paul...@hotmail.com> wrote in message
news:3839a34f.03092...@posting.google.com...
KR
me, I would rather be induced then opt for a c-section any day. A
c-section is major surgery. There is also the possibility that the
baby could come naturally in the next 4 weeks.
There are lots of big babies (10+ pounds) who are born naturally
without incident. Some people even claim that bigger babies are
easier to push out.
paul...@hotmail.com (paul williams) wrote in message news:<3839a34f.03092...@posting.google.com>...
Mary Gordon
babies (9lb 11.5 ounces, 9 lb 8 ounces and 10 lb 4 ounces), I'm a bit
perplexed. For starters, it is very hard to accurately estimate the
size of a baby at term - they can be off as much as 20%. Unless your
wife has had babies before and thus has a history of large babies and
big problems with delivery, or a known pelvic or uterine deformity,
you can't know how big this baby might be or how big a baby she is
capable of birthing. I'm not a big woman, and I pushed out a 10 lber
no problem.
I think its NUTS to schedule a section at 39 weeks because she MIGHT
have a problem. It seems a very extreme solution to something that is
only a potential issue - to leap to surgery with all that entails
(including increased risks and problems for future pregnancies and
births). I can't see any advantage to this at all.
Nor can I see any advantage to induction at 40 weeks. In the last
weeks, babies tend to put on body fat, not head and shoulder size, so
a few extra days, even into the overtime innings is not going to make
much difference in the scheme of things. Fat squishes. So, even if she
goes to 41 or 42 weeks, as long as she is healthy and baby is doing
well, you would not be losing anything at all to wait for spontaneous
labour. If she has any difficulty, she may end up with a section, but
at least then you've given a vaginal the best possible shot
(inductions often fail - a full 30% of first time moms who agree to
induction end up in the OR, even with smaller babies).
I'd be saying no to either option and letting labour kick in and see
what happens.
Mary G.
Mary Gordon
Vijay
> paul williams wrote:
> > Wifes now 36 weeks but baby is measuring up to 40 weeks already so it
> > looks very large.
> >
How do they know for sure that the baby is dagerously large? Numerous
women in this group have been told to induce b/c of a 10-11lb baby
that turned out to be 8-9lbs. That said, it is possible to give birth
to an 11lb baby naturally, so I'm still not seeing a clear reason to
induce or schedule a c-section.
-V.
Circe
>
> 1. Elective C-section at 39 weeks.
> 2. Induce at 40 weeks.
>
> Option 1 seems OK but consultant highlighted the risks involved with
> any C-section.
>
> Option 2 seems better if natural birth is possible. However, theres a
> higher risk of emergency C-section which is obviously worse.
>
option 1), which is to do nothing at all and let the baby come under its own
steam.
Before you make any decisions, I suggest you read this article on induction
of labor for suspected large babies by Henci Goer, an acknowledged expert in
childbirth and childbirth research:
http://www.parentsplace.com/expert/birthguru/articles/0,10335,243385_234322,00.html
> Are there any stats on how many Elective C-sections have problems ?
>
> What about stats on how many large babies get forced down the
> emergency C anyway? What about the extra risks of an emergency C
> compared to an elective?
>
> Also, my wifes decided on an epidural anyway in the event of normal
> birth. Does'nt this provide problems with larger babies anyway?
It might, but you can't even be sure you've *got* a larger baby. Really.
The "issue" with larger babies and epidurals is that a large baby might get
hung up on the pelvis during descent (called "shoulder dystocia"). The most
effective solution to this problem is to get the mother to flip over into an
all-fours position. This move usually frees the baby's shoulder from the
pelvis and allows a normal descent. The problem is that if the mother has
had an epidural, she's probably not going to have enough sensation in her
legs to support herself on all fours. So the practitioner has to resort to
other methods for freeing the baby, some of which can result in birth
injuries.
But honestly, *most* vaginally birthed large babies don't encounter shoulder
dystocia at all and a fair number of babies who *do* experience it are not
large.
> I'e'
> forceps or ventouse delivery? Not what we want either....
>
Assisted delivery (whether by ventouse or forceps) goes way up with
epidurals *regardless* of baby's size. I had one birth with an epidural and
ventouse assistance was needed at the end of the pushing phase because I
could not feel well enough to push properly. Baby was an even 8 lbs., though
he did have a rather large head (15").
So if you don't want a forceps or ventouse delivery, you'd have the best
chance of doing so by avoiding the epidural regardless of the baby's size.
Obviously, epidurals have their place in childbirth and your wife should
have one in labor if she feels the benefits (pain relief) outweigh the risks
(potential assisted delivery, limited options for treating dystocia, etc.),
but maybe she shouldn't make that decision until she's actually *in* labor
and knows how well or poorly she's coping. Because, honestly, I've had two
unmedicated births since that first one with an epidural and I was never
remotely tempted to have another.
--
Be well, Barbara
(Julian [6], Aurora [4], and Vernon's [18mo] mom)
This week's special at the English Language Butcher Shop:
"She rose her eyebrows at Toby" -- from "O' Artful Death", by Sarah Stewart
Taylor
Daddy: You're up with the chickens this morning.
Aurora: No, I'm up with my dolls!
All opinions expressed in this post are well-reasoned and insightful.
Needless to say, they are not those of my Internet Service Provider, its
other subscribers or lackeys. Anyone who says otherwise is itchin' for a
fight. -- with apologies to Michael Feldman
Sophie
"paul williams" <paul...@hotmail.com> wrote in message
news:3839a34f.03092...@posting.google.com...
> Wifes now 36 weeks but baby is measuring up to 40 weeks already so it
> looks very large.
What's "very large"?
>
> Consultant has given us the choice :-
>
> 1. Elective C-section at 39 weeks.
> 2. Induce at 40 weeks.
What about letting things happen on their own?
> Option 1 seems OK but consultant highlighted the risks involved with
> any C-section.
As someone who has had 3 c-sections (2 elective) do not, not, not, not, not
have a c-section unless it's medically necessary.
> Option 2 seems better if natural birth is possible. However, theres a
> higher risk of emergency C-section which is obviously worse.
Not necessarily - depending on the reason for it to be an emregency. A big
baby is hardly an emergency. My first c-section was not planned and went
perfectly fine.
> Are there any stats on how many Elective C-sections have problems ?
I've had 3 c-sections - one not planned, 2 planned. With the 3rd one
(planned before I was even pregnant!) was the worst - no anesthetic. Just
cos it's planned doesn't mean it'll go smoothly.
> What about stats on how many large babies get forced down the
> emergency C anyway? What about the extra risks of an emergency C
> compared to an elective?
Problems can occur whether it's planned or not.
> Also, my wifes decided on an epidural anyway in the event of normal
> birth. Does'nt this provide problems with larger babies anyway? I'e'
> forceps or ventouse delivery? Not what we want either....
>
> Confused Father....
Pretty late in the game to still be confused IMO but anyway, I say let
things go and see what happens.
--
Sophie-
TTC #4
Puester
>
> There are lots of big babies (10+ pounds) who are born naturally
> without incident. Some people even claim that bigger babies are
> easier to push out.
And some people lie....
gloria p
Cathy Weeks
> looks very large.
Depending on how they were done, did you know that "measurements" of
babies prior to birth are notoriously inaccurate? Sometimes by as
much as a pound or two? A skilled midwife or OB can feel the baby by
running hands firmly along the belly, and get a reasonably accurate
idea of the baby's size. Ultrasounds however, are terrible inaccurate
in this. And measuring the fundus with a tape measure isn't a
particularly accurate measure at all....it measures the size of the
uterus, not the baby. And it can go in fits and starts. I measured a
month or two ahead, then wouldn't "progress" for a couple of weeks,
then I'd jump ahead again.
>
> Consultant has given us the choice :-
>
> 1. Elective C-section at 39 weeks.
> 2. Induce at 40 weeks.
>
> Option 1 seems OK but consultant highlighted the risks involved with
> any C-section.
>
> Option 2 seems better if natural birth is possible. However, theres a
> higher risk of emergency C-section which is obviously worse.
Can you get a second opinion? I think your wife may be well on the
road to a possibly unnecessary c-section. I don't know all the
information, but I'd check with a midwie and get a second opinion.
Cathy Weeks
Mommy to Kivi Alexis 12/01
Larry McMahan
: Wifes now 36 weeks but baby is measuring up to 40 weeks already so it
: looks very large.
This is notoriously unreliable. Even ultrasound, probably the most
accurate way to measure late size can be off by a pound or two. I
would suggest remaining skeptical.
: Consultant has given us the choice :-
: 1. Elective C-section at 39 weeks.
: 2. Induce at 40 weeks.
Why? I would suggest telling the consultant to buzz off, and waiting
for labor to begin natrually. Is this your wife's first baby? If so,
I think you could be severely limiting your future options by doing an
elective c-section.
: Option 1 seems OK but consultant highlighted the risks involved with
: any C-section.
: Option 2 seems better if natural birth is possible. However, theres a
: higher risk of emergency C-section which is obviously worse.
: Are there any stats on how many Elective C-sections have problems ?
: What about stats on how many large babies get forced down the
: emergency C anyway? What about the extra risks of an emergency C
: compared to an elective?
Some studies have been done showing the following.
1. Women do better in later pregnancies if the c-sections is preceeded
by a trial of labor.
2. Attempting to induce creates a larger risk of having to go with
the c-section.
I have not seen any data saying that elective c-section is better.
: Also, my wifes decided on an epidural anyway in the event of normal
: birth. Does'nt this provide problems with larger babies anyway? I'e'
: forceps or ventouse delivery? Not what we want either....
Why is she certain about an epidural? This also raises the risks of
requiring a c-section. Of course, it may be necessary if your agree
to induction.
: Confused Father....
I would suggest doing your best to avoid all of c-section, induction,
and epidural. Your chances of an uneventful birth are better in that
case.
Good luck,
Larry
Ilse Witch
> Wifes now 36 weeks but baby is measuring up to 40 weeks already so it
> looks very large.
IME estimates at this stage are highly unreliable. I have seen a
friend deliver a 5lb baby, where it was estimated at at least 7lb.
Simply because she was small, they overestimated the babies size.
Also, women give birth to 9 and 10lb babies naturally. Although
it is rare, it is not impossible. Average 40w babies are around
7lb, if yours is really that heavy now, you'd probably end up
with a delivery weight around 9lb. In the past, when gestational
diabetes was less well known, babies could even weigh up to 14lb
and still be born the natural way. The biggest problem is the
size of the head compared to the width of the pelvis. If the
head fits (and it usually does) the rest will be able to come
out as well. DS had a big head, measured 3 weeks ahead of normal
around 32 weeks, but still came out the normal way.
Finally, there is nothing that guarantees the baby will grow at
the current rate during the last weeks. DS grew in spurts, and
would sometimes measure one week ahead, then one week behind. He
didn't grow much at all during the last month.
So before you decide any which way to go, just wait and see.
I would opt for the baby to come out the natural way *and* at its
own time. Really, my impression is that the doc is making a big
fuzz over nothing, making you worry unnecessarily.
> Also, my wifes decided on an epidural anyway in the event of normal
> birth. Does'nt this provide problems with larger babies anyway? I'e'
> forceps or ventouse delivery? Not what we want either....
Epidurals always have a higher risk of interventions, since the
mother is less aware of her contractions and when to push.
--
-- I
mommy to DS (14m)
guardian of DH
EDD 05-17-2004
War doesn't decide who's right - only who's left
Clisby
Ilse Witch wrote:
> paul williams wrote:
>
>> Wifes now 36 weeks but baby is measuring up to 40 weeks already so it
>> looks very large.
>
>
> IME estimates at this stage are highly unreliable. I have seen a
> friend deliver a 5lb baby, where it was estimated at at least 7lb.
> Simply because she was small, they overestimated the babies size.
>
> Also, women give birth to 9 and 10lb babies naturally. Although
> it is rare, it is not impossible.
Is it really *rare*? My mother had 6 children, and 4 were over 9
pounds. One was over 10 pounds. I was in college before I realized a
7 lb., 11 oz. baby (me) was not unusually tiny.
Clisby
Circe
news:3F73E25F...@mindspring.com...
> Ilse Witch wrote:
> > IME estimates at this stage are highly unreliable. I have seen a
> > friend deliver a 5lb baby, where it was estimated at at least 7lb.
> > Simply because she was small, they overestimated the babies size.
> >
> > Also, women give birth to 9 and 10lb babies naturally. Although
> > it is rare, it is not impossible.
>
> Is it really *rare*? My mother had 6 children, and 4 were over 9
> pounds. One was over 10 pounds. I was in college before I realized a
> 7 lb., 11 oz. baby (me) was not unusually tiny.
>
age (LGA) or macrosomic if his/her weight is at or above the 90th percentile
for full-term newborns. So, in theory at least, only about 10% of babies
should wind up being macrosomic (which is typically defined as a birthweight
over 8 lbs., 13 oz.). That may not be really rare, but it does mean that the
vast majority of babies should NOT be macrosomic.
That said, a woman who has already had a macrosomic baby has a much greater
chance of having another. Which could explain why more than half of your
mother's babies were macrosomic.
The question is whether having a baby who is at or above the 90th percentile
at birth should be considered a problem at all. Both my boys went to weights
and heights at or above the 90th percentile by the time they were a month
old in spite of having been around the 50th percentile at birth. No one
thought it was a problem that they'd gotten big after getting *out*, so I'm
not sure why it should be thought to be a problem if they do it before
getting out!
Nina
"Circe" <gua...@yahoo.com> wrote
> Well, my understanding is that a baby is considered large for gestational
> age (LGA) or macrosomic if his/her weight is at or above the 90th
percentile
> for full-term newborns. So, in theory at least, only about 10% of babies
> should wind up being macrosomic (which is typically defined as a
birthweight
> over 8 lbs., 13 oz.). That may not be really rare, but it does mean that
the
> vast majority of babies should NOT be macrosomic.
>
> That said, a woman who has already had a macrosomic baby has a much
greater
> chance of having another. Which could explain why more than half of your
> mother's babies were macrosomic.
Interesting, my kids were 8lbs 12 oz and 8 lbs 15 oz, I never knew there was
anything unusual about it. In fact, Im over here now making sure I eat
enough because I want the new one to be "decent sized" too,lol.
>
> The question is whether having a baby who is at or above the 90th
percentile
> at birth should be considered a problem at all.
Probably not if the mother isnt tiny. My kids were born big and will stay
big. My 8 year old daughter has been as large as her 10 year old brother for
about 2 years now, since I have aunts and cousins who are over 6 feet, Im
not worried.
Kereru
I am 38 weeks pregnant with my second child. My first was 10lb 8oz at birth,
he was delivered vaginally. This time around I had a scan (to rule out
breech presentation) at 36 weeks and the baby measured at about 9lbs this is
+/- 1lb, the estimate was 11lb by term and his head circumference is
measuring really big.
Fundal height is only a guide and give you a very rough estimate of size.
Given that my first was so large the chances are that the scan is right and
this one will be big too. Probably even bigger.
I will not be having an elective cesarean. I have discussed it with my
primary carer. Induction at or near term is an option but one we both want
to avoid. So the plan is a series of internal exams to hopefully stir things
up, and some acupuncture.
Plenty of people give birth to really large babies without intervention and
have a much better recovery because of it. Some people even say that big
babies are often easier because gravity helps.
I would be really reluctant to have an elective c-section in your position
and I would view induction as a last option. Don't be scared of having a big
baby!
Judy
Elizabeth Reid
> The size of the baby as measured externally is just an estimate. To
> me, I would rather be induced then opt for a c-section any day. A
> c-section is major surgery. There is also the possibility that the
> baby could come naturally in the next 4 weeks.
I will say, though, that it's not like you're necessarily choosing
induction vs. c-section; you're choosing (induction + chance of
post-labor-c-section) vs. elective c-section. I really, really
wanted a vaginal birth with my son, and hung in through lots of
hours of unproductive labor to try to have one. I have to admit,
though, that if I do it again I would waver on whether to just go
straight to the c-section, because a c-section after 36 hours of labor
REALLY sucks. You get the worst of both worlds that way, or
that's how it seemed to me. I guess you at least get the knowledge
that you did try, but I'm not sure that would be enough for me
when weighed against going into the surgery with no resources
after a useless labor.
Which is not to say that the OP's wife should opt for the section,
because the big baby thing is notoriously unreliable apparently.
However, if the provider is already talking c-section the
chances aren't bad that it's going to end up that way anyway after
the induction 'fails' (this does not sound like a let-nature-take-
its-course kind of doctor) and the risk of that happening should
be taken into account.
Beth
Sam 8/16/2002
Sophie
"Elizabeth Reid" <eliz...@yahoo.com> wrote in message
news:c3338aa8.03092...@posting.google.com...
There is a *HUGE* difference between choosing a repeat c-section, and
choosing one right off the bat without even trying labor with a first baby.
Mary W.
Sophie wrote:
> "Elizabeth Reid" <eliz...@yahoo.com> wrote in message
> news:c3338aa8.03092...@posting.google.com...
> > kay...@yahoo.com (KR) wrote in message
> news:<46be5225.03092...@posting.google.com>...
> > > The size of the baby as measured externally is just an estimate. To
> > > me, I would rather be induced then opt for a c-section any day. A
> > > c-section is major surgery. There is also the possibility that the
> > > baby could come naturally in the next 4 weeks.
> >
> > I will say, though, that it's not like you're necessarily choosing
> > induction vs. c-section; you're choosing (induction + chance of
> > post-labor-c-section) vs. elective c-section. I really, really
> > wanted a vaginal birth with my son, and hung in through lots of
> > hours of unproductive labor to try to have one. I have to admit,
> > though, that if I do it again I would waver on whether to just go
> > straight to the c-section, because a c-section after 36 hours of labor
> > REALLY sucks. You get the worst of both worlds that way, or
> > that's how it seemed to me. I guess you at least get the knowledge
> > that you did try, but I'm not sure that would be enough for me
> > when weighed against going into the surgery with no resources
> > after a useless labor.
Remember that good things happen during labor too. Things
that prepare the baby for birth.
> > Which is not to say that the OP's wife should opt for the section,
> > because the big baby thing is notoriously unreliable apparently.
> > However, if the provider is already talking c-section the
> > chances aren't bad that it's going to end up that way anyway after
> > the induction 'fails' (this does not sound like a let-nature-take-
> > its-course kind of doctor) and the risk of that happening should
> > be taken into account.
I had a similar situation with my doctor, and I believe his fear of
a big baby contributed to my c-section. What I regret most was
not switching providers. It is *never* too late to find a new doctor
or midwife.
> There is a *HUGE* difference between choosing a repeat c-section, and
> choosing one right off the bat without even trying labor with a first baby.
Yup, a whole new set of risks to consider.
Mary
hierophant
Puester wrote:
Now that is an interesting comment. I'm going to remember that the next
time I hear one of those horror stories I hear that women call "birth
stories". They must be lying!
Kris, mother to three babies who were all over 10lbs and easy to push out.
Warwick
paul...@hotmail.com says...
Not surprised you're confused. The consultant appears to have not read
any of the current literature and is stuck in the 80's.
How have they come up with the baby size? Very recently, my sister's
baby was estimated as 'huge' where Johanna (my wife) was estimated as
having a 'large' baby (going to be 8lbs+). Comparisons of the bumps with
my sister being a couple of weeks behind Jo showed her being very much
the 'beached whale' courtesy of the size of her bump and with
positioning and baby activity, it felt like a large baby was going to be
coming out.
Her son (Alexander) came out at 5lb 11oz and what seemed like gallons of
fluid apparently. My daughter weighed in at 9lb 7oz.
The attitude of both sets of parents was different too. We wanted
minimal drugs and were OK'd for a home birth (we started there). My
sister wanted drugs and to have the re-assurance of a hospital and an
epidural.
My sister didn't get her epidural since she wasn't in labour long enough
for it to take effect and had a drug free birth. We, with our assessed
perfect pregnancy and planned natural birth ended up with an epidural
and forceps being tried as a last minute attempt to avoid a C-section.
In both cases the estimates were *wrong* and the plans ended up being
binned.
In Johanna's case, the epidural was the right thing to do by that stage
of labour and with a very good team in the hospital they managed to get
the dose exactly right to leave her feeling enough to be able to push.
It wasn't assessed to be the right thing any earlier and the
intervention wasn't the right thing earlier either.
We nearly had a C-section, will probably have baby size checked by
ultrasound on the next one towards the end of pregnancy and may end up
with one due to Jo's build. Otherwise, we'd try to stay as close to the
real thing as possible.
Warwick
Ericka Kammerer
Sorry, but I might be here to confuse you even further.
Late pregnancy ultrasounds are notoriously bad at estimating
weight accurately. The margin of error is at least 1.5 *POUNDS*
either way, which is huge when you're talking about newborn
babies! Furthermore, there is no medical evidence that it
makes any sense to induce for suspected large baby, much less
incur the risks of a c-section for suspected large baby.
Frankly, if there's nothing going on besides a suspected large
baby here, I would summarily *FIRE* any caregiver who
actually suggested a c-section just because the baby seemed
big.
Yes, there are stats on the risks associated with
elective c-sections. While elective c-sections are slightly
less risky than emergency c-sections, both are significantly
more risky for the mother than vaginal birth. According to
one relatively recent study, the maternal mortality rate
for c-sections is 5 times that of vaginal births (after
eliminating the really high risk situations). They found
the risk for intrapartum c-sections to be 1.5 times that
of elective c-sections. A study came out earlier this
year in the Journal of Perinatology showing that vaginal
delivery is achievable in almost 90 percent of pregnancies
with macrosomic infants. Personally, given that you don't
even really know this baby is big to begin with, I would
be extremely uninterested in signing up for a c-section
when there's a really good chance that a vaginal delivery
is possible! Furthermore, studies don't suggest that
inductions improve outcomes in this case either, so I
wouldn't be all that excited about signing up for an
induction, which can put her on the fast track to a
c-section if her body isn't really ready.
Henci Goer's books (_Obstetric Myths verus
Research Realities_ and _The Thinking Woman's Guide
to a Better Birth_) give a bunch of stats on c-sections.
Here are the risks mentioned:
- Pain (25 percent report pain at 2 weeks, 15 percent at
8 weeks; 15 percent report difficulty with normal
activities at 2 weeks; 10 percent at 8 weeks)
- Transfusion (1-6 percent of women need a transfusion
after a c-section)
- Injury (2 percent rate of surgical injury to bowel,
bladder, uterus, or uterine blood vessels; some studies
show a uterine injury rate as high as 10 percent)
- Infection (8-27 percent)
- Pulmonary embolism (1-2 per 1000)
- Blood clots in legs (6-18 per 1000)
- Baby cut (1 percent of head down babies; 6 percent breech)
- Baby more likely to be in poor condition at birth (babies
with low APGARs after healthy pregnancies were half again
as likely to have been c-sections; c-section babies three
times as likely to need intermediate or intensive care
and five times more likely to need help with breathing)
One of the big things to weigh when considering a
c-section that might not be necessary is the risk of
placenta previa and/or placenta accreta/increta/percreta
in future pregnancies. If you're planning on future
pregnancies, a prior c-section significantly increases
the risks of these conditions, which can sometimes be
quite dangerous. In addition, with a prior c-section,
you'll have to weigh VBAC versus an elective repeat
c-section for future births.
As far as the epidural goes, that could potentially
be an issue. *IF* the baby is large (which is by no means
established), her ability to move around and adopt different
positions during labor can make a huge difference in her
ability to deliver vaginally. An epidural can make it
difficult for her to do that. Staying off her tailbone
can open the birth canal an additional 30 percent. While
some women with epidurals can manage a side-lying position,
other positions will be impossible.
Best wishes,
Ericka
She's A Goddess
"Puester" <pue...@worldnet.att.net> wrote in message
news:3F746B02...@worldnet.att.net...
>
>
> And some people lie....
>
LOL. Well I don't know that my larger baby was easier, it certainly hurt
one heckuvalot more, but it was faster. My 7lb9oz DD took over 2 1/2 hours,
my 9lb11oz DS took just 1 1/4 hours.
--
Rhiannon
Madison Sophia - 9/6/01
Owen Grady - 6/23/03
Nina
"Ericka Kammerer" <e...@comcast.net> wrote > As far as the epidural goes,
that could potentially
> be an issue. *IF* the baby is large (which is by no means
> established), her ability to move around and adopt different
> positions during labor can make a huge difference in her
> ability to deliver vaginally. An epidural can make it
> difficult for her to do that. Staying off her tailbone
> can open the birth canal an additional 30 percent. While
> some women with epidurals can manage a side-lying position,
> other positions will be impossible.
>
My 2nd born was 9 lbs and facing the wrong way, I am SO glad I didnt have an
epidural because i ws able to get on hands and knees long enough to get her
to turn.
I think its crucial to know what to expect and how to deal with it. I'd read
a lot and when the time came, it was me who told the nurses "Put me on all
4s". No one suggested it, or gave me any ideas. They were perfectly content
to let me labor miserably on my back for another few hours. You have to be
aware o the possibilities and what actions YOU can take to deal with them.
If not, you will be subject to more and more interventions.
I think I did ok, a 9lb baby w/no epidural or episiotomy and a 6 hour labor.
AND it was an induction, so there was a LOT of pain. But preparation
andknowlege are crucial.
Nina
Natalie
It is your decision at the end of the day but if you feel strongly about it
I would opt for the Induction at 40 weeks.
You may end up having a c section if things are not good but I would have
this as the last option so to speak.
My feeling anyway!
Natalie
"paul williams" <paul...@hotmail.com> wrote in message
news:3839a34f.03092...@posting.google.com...
paul williams
Hmmm. Possible or ideal ???
paul williams
> I would do neither one and let nature take its course. You have to remember
> that ultrasound weights are typically off and just an estimate. I have heard
> of women being told that their babies are measuring 10 lbs and they are born
> at 7 lbs. Measurements based on ultrasounds are just an estimate too. Are
> you sure about the dates? Dates can go two weeks either way so I wouldn't
> put too much emphasis on what the ultrasound is saying. Based on that
> knowledge alone, I would not induce nor have a C-section. Women's bodies are
> made to have children, trust your wife's body to deliver the baby (unless
> there is medical problems or baby is in huge distress). Your wife should
> probably educate herself more on delivery and perhaps find different
> techniques that will get her through labor.
>
> --
> Sue
> mom to three girls
>
Appreciate your point but expert opinion says that ultrasound
estimates are accurate within 10-15%.
paul williams
> age (LGA) or macrosomic if his/her weight is at or above the 90th percentile
> for full-term newborns. So, in theory at least, only about 10% of babies
> should wind up being macrosomic (which is typically defined as a birthweight
> over 8 lbs., 13 oz.). That may not be really rare, but it does mean that the
> vast majority of babies should NOT be macrosomic.
>
> That said, a woman who has already had a macrosomic baby has a much greater
> chance of having another. Which could explain why more than half of your
> mother's babies were macrosomic.
>
> The question is whether having a baby who is at or above the 90th percentile
> at birth should be considered a problem at all. Both my boys went to weights
> and heights at or above the 90th percentile by the time they were a month
> old in spite of having been around the 50th percentile at birth. No one
> thought it was a problem that they'd gotten big after getting *out*, so I'm
> not sure why it should be thought to be a problem if they do it before
> getting out!
> --
> Be well, Barbara
> (Julian [6], Aurora [4], and Vernon's [18mo] mom)
>
Last two ultrasounds where head and abdomen were measured have put the
babies size slightly above the 97th percentile...
Chotii
That depends. Exactly what outcome are you hoping for?
I've had 2 cesareans - one for no good reason, one for very good reasons. I
just had a vaginal birth (with venteuse) - a 7 lb 14 oz baby who was quite
large for my 4'10" body, yet fit through my pelvis just fine. I would
rather have another vaginal birth, of a baby of any size, any day, rather
than have another cesarean for anything other than a real medical reason - I
mean, 'this is a problem right now, we have to solve it right now' rather
than 'this might be a problem, so let's just cut'.
A small baby, with a small head that's presenting badly may be much more
difficult to birth than a big baby that's presenting ideally. Presentation
is *very* important. Size is a whole lot less important than you think.
Medically-minded birth attendants tend to treat all head-down positions as
equal (because after all, if it doesn't work, we can just do a cesarean) but
this isn't true. And there is a lot a pregnant woman can do to help her baby
line up in an ergonomically-positive position for birth.
Sir, surgery should be a *last* resort, not a "something might go wrong, so
let's cut 'er open" attitude. I wouldn't wish a cesarean on anybody for
anything but the most important reasons: immediate threat to mother and/or
baby. Recovering from major abdominal surgery *sucks*. Being told you will
have *no choice* but to have major surgery because you're a woman and you
got pregnant again.....sucks. And that's what's happening to a great many
women now, who have had previous cesareans. Not because a c/s is safer for
the woman or the baby, but because it's less of a liability for the
hospital. It's not demonstrably safer for your wife at this point. It's
not safer for your baby. So what is the appeal here?
Thank god for cesareans when they're needed.
This situation doesn't sound like a "needed" cesarean.
--angela
Ericka Kammerer
> berr...@earthlink.net (Vijay) wrote in message news:<af359b29.03092...@posting.google.com>...
>
>>Mary Ann Tuli <tu...@ebi.ac.uk> wrote in message news:<3F741554...@ebi.ac.uk>...
>>
>>>paul williams wrote:
>>>
>>>>Wifes now 36 weeks but baby is measuring up to 40 weeks already so it
>>>>looks very large.
>>
>>How do they know for sure that the baby is dagerously large? Numerous
>>women in this group have been told to induce b/c of a 10-11lb baby
>>that turned out to be 8-9lbs. That said, it is possible to give birth
>>to an 11lb baby naturally, so I'm still not seeing a clear reason to
>>induce or schedule a c-section.
>
> Hmmm. Possible or ideal ???
If it's successful without causing any problems, definitely
ideal. The only downside to trying to birth the baby vaginally
is that you might end up with an intrapartum c-section rather
than a scheduled c-section. While intrapartum c-sections are
slightly more risky than scheduled c-sections, they are not
as risky as true emergency c-sections. It is *not* an emergency
to do a c-section for failure to progress because the baby is
too large. It may not be the most fun choice to labor a while
and then end up with a c-section, but with good planning and
a supportive birth team you've got a really good chance of
making it and not having to deal with the consequences of
a c-section.
Best wishes,
Ericka
Ericka Kammerer
> Appreciate your point but expert opinion says that ultrasound
> estimates are accurate within 10-15%.
That's not a particularly accurate statement.
Here are a few studies you might be interested in:
http://tinyurl.com/owwv
--Compared the accuracy of sonographers versus maternal-
fetal medicine specialists and found that sonographers
were better, but even they only hit within 10% of actual
70% of the time (the doctors only hit within 10% of
actual 54% of the time).
http://tinyurl.com/owx3
--Studied 758 patients, half of which had birth weight
estimated by ultrasound and the other half by clinical
examination (e.g., palpation). Clinical examination got
within 10% of actual 58% of the time, and ultrasound
fared worse, only getting within 10% of actual 32% of
the time.
http://tinyurl.com/owxa
--This one compared different sonographic models for
estimating birth weight for macrosomic infants. It
found the various models got within 10% of actual
53-66% of the time, depending on the model.
So, sure, they define accuracy as getting within 10%
or so of actual (which, by the way, leaves quite a
bit of latitude--that gives them a 1.5 pound spread
on an average sized baby!). But the fact is that
ultrasound estimates of weight only get within that
range somewhere between 50 and 70 percent of the time!
I wouldn't be keen on making a decision about attempting
major abdominal surgery with those odds, especially
considering that the risks of a wait and see approach
are minimal.
Best wishes,
Ericka
Ericka Kammerer
> Last two ultrasounds where head and abdomen were measured have put the
> babies size slightly above the 97th percentile...
If the baby is a girl, the 97th percentile at birth
would only be about 9.5 pounds, which many, many women
deliver quite successfully vaginally (even with lousy
support--with the support of a birth team skilled at
supporting vaginal births of large babies, the odds are
even better).
Best wishes,
Ericka
Phoebe & Allyson
> Last two ultrasounds where head and abdomen were measured have put the
> babies size slightly above the 97th percentile...
For a girl, 97th percentile is only 10 pounds even if you go
to 42 weeks. At 40 weeks, you're looking at 9 pounds.
Phoebe :)
--
yahoo address is unread - substitute mailbolt
Phoebe & Allyson
> expert opinion says that ultrasound
> estimates are accurate within 10-15%.
Apparently, the percentage of ultrasound estimates that get
the baby's weight within plus or minus 10% is somewhere
between 32 and 69%. So you've got a 31-68% chance that the
ultrasound estimate will be off by more than 10%. The mean
error is within 10-15%, but there's no guarantee you aren't
an outlier. http://www.emedicine.com/med/topic3281.htm
Kereru
That may well be true, I trust the ultrasound estimate I have been given
(11lbs by 40 weeks) because I have already had a baby nearly that big.
However the point still remains that large size of the baby doesn't mean
that a vaginal delivery is dangerous. Believe me I am in a very good
position to say I know how scary it is to be told you are having a large
baby. But I can also tell you that my birth story with a 10lb 8oz baby was a
dream compared to a lot of the births my friends have had ALL with smaller
babies.
I will not be delivering this baby by co-section even if it's 12lbs!
C-section is not the easy option.
Judy
Linz
wrote:
>Last two ultrasounds where head and abdomen were measured have put the
>babies size slightly above the 97th percentile...
How tall/large are you and your wife?
--
EDD 1/11/03
33 weeks
Mary Gordon
if they are guessing you have a big baby it could be quite average
sized...and even if it IS big, you don't know you are going to have a
problem.
There are tons of studies about macrosomia that say spontaneous labour
is the best route (what they term "expectectant management" - in other
words, they are aware the baby MAY be larger than average, but they
just sit back and see what happens), and you take it from there. If
there IS a genuine problem, you go to the OR - but you don't take
radical steps to head one off when you don't know you are going to
have an issue.
Below link is a sample of what the best practice literature is saying
- no advantage to cutting to the chase and having a section right off,
and no advantage of induction either. This is particularly true of a
first baby when you don't know what you might be capable of. After I
had a section for my first, I got told macrosomia was a factor, but
that was bogus, since I went on to push out a similar sized baby and a
larger one in subsequent pregnancies with no problems and I would have
saved myself a LOT of angst, pain, risk and hassle had I not had that
section.
http://www.aafp.org/afp/20010115/302.html
Mary G.
(9 lb 11.5 ounces by section - iatragenic and unnecessary, I might
add, followed by 9 lb 8 ounces VBAC and 10 lb 4 ounces VBAC)
Vijay
> "paul williams" <paul...@hotmail.com> wrote in message
> news:3839a34f.03092...@posting.google.com...
> > Wifes now 36 weeks but baby is measuring up to 40 weeks already so it
> > looks very large.
> >
> > Consultant has given us the choice :-
> >
> > 1. Elective C-section at 39 weeks.
> > 2. Induce at 40 weeks.
> >
How would you feel if your dentist suggested a root canal in a
perfectly healthy tooth because there was a potential for future
problems? Get a second opinion? Tell him to take a flying leap? Or opt
for the preventative root canal?
The decision would be an easy one for me if I were in your shoes: let
nature take its course.
Just my two cents.
-V.
Maggie Lawson
"Mary Gordon" <Mary_...@tvo.org> wrote in message
news:40b9e4c0.0309...@posting.google.com...
> (9 lb 11.5 ounces by section - iatragenic and unnecessary, I might
> add, followed by 9 lb 8 ounces VBAC and 10 lb 4 ounces VBAC)
On the subject of large babies - my 5' 4" tall, medium build, probably about
140 lb at the time grandmother had a 12 lb baby in 1954.
The doctors told my grandfather, during the birth, that they were going to
lose either mother or child, and due to the fact that it's a Catholic
hospital, it was their policy to save the child. I can't imagine what Papa
went through, knowing that for hours... And of course, these were the days
of waiting outside and pacing while the delivery occurred.
She survived, and went on to have two other children. And my uncle lived,
and he went on to be a brilliant business man, to have two children of his
own, and so it goes.
Maggie
Sue
> > Last two ultrasounds where head and abdomen were measured have put the
babies size slightly above the 97th percentile...
Ericka Kammerer <e...@comcast.net> wrote in message
> If the baby is a girl, the 97th percentile at birth
> would only be about 9.5 pounds, which many, many women
> deliver quite successfully vaginally (even with lousy
> support--with the support of a birth team skilled at
> supporting vaginal births of large babies, the odds are
> even better).
And my 97th percentile baby was 9 pounds and was by far the easiest delivery
I had. She was born under two hours with only three pushes and no
medications or interventions. I went home the next morning and felt
wonderful.
Unfortunately Paul, you sound like you put your 100% trust in the medical
professionals that you are dealing with. To a certain extent, you should
trust them. But at the same time, you must keep in mind that doctors do a
lot of interventions to save them from getting sued. They do these things,
not in the best interest of the patient, they do it for their best interest.
Not a good thing, imo. The patient needs to be educated on what
interventions are truly needed and what interventions are just done for the
convenience of the doctor and staff.
It doesn't sound like you have done much research on birthing babies. Ericka
gave you some good books to read, perhaps you can look them over quickly to
give you a better idea of what having a baby is really like and not one that
hospitals make you believe that you should do. Good luck.
Daye
wrote:
> If the baby is a girl, the 97th percentile at birth
>would only be about 9.5 pounds, which many, many women
>deliver quite successfully vaginally
At birth, I weighted 9lb. 4oz. My mother gave birth to me vaginally.
She weighted maybe 160 pounds at the time, and she is 5'6". She had
no problems giving birth to me.
--
Daye
Momma to Jayan
"Boy" EDD 11 Jan 2004
See Jayan: http://jayan.topcities.com/
paul williams
> That depends. Exactly what outcome are you hoping for?
Obviously, a birth with as little problem as possible resulting in a
healthy baby and healthy mother.
>
> I've had 2 cesareans - one for no good reason, one for very good reasons. I
> just had a vaginal birth (with venteuse) - a 7 lb 14 oz baby who was quite
> large for my 4'10" body, yet fit through my pelvis just fine. I would
> rather have another vaginal birth, of a baby of any size, any day, rather
> than have another cesarean for anything other than a real medical reason - I
> mean, 'this is a problem right now, we have to solve it right now' rather
> than 'this might be a problem, so let's just cut'.
>
> A small baby, with a small head that's presenting badly may be much more
> difficult to birth than a big baby that's presenting ideally. Presentation
> is *very* important. Size is a whole lot less important than you think.
> Medically-minded birth attendants tend to treat all head-down positions as
> equal (because after all, if it doesn't work, we can just do a cesarean) but
> this isn't true. And there is a lot a pregnant woman can do to help her baby
> line up in an ergonomically-positive position for birth.
>
> Sir, surgery should be a *last* resort, not a "something might go wrong, so
> let's cut 'er open" attitude. I wouldn't wish a cesarean on anybody for
> anything but the most important reasons: immediate threat to mother and/or
> baby. Recovering from major abdominal surgery *sucks*. Being told you will
> have *no choice* but to have major surgery because you're a woman and you
> got pregnant again.....sucks. And that's what's happening to a great many
> women now, who have had previous cesareans. Not because a c/s is safer for
> the woman or the baby, but because it's less of a liability for the
> hospital. It's not demonstrably safer for your wife at this point. It's
> not safer for your baby. So what is the appeal here?
I can see your point but I think you're missing my point a little.
Yes. Ideally for everyone involved a natural birth is MUCH, MUCH
better than
anything.
Since the baby is big (based on head and abdomen size NOT 'guessed'
weight) the consultant has said that an induction at term would be
done rather than waiting too long. Also, my wife plans to have an
epidural in the instance of natural birth anyway.
But, neither of us are keen on ventouse or forceps. Risks of this are
increased with epidural, large baby, and inducing....
However, an emergency C-section after 25 hours labour is the worst
option by far. You're operating on a mother whos already exhausted,
possbily having to rush the op, cutting through contracting muscle
etc...
However, we both understand the issues with a C, in terms of recovery.
Yes, it is major abdominal surgery. (BTW. My wifes a qualified nurse -
recovery specialist at that !)
paul williams
> "paul williams" <paul...@hotmail.com> wrote in message
> news:3839a34f.03092...@posting.google.com...
> > Wifes now 36 weeks but baby is measuring up to 40 weeks already so it
> > looks very large.
>
> predicted a large baby especially as my second baby had been 8lbs 11 oz
> ...Thomas was 7lbs 11oz !! Perfectly average weight. I hope the hospital
> aren't basing their judgement on this being a big baby solely on the fundal
> measurement. In any case unless the baby is an absolute whopper is there any
> reason to think hat your wife wouldn't be able to deliver vaginally, ie does
> she have a very narrow pelvis?
>
> Nicky
Research and expert opinion says that ultrasound measurements and
estimates are accurate to within 10-15%. We've had two and both have
been consistent.
Head and abdomen measurements in both instances place the baby size
slightly above the 97th percentile on the fetal growth chart. So, I
guess this means its in the top 3% with regards to size...
paul williams
Agree that not every unplanned C should be classed as emergency.
However, every unplanned C where labour has taken place for any length
of time (be it natural or induced), results in an op being performed
on a possibly fatigued and stresses mother, and also having to cut
through contracting muscle (i.e. the uterus).
paul williams
> The size of the baby as measured externally is just an estimate. To
> me, I would rather be induced then opt for a c-section any day. A
> c-section is major surgery. There is also the possibility that the
> baby could come naturally in the next 4 weeks.
>
Yes. Agreed that would be better!
paul williams
> induction vs. c-section; you're choosing (induction + chance of
> post-labor-c-section) vs. elective c-section. I really, really
> wanted a vaginal birth with my son, and hung in through lots of
> hours of unproductive labor to try to have one. I have to admit,
> though, that if I do it again I would waver on whether to just go
> straight to the c-section, because a c-section after 36 hours of labor
> REALLY sucks. You get the worst of both worlds that way, or
> that's how it seemed to me. I guess you at least get the knowledge
> that you did try, but I'm not sure that would be enough for me
> when weighed against going into the surgery with no resources
> after a useless labor.
>
> Which is not to say that the OP's wife should opt for the section,
> because the big baby thing is notoriously unreliable apparently.
> However, if the provider is already talking c-section the
> chances aren't bad that it's going to end up that way anyway after
> the induction 'fails' (this does not sound like a let-nature-take-
> its-course kind of doctor) and the risk of that happening should
> be taken into account.
>
> Beth
> Sam 8/16/2002
Ah ha. Someone whos thinking along my lines !!!!
No. Doctors first choice was for induction. Since baby is large enough
to be in the 97th percentile he says that its best not to go over
term.
paul williams
Why the difference between boy and girl? Are boys born larger then?
BTW. Its a boy.... (we know :-) )
paul williams
Not sure I agree with you there. Doctor has offered his opinion that
induding at 30 weeks is the best option. My wife is keen on the C
section.
BTW. My wifes a registered nurse (and a theatre recovery nurse at
that!) so knows a bit about things.
paul williams
Both of us are pretty short. Shes 5' "2 and I'm 5' 8".
Maybe I should have a word with the postman !!! :-)
Helen Johnson
<elfani...@soderblom.net> writes
>And you're operating after many hours of labor...
>which is BENEFICIAL to the baby! That's why many moms who PLAN to
>have a cesarean...still want to wait and go into labor and labor for a
>while before the planned cesarean. There are many health benefits to
>mom and to baby if they labor prior to surgery.
>
>A cesarean after 25 hours of labor isn't usually considered the worst
>option....since you've given your body the option of having a vaginal
>delivery as well as prepared the baby for birth.
i have to strongly disagree here. an emergency caesarean section after
labourin for 35 hours is a terrible option - both pychologically and
physically for the mohter. the risks of haemorrahge, infection and deep
vein thrombosis are significantly raised.
i disagree entirely that there are health benefits to be gained from
labouring before the caesarean. show me your data, and i'll show you
mine.
--
Helen Johnson
Helen Johnson
the only answer is to do what you feel is best for you.
the prime reason for delivering early or by caesarean a large baby is to
avoid shoulder dystocia. this is where the baby's head delivers, and the
shoulders get stuck. it can be a very difficult problem, and all the
obstetricians and midwives on your unit will have regular emergency
drills where they practice the different manouvers to release the baby.
these are not straight forward, and there are risks to the baby as well
as mother.
however, although a baby over 4kg is at a higher risk of this, it is by
no means assured that it will happen, and babies less than 4kg also get
shoulder dystocia. the fact the baby is large doesn't mean that the baby
will have difficulties, just that since it is impossible to predict
easily on a person basis, may obstetricians will leave you free to
decide whether you prefer to have an unnecesary induction/caesarean or a
problem birth with complications as your better of 2 evils scenario.
since neither of you are tall, adn the baby seems big on scan [scans can
be 1lb out, so no magic there either] i think your consultant is
offering you best care by offering you a choice, and not pretending that
there is a right answer.
--
Helen Johnson
Circe
> > would only be about 9.5 pounds, which many, many women
> > deliver quite successfully vaginally (even with lousy
> > support--with the support of a birth team skilled at
> > supporting vaginal births of large babies, the odds are
> > even better).
>
>
girl weighs about a 1/2 lb. less.
--
Be well, Barbara
(Julian [6], Aurora [4], and Vernon's [18mo] mom)
This week's special at the English Language Butcher Shop:
"She rose her eyebrows at Toby" -- from "O' Artful Death", by Sarah Stewart
Taylor
Daddy: You're up with the chickens this morning.
Aurora: No, I'm up with my dolls!
All opinions expressed in this post are well-reasoned and insightful.
Needless to say, they are not those of my Internet Service Provider, its
other subscribers or lackeys. Anyone who says otherwise is itchin' for a
fight. -- with apologies to Michael Feldman
Paul W
news:4SwV7rFkoDe$Ew...@familyfrench.co.uk...
Helen. Agreed. Can't see any way how this is beneficial.
Circe
> induding at 30 weeks is the best option.
I think you mean 40 weeks, but never mind.
> My wife is keen on the C section.
>
> BTW. My wifes a registered nurse (and a theatre recovery nurse at
> that!) so knows a bit about things.
She knows what recovery from surgery is like; what she doesn't realize, I
suspect, is how much *harder* recovery from surgery generally is than
recovery from a normal vaginal birth.
Still, it's pretty obvious to me that:
1) You put complete faith in the ultrasound estimates of your baby's size
despite a lot of evidence that it could be inaccurate.
2) You are convinced that a large baby is a problem and intervention is
necessary.
3) You don't WANT to consider alternatives to intervention.
That being the case and given your wife's apparent fear of a vaginal birth,
I'd actually go with a C-section over induction because I think the chances
are VERY high that induction at 40 weeks with a suspected large baby will
fail (statistically, the odds are not good for successful induction prior to
41 weeks in women who have not had a prior vaginal birth and they are also
not good for *any* woman being induced because the baby is suspected to be
large) and your wife will end up with a section anyway. In your situation,
I'd give induced labor no better than 50/50 odds of succeeding, and probably
less. If you're not willing to let nature take its course to give you the
best chance for a vaginal birth (and if you look at the research that has
been done by medical professionals, waiting for spontaneous labor does give
you the best chance regardless of the baby's size or gestational age), I
can't see any logical reason to put your wife through an induced labor (the
worst sort, IME) she doesn't want when there's such a high likelihood of a
c-section being the end result anyway.
I wouldn't normally recommend an elective c-section, but I'm a realist:
you're one the road to one anyway, so why not cut out the middle man?
Carolyn Jean Fairman
>Ericka Kammerer <e...@comcast.net> wrote:
>> If it's successful without causing any problems, definitely
>> ideal. The only downside to trying to birth the baby vaginally
>> is that you might end up with an intrapartum c-section rather
>> than a scheduled c-section. While intrapartum c-sections are
>> slightly more risky than scheduled c-sections, they are not
>> as risky as true emergency c-sections. It is *not* an emergency
>> to do a c-section for failure to progress because the baby is
>> too large. It may not be the most fun choice to labor a while
>> and then end up with a c-section, but with good planning and
>> a supportive birth team you've got a really good chance of
>> making it and not having to deal with the consequences of
>> a c-section.
>>
>> Best wishes,
>> Ericka
>
>Agree that not every unplanned C should be classed as emergency.
Yes, if there is true failure to progress, the OB usually talks to you
about options, and if there wasn't any anesthesia before, the woman
gets an epidural and then they prep an operating room, etc.
>However, every unplanned C where labour has taken place for any length
>of time (be it natural or induced), results in an op being performed
>on a possibly fatigued and stresses mother, and also having to cut
>through contracting muscle (i.e. the uterus).
This doesn't make any sense at all -- and I saw you repeated this
several times about 'contracting muscle'. A c-section on a
contracting uterus is NOT a problem at all!! It is not medically
worse to have a c-section once labor had started (an exhausted Mom who
has to also recover from major abdominal surgery has it a little worse
than the women who slept right before, sure :)
But, in fact, the opposite is true -- labor prepares the baby to be
born, and babies born from scheduled c-sections are more likely to
have breathing problems specifically because none of the hormones
generated in labor have helped the baby's system get ready. It is
significantly better to labor and see how it goes. When women have
problems like pre-eclampsia with super high blood pressure, the
response is to *induce* *labor*. Not to schedule a c-section!
Also, no matter how the OB tries to tell you they have 'measured' the
baby, it is just a *guess*, not an exact measurement like if you set a
ruler down next to something and read off 20 in. It will be inaccurate
with wide margins of error in the ultrasound measurement and as such
as a rought approximation of the baby's size.
Carolyn
--
Carolyn Fairman
http://www.stanford.edu/~cfairman/
Vicki S
> I wouldn't normally recommend an elective c-section, but I'm a realist:
I agree with Circe. You really sound like you've made up your mind
already and like nothing you read that disagrees with your preference
makes any impact. Happy c-section, and I hope you don't want a lot of
children.
--
-- Vicki
Married DH May 21, 1995
Ima shel DS, born 11/16/99; and DD, born 5/19/02.
"Stay-at-home" Ima since October 2002.
An ounce of mother is worth a pound of clergy. -Spanish proverb
I may not currently be pregnant, but I look pregnant, does that count?
Ilse Witch
>
> Last two ultrasounds where head and abdomen were measured have put the
> babies size slightly above the 97th percentile...
Have you ever considered talking to a doula or midwife? Or even
having a second opinion by another doctor? Don't forget: we are
talking major surgery here, having a second opinion is perfectly
warranted. Wouldn't you want to make sure that surgery is really
the only possible alternative? I'm sure you would if this weren't
a pregnancy but some rare illness.
Besides, midwifes and doulas approach birth from an entirely
different aspect, but are equally well trained (especially the
midwife) as an OB/GYN when it comes to normal births. In spite
of your wife being a nurse, she doesn't know what it is like to
give birth as long as she hasn't done it. It is perfectly normal
to be afraid of giving birth, especially when they tell you the
baby is big.
It does sound like you put way too much faith in what this one
doctor says, and I can only add my warning against that. I've
BTDT and regretted it ever since. Please go for that second
opinion. If you don't believe us, perhaps you will listen to
what another physician or experienced midwife has to say.
--
-- I
mommy to DS (14m)
guardian of DH
EDD 05-17-2004
War doesn't decide who's right - only who's left
Sue
> weight) the consultant has said that an induction at term would be
> done rather than waiting too long. Also, my wife plans to have an
> epidural in the instance of natural birth anyway.
No sorry Paul, they are guesses. I know this because I almost became an
ultrasound technologist and was only 4 months away from graduating when I
decided that it wasn't for me. Ultrasound measurements are estimated sizes
of the baby. They measure the abdomen and the head as best as they can. No
two techs will get the same measurement because there is a margin of error,
baby's position and lie can make a huge difference. I would make no
decisions based on an ultrasound. When the baby is born, please come back
and tell us how much the baby weighed and how big/tall the baby was. I am
really curious. :o)
--
Sue (mom to three girls)
I'm Just a Raggedy Ann in a Barbie Doll World...
Ericka Kammerer
http://tinyurl.com/p369
CONCLUSION: Severe RDS [respiratory distress sysndrome] on the basis of
HMD [hyaline membrane disease] can also occur in near-term babies after
CS; even a fatal outcome can not be excluded. The severity of illness in
elective CS without labour may be quite high and is comparable to
newborns delivered by CS (after onset of labour and/or rupture of the
membranes) who were 1 week younger.
http://tinyurl.com/p377
Respiratory morbidity is an important complication of elective caesarean
section. The presence of labour preceding caesarean section reduces the
risk of neonatal respiratory morbidity.
http://tinyurl.com/p37h
Respiratory morbidity in term neonates is an important complication of
elective cesarean delivery. The effect of preceding labor on the
incidence and severity of respiratory morbidity in two comparable groups
of neonates, 107 with and 80 without labor and with no predisposing
factors to respiratory morbidity, was evaluated. Transient tachypnea of
the newborn accounted for the majority of cases in term neonates.
Respiratory morbidity occurred less frequently in neonates delivered
after the onset of labor compared with those delivered before labor
(11.2 versus 30%, P less than .002). The risk of respiratory morbidity
decreased 1.5 times for each week of advancing gestational age. The
presence of labor significantly reduced the risk of respiratory
morbidity, independently of gestational age (P less than .03), and
disease was less severe in neonates born during labor. Awaiting the
onset of labor appears to be beneficial in preventing respiratory
morbidity in term neonates delivered by elective cesarean section.
http://tinyurl.com/p37p
The mechanisms of fetal and newborn adaptation to extrauterine life
after normal and abdominal delivery were under study. Laboratory and
instrumental methods were employed to examine the status of the
intrauterine fetus and the clinical picture of the newborn adaptation in
the early neonatal period: radioimmunoassays of dopamine, noradrenaline,
adrenaline were carried out in fetuses and newborns after normal
delivery and after cesarean section performed before and in labor. The
results evidence that the adaptation shifts develop later in the
newborns after cesarean section performed before labor than in those
born spontaneously or by cesarean section that was performed in labor.
The same tendency can be traced in the changes developing in the
sympathoadrenal system. This result brings the authors to a conclusion
that planned cesarean section should be performed after the onset of
labor, if possible.
Gotta run--there are more, though.
Best wishes,
Ericka
Larry McMahan
: "Helen Johnson" <news...@familyfrench.co.uk> wrote in message
Please take a look at Ericka's post citing the studies showing the
benefits of a trial of labor before c-section. It is pretty clear
cut.
Larry
Liz S. Reynolds
Ericka Kammerer <e...@comcast.net> wrote:
>
>http://tinyurl.com/p369
>CONCLUSION: Severe RDS [respiratory distress sysndrome] on the basis of
>HMD [hyaline membrane disease] can also occur in near-term babies after
>CS; even a fatal outcome can not be excluded. The severity of illness in
>elective CS without labour may be quite high and is comparable to
>newborns delivered by CS (after onset of labour and/or rupture of the
>membranes) who were 1 week younger.
<and a bunch more cites, good stuff>
The OP had been talking about a cesaerean after 25 hours of labor, which
after experiencing close to that I can agree sucks pretty badly. Is there
any concensus on how long a trial of labor confers these benefits on the
baby? Maybe 12 hours or 8 hours is long enough. I don't think there are too
many women planning an elective section who would volunteer to labor for
that long first, but might consider doing it for a shorter time if it would
be beneficial to the baby.
-Liz
Mary Gordon
I ask because I certainly didn't when I had one with my first baby. I
also didn't realize of the implications for future pregnancies and
deliveries, and the angst and hassle I would go through to have VBACs.
I wouldn't take on the risks voluntarily unless there was a clearcut
advantage.
MEG
Daye
wrote:
>Research and expert opinion says that ultrasound measurements and
>estimates are accurate to within 10-15%. We've had two and both have
>been consistent.
Have you done the math on this? You are quoting this stat over and
over, but have you done the math? Do you know how much that actually
is in pounds or grams???
Daye
wrote:
>My wife is keen on the C
>section.
Then why are you asking for opinions and arguing? If she wants a
c-section, let her have one. You said that she is a nurse. She is
medically with it enough to figure out the risks etc.
Just let it go...
Sue
has missed the class on ultrasounds being notorious inaccurate.
--
Sue (mom to three girls)
I'm Just a Raggedy Ann in a Barbie Doll World...
paul williams <paul...@hotmail.com> wrote in message
news:3839a34f.03092...@posting.google.com...
nicky
> slightly above the 97th percentile on the fetal growth chart. So, I
> guess this means its in the top 3% with regards to size...
but still within normal range!
So far it seems that you and your wife are scared about giving birth to a
large baby and are seriously thinking of opting for c-section. There is
nothing to suggest that she can't give birth vaginally to this baby and as
everyone else has pointed out the vaginal route offers far more benefits to
both mother and baby than a c-section that is not medically necessary.
I totally understand your fear, I was terrified of labour(having never
experienced it with my first child) with my second child after having had a
section with my first ( I begged for a repeat section but my hospital had a
policy of VBAC unless good reasons were present) but I can honestly tell you
that it was a far more positive experience. He was on the big side at 8lbs
11 oz and he had a big head too. He was my first labour and it was less than
3 hrs start to finish 9 I didn;t go into labour with my first- DD due to
elective CS for placenta previa)
Would you really opt for major abdominal surgery for no good reason?
Nicky
Taniwha grrrl
>> BTW. My wifes a registered nurse (and a theatre recovery
nurse at
>> that!) so knows a bit about things.
>
> She knows what recovery from surgery is like; what she
doesn't
> realize, I suspect, is how much *harder* recovery from
surgery
> generally is than recovery from a normal vaginal birth.
Not to mention taking care of a newborn baby while
recovering from surgery, I don't think she'll have
experience in that. You can't pick up your baby to comfort
him when he cries, you can't put him to the breast, you
can't even pull the bassinette close by to gaze at him
without using that buzzer to get the staff to come in and do
it for you. Your totally dependant on other people to help
you care for *your* baby in those first day's after surgery,
it can be very depressing. It was torture to me, as I'm very
independent, to have to ask someone to pass me my baby when
she cried so I could put her to the breast.
--
Andrea
If I can't be a good example, then I'll just have to be a
horrible warning.
Ericka Kammerer
> On Sat, 27 Sep 2003 21:09:06 -0400, Ericka Kammerer <e...@comcast.net>
> wrote:
>
>
>>While intrapartum c-sections are
>>slightly more risky than scheduled c-sections,
>
> do you have some place that I can read more about this..? Because
> this goes against what I have seen/read, which is that there are
> benefits to labor for mom and the baby, and therefore having an
> intrapartum cesarean is therefore LESS risky than a scheduled
> cesarean....
Yes...let me dig up some cites. Basically, having
the c-section after labor starts is significantly better for
the *baby* (for several reasons--you know for sure the baby is
ready, and the labor prepares the baby for birth better), but
it is slightly more risky for the mother. In balancing the
two out, I'd take the intrapartum c-section personally because
I think the value to the baby is higher than the risk to the
mother in that case, but there is a slight increase in risk
to the mother.
Here's one cite to get started:
http://tinyurl.com/p45n
CONCLUSION--The attributable relative mortalities of caesarean section
compared with vaginal delivery and intrapartum compared with elective
caesarean section are lower than the overall relative mortalities of
these modes of delivery and are approximately 5:1 and 1.5:1
respectively. These data are crucially important in the decision to
recommend elective caesarean section compared with trial of labour.
Best wishes,
Ericka
Ericka Kammerer
> Ericka Kammerer <e...@comcast.net> wrote in message news:<3F763975...@comcast.net>...
>> If the baby is a girl, the 97th percentile at birth
>>would only be about 9.5 pounds, which many, many women
>>deliver quite successfully vaginally (even with lousy
>>support--with the support of a birth team skilled at
>>supporting vaginal births of large babies, the odds are
>>even better).
> Why the difference between boy and girl? Are boys born larger then?
>
> BTW. Its a boy.... (we know :-) )
Boys tend to be slightly larger. I just didn't happen
to have the boy weight-for-age charts on hand, so I looked it
up on the girl chart. It's not enough of a difference that
there's any more difficulty birthing boys (statistically
speaking), but there's a bit of a difference in weight.
Best wishes,
Ericka
Ericka Kammerer
> well, gave up reading all the other answers as head spinning.
> the only answer is to do what you feel is best for you.
> the prime reason for delivering early or by caesarean a large baby is to
> avoid shoulder dystocia. this is where the baby's head delivers, and the
> shoulders get stuck. it can be a very difficult problem, and all the
> obstetricians and midwives on your unit will have regular emergency
> drills where they practice the different manouvers to release the baby.
> these are not straight forward, and there are risks to the baby as well
> as mother.
However, flipping the mother to all fours is *quite*
successful at resolving many shoulder dystocias, if the mother
has retained enough mobility to do that.
Best wishes,
Ericka
Phoebe & Allyson
> She knows what recovery from surgery is like; what she doesn't realize, I
> suspect, is how much *harder* recovery from surgery generally is than
> recovery from a normal vaginal birth.
I had my gallbladder out laparascopically when Caterpillar
was 3.5 months old. Outpatient surgery, easy recovery, no
big deal.
But I'd been home for 3 or 4 hours before I got up the nerve
to try nursing, and it was a week before it was as easy as
it had been pre-op. I spent more time in bed that week than
I did the week after giving birth, and was much more
physically miserable. I can't imagine going through that
with a brand new baby, especially as a first-time mom. And
a C-section is much bigger surgery.
That said, if the mom isn't keen on a vaginal birth, I'd go
for the C-section over an induction.
Phoebe :)
--
yahoo address is unread - substitute mailbolt
Chotii
> >
> > That depends. Exactly what outcome are you hoping for?
>
> Obviously, a birth with as little problem as possible resulting in a
> healthy baby and healthy mother.
>
> >
> > I've had 2 cesareans - one for no good reason, one for very good
reasons. I
> > just had a vaginal birth (with venteuse) - a 7 lb 14 oz baby who was
quite
> > large for my 4'10" body, yet fit through my pelvis just fine. I would
> > rather have another vaginal birth, of a baby of any size, any day,
rather
> > than have another cesarean for anything other than a real medical
reason - I
> > mean, 'this is a problem right now, we have to solve it right now'
rather
> > than 'this might be a problem, so let's just cut'.
> >
> > A small baby, with a small head that's presenting badly may be much more
> > difficult to birth than a big baby that's presenting ideally.
Presentation
> > is *very* important. Size is a whole lot less important than you think.
> > Medically-minded birth attendants tend to treat all head-down positions
as
> > equal (because after all, if it doesn't work, we can just do a cesarean)
but
> > this isn't true. And there is a lot a pregnant woman can do to help her
baby
> > line up in an ergonomically-positive position for birth.
> >
> > Sir, surgery should be a *last* resort, not a "something might go wrong,
so
> > let's cut 'er open" attitude. I wouldn't wish a cesarean on anybody for
> > anything but the most important reasons: immediate threat to mother
and/or
> > baby. Recovering from major abdominal surgery *sucks*. Being told you
will
> > have *no choice* but to have major surgery because you're a woman and
you
> > got pregnant again.....sucks. And that's what's happening to a great
many
> > women now, who have had previous cesareans. Not because a c/s is safer
for
> > the woman or the baby, but because it's less of a liability for the
> > hospital. It's not demonstrably safer for your wife at this point.
It's
> > not safer for your baby. So what is the appeal here?
>
> I can see your point but I think you're missing my point a little.
>
> Yes. Ideally for everyone involved a natural birth is MUCH, MUCH
> better than
> anything.
>
> Since the baby is big (based on head and abdomen size NOT 'guessed'
> weight) the consultant has said that an induction at term would be
> done rather than waiting too long. Also, my wife plans to have an
> epidural in the instance of natural birth anyway.
So WHAT if the baby is "big"? My 4th daughter was "big" (almost 8 lbs). I'd
never had a vaginal birth. I wound up with an epidural. And I'm notably
smaller than your wife is. I don't know what this fear of "big" is all
about. I honestly, sincerely don't.
> But, neither of us are keen on ventouse or forceps. Risks of this are
> increased with epidural, large baby, and inducing....
I agree that your risks are increased. But *why* oh *why* choose the risks
of major surgery - which taken part-and-parcel with the choice of c/s - over
the risks from a venteuse - which is by no means guaranteed with an
attempted vaginal birth?
> However, an emergency C-section after 25 hours labour is the worst
> option by far. You're operating on a mother whos already exhausted,
> possbily having to rush the op, cutting through contracting muscle
> etc...
I'm not sure where you're getting the idea that labor will necessarily take
25 hours (my first labor did, *and* it ended in cesarean, but this is by no
means predicative - I believe the average length of labor for a first labor
is 12 hours) and why a failed induction == an emergency cesarean? Yes, I
know all about the exhaustion - I've been there, done that. My doctor
didn't have any trouble cutting through contracting muscle, and it was not
an emergency, just an eventuality.
> However, we both understand the issues with a C, in terms of recovery.
> Yes, it is major abdominal surgery. (BTW. My wifes a qualified nurse -
> recovery specialist at that !)
I'd say there's a world of difference between working with people who've had
surgery, and being the one who's had surgery. And speaking as somebody
who's spent far too much time in hospitals either having things done to her,
or watching things done to her children, I think medical folks learn to tune
out the fact that they're hurting people with their procedures. They can't
afford to be empathetic or even sympathetic, when painful things have to be
done. But, if she really wants to have surgery rather than try an induced
labor, well, she may just find out the difference between theory and
reality. :(
Anyway, as far as I can tell, I have to agree with the other ladies: you
folks seem to have made up your mind already and aren't really interested in
anyone's opinions or even cited articles from peer-reviewed medical
journals. So what are you hoping for from us?
--angela
Kereru
> for the C-section over an induction.
>
> Phoebe :)
Mind if I ask why you say that? I ask because I am having a large baby
(looking to be 10-11lb by 40 weeks) and the midwife isn't keen to let me go
too far past term so induction may come into the picture.
So do you mean that induction is worse then c-section in general or do you
just mean that in the case of this woman who's scared of a vaginal birth?
I REALLY want another vaginal birth, I'm pretty much terrified of having
surgery.
Judy
Ericka Kammerer
> The OP had been talking about a cesaerean after 25 hours of labor, which
> after experiencing close to that I can agree sucks pretty badly. Is there
> any concensus on how long a trial of labor confers these benefits on the
> baby? Maybe 12 hours or 8 hours is long enough. I don't think there are too
> many women planning an elective section who would volunteer to labor for
> that long first, but might consider doing it for a shorter time if it would
> be beneficial to the baby.
Well, there are three ways that a TOL confers benefits,
as I see it:
1) You know the baby is ready to be born and that you're not
artificially inducing prematurity. There's a complex set
of things that happens to kick off labor, and as far as
anyone can tell, it's kicked off by the *baby*. So
waiting to go into labor really means something, and going
any sooner means the baby hasn't told you he or she is
ready yet. I imagine these benefits would be gained if
you just waited until you knew you were really in labor.
2) You might end up with a vaginal birth, which better all
around. For this benefit, you obviously have to labor
as long as it takes to get the baby out ;-) So the big
question is when have you gone long enough that you can
feel confident the baby can't be born vaginally. There's
no set time for that, obviously.
3) You expose the baby to labor, which appears to have
benefits for reducing things like respiratory distress.
We know that vaginal birth has even more benefits in
this department, due to the baby being squeezed through
the birth canal. Unfortunately, as far as I can tell,
we're not entirely sure what the benefits of first
stage labor are prior to a c-section above and beyond
the benefits from knowing the baby is ready to be born
(though some studies demonstrate the existence of these
benefits). Since we don't really know precisely what
causes them, it's hard to say how long you'd have to labor
to get them. I don't recall running across any studies
that compared how long the TOL lasted with how much
benefit was conferred :-(
But to be honest, if vaginal birth is *safe* (which I assume
is the case if a TOL is an option), I don't really understand
why one would take the approach of laboring for a little
while before definitely having a c-section. Why expose
yourself to the significant risks to future pregnancies
(from placenta previa and placenta accreta/increta/percreta--
the incidence of which has grown by an order of magnitude
or more as c-sections have been on the rise) if a vaginal
birth is an option? I don't understand the downsides of
attempting the vaginal birth and only going for the c-section
if the vaginal birth doesn't work. Since every situation is
different, women will choose to define "doesn't work"
differently, but that's better (in my mind) than establishing
an arbitrary limit for how long someone will labor. Heck,
especially for a lot of first timers, the first eight hours
are pretty lightweight!
Best wishes,
Ericka
Ericka Kammerer
> Mind if I ask why you say that? I ask because I am having a large baby
> (looking to be 10-11lb by 40 weeks) and the midwife isn't keen to let me go
> too far past term so induction may come into the picture.
Be really cautious here--as so many have posted, estimates
can be really off, there is no good evidence that induction or
elective c-section for suspected large baby improves outcomes,
and larger babies are not necessarily more difficult to birth.
> So do you mean that induction is worse then c-section in general or do you
> just mean that in the case of this woman who's scared of a vaginal birth?
I interpreted her to mean that if you don't want a vaginal
birth anyway, an induction is a waste of time and energy for all
involved ;-) Also, since induction (particularly if done in a
less favorable situation) can increase the odds of a more painful
labor and instrumental or surgical delivery, it's not necessarily
a nice option for someone already afraid of vaginal birth.
> I REALLY want another vaginal birth, I'm pretty much terrified of having
> surgery.
If you really want it and plan for it and have a good team
to support it, odds are you *will* have another vaginal birth,
even with a large baby. Also, all inductions are not created
equal. If somehow you find yourself in a situation where an
induction really is the best thing, you may be able to get by
with a much more gentle approach than cervical ripening followed
by loads of pitocin.
Best wishes,
Ericka
Liz S. Reynolds
Ericka Kammerer <e...@comcast.net> wrote:
>
>But to be honest, if vaginal birth is *safe* (which I assume
>is the case if a TOL is an option), I don't really understand
>why one would take the approach of laboring for a little
>while before definitely having a c-section. Why expose
>yourself to the significant risks to future pregnancies
>(from placenta previa and placenta accreta/increta/percreta--
>the incidence of which has grown by an order of magnitude
>or more as c-sections have been on the rise) if a vaginal
>birth is an option? I don't understand the downsides of
>attempting the vaginal birth and only going for the c-section
>if the vaginal birth doesn't work. Since every situation is
>different, women will choose to define "doesn't work"
>differently, but that's better (in my mind) than establishing
>an arbitrary limit for how long someone will labor. Heck,
>especially for a lot of first timers, the first eight hours
>are pretty lightweight!
Thanks for your insight.
I guess I'm thinking of it more as a way to psyche yourself into it - if
you start out saying "I'm going to do this for 8 hours because it's good
for the baby, then I can quit and have the section" maybe when you get
there you'll find you can go through with it and have the vaginal birth
after all. If you don't know of a good reason to even try, maybe you'll be
more likely to skip out altogether and take the elective section if it's
offered. This is for random values of "you" :)
-Liz
Paul W
news:u99hnvk4qoqvt8faf...@4ax.com...
Yes. Of course. With a baby estimated at 10lbs 0oz (for instance), 15% gives
an extra 21oz (so it'd be 11lbs 7oz, or 21oz less (giving 8lb 7oz).
Paul W
> I'd say there's a world of difference between working with people who've
had
> surgery, and being the one who's had surgery. And speaking as somebody
> who's spent far too much time in hospitals either having things done to
her,
> or watching things done to her children, I think medical folks learn to
tune
> out the fact that they're hurting people with their procedures. They can't
> afford to be empathetic or even sympathetic, when painful things have to
be
> done. But, if she really wants to have surgery rather than try an induced
> labor, well, she may just find out the difference between theory and
> reality. :(
>
> Anyway, as far as I can tell, I have to agree with the other ladies: you
> folks seem to have made up your mind already and aren't really interested
in
> anyone's opinions or even cited articles from peer-reviewed medical
> journals. So what are you hoping for from us?
>
> --angela
>
>
Bit of a negative comment here. As I think I've said earlier, our decision
is merely 'pencilled in' at the moment. Surely, my willingness to discuss
these issues in this NG (after all I did start the thread!) shows that I'm
interested in others opinions !
Just because my opinion is slightly different to yours, doesnt mean that I'm
not interested in anyone opinion.
Paul W
> This doesn't make any sense at all -- and I saw you repeated this
> several times about 'contracting muscle'. A c-section on a
> contracting uterus is NOT a problem at all!! It is not medically
> worse to have a c-section once labor had started (an exhausted Mom who
> has to also recover from major abdominal surgery has it a little worse
> than the women who slept right before, sure :)
>
This came from my wife about 'contracting muscle' (from her experiences as a
recovery nurse). Maybe shes got it wrong?
Paul W
> Yes...let me dig up some cites. Basically, having
> the c-section after labor starts is significantly better for
> the *baby* (for several reasons--you know for sure the baby is
> ready, and the labor prepares the baby for birth better), but
> it is slightly more risky for the mother. In balancing the
> two out, I'd take the intrapartum c-section personally because
> I think the value to the baby is higher than the risk to the
> mother in that case, but there is a slight increase in risk
> to the mother.
>
> Here's one cite to get started:
>
> http://tinyurl.com/p45n
> CONCLUSION--The attributable relative mortalities of caesarean section
> compared with vaginal delivery and intrapartum compared with elective
> caesarean section are lower than the overall relative mortalities of
> these modes of delivery and are approximately 5:1 and 1.5:1
> respectively. These data are crucially important in the decision to
> recommend elective caesarean section compared with trial of labour.
>
> Best wishes,
> Ericka
Ericka,
You seem to come up with some great stuff. If you don't mind me asking - are
you a healthcare professional ?
Paul W
"nicky" <fecki...@hotmail.com> wrote in message
news:KY1eb.4246$rh3.35...@news-text.cableinet.net...
Hmmm. Take your point. We are now seriously considering the options
availanle....
>
> Nicky
>
>
Paul W
> Still, it's pretty obvious to me that:
>
> 1) You put complete faith in the ultrasound estimates of your baby's size
> despite a lot of evidence that it could be inaccurate.
> 2) You are convinced that a large baby is a problem and intervention is
> necessary.
> 3) You don't WANT to consider alternatives to intervention.
>
> That being the case and given your wife's apparent fear of a vaginal
birth,
> I'd actually go with a C-section over induction because I think the
chances
> are VERY high that induction at 40 weeks with a suspected large baby will
> fail (statistically, the odds are not good for successful induction prior
to
> 41 weeks in women who have not had a prior vaginal birth and they are also
> not good for *any* woman being induced because the baby is suspected to be
> large) and your wife will end up with a section anyway. In your situation,
> I'd give induced labor no better than 50/50 odds of succeeding, and
probably
> less. If you're not willing to let nature take its course to give you the
> best chance for a vaginal birth (and if you look at the research that has
> been done by medical professionals, waiting for spontaneous labor does
give
> you the best chance regardless of the baby's size or gestational age), I
> can't see any logical reason to put your wife through an induced labor
(the
> worst sort, IME) she doesn't want when there's such a high likelihood of a
> c-section being the end result anyway.
>
> I wouldn't normally recommend an elective c-section, but I'm a realist:
> you're one the road to one anyway, so why not cut out the middle man?
> --
>
Barbara,
I'm a little insulted that you seem to have brushed my opinions off in this
way. As I said in another post,. if I was'nt interested to learn I would'nt
have started this post, would I ?
However, your last paragraph seems to have hit it on the head...
I would note, however, that when I started this post (which was shortly
after our last visit to the hospital), I was'nt even aware that the option
of no C, no intervention was even viable.
The docs words ere something like - Its a large baby so we won't let u go
over term. No mention of doing nothing...
Paul W
news:revsf90-F7F0AD...@news.kiva.net...
> "Circe" <gua...@yahoo.com> wrote:
> > I wouldn't normally recommend an elective c-section, but I'm a realist:
>
> I agree with Circe. You really sound like you've made up your mind
> already and like nothing you read that disagrees with your preference
> makes any impact. Happy c-section, and I hope you don't want a lot of
> children.
>
Vicki,
Hmm. Pretty pointless post really.
May I suggest if u don't like my views or my attitude or whatever you ignore
this thread rather than post this sort of rubbish.
Paul W
news:blab95$5nr$1...@lust.ihug.co.nz...
Yep. Agreed. This is something, obviously, neither us have any experience
in...
Paul W
Seems childbirth is a pretty non-exact science. I've certainly learned that
!
Paul W
> >section.
>
> Then why are you asking for opinions and arguing? If she wants a
> c-section, let her have one. You said that she is a nurse. She is
> medically with it enough to figure out the risks etc.
>
> Just let it go...
And is there any harm in finding out as much as you can before the final
decision needs to be made?
Vicki S
> > to support it, odds are you *will* have another vaginal birth,
> > Best wishes, Ericka
"Paul W" <paulfoel_rem...@hotmail.com> wrote:
> Seems childbirth is a pretty non-exact science. I've certainly learned that!
Nope, childbirth is not an exact science. It's not science, either.
Neither is parenting, or marriage, or many other things. We get the
best information we can (often using science) and do the best we can
with it. We have to figure in our own idiosyncrasies and needs and
hopes and abilities, too. Life is not an exact science.
--
-- Vicki
Married DH May 21, 1995
Ima shel DS, born 11/16/99; and DD, born 5/19/02.
"Stay-at-home" Ima since October 2002.
An ounce of mother is worth a pound of clergy. -Spanish proverb
I may not currently be pregnant, but I look pregnant, does that count?
Vicki S
"Paul W" <paulfoel_rem...@hotmail.com> wrote:
Paul, you are not the only person reading this thread.
Linz
"Paul W" <paulfoel_rem...@hotmail.com> wrote in message
news:blc4mk$4ck$1...@titan.btinternet.com...
> I would note, however, that when I started this post (which was
> shortly after our last visit to the hospital), I was'nt even aware
> that the option of no C, no intervention was even viable.
>
> The docs words ere something like - Its a large baby so we won't let
> u go over term. No mention of doing nothing...
I love it when the doctors say things like this. Yes, there may well be
very good reasons why your wife shouldn't go too far overdue, or
shouldn't have a vaginal delivery - and I'd say check them out so you
both have fully informed consent. But I always laugh when I hear "We
won't let you go over term". What is the doctor going to do? Come round
to your house and drag you in to hospital?
If your wife and you do your research and feel you would rather go into
labour normally and then have a section; or do the research and opt for
induction; or do the research and go straight to theatre, the important
thing is to do the research /yourselves/ - don't let the doctor bully
you (they may think they're gods, but your wife should know you from
experience that they aren't!). Goodluck with your decision, whatever you
decide.
Circe
this
> way.
Well, I'm a bit insulted that you've brushed off the many well-reasoned and
well-researched opinions of those of us who have suggested that you have
other options, so I guess we're even, eh?
> As I said in another post,. if I was'nt interested to learn I would'nt
> have started this post, would I ?
>
Well, it's hard to say. Nearly *everyone* posting to this thread has
repeatedly told you both that ultrasound estimates of fetal weight are
unreliable and that intervention of any sort is not required or even
desirable in the event of a large baby. Some of us have even backed this up
with research evidence.
Did you even bother to read Henci Goer's article on fetal macrosomia and
induction, to which I provided a link for you? That one document provides
dozens of references to studies which show that babies assumed to be big
often turn out to be quite average and that when intervention is taken
because the baby is assumed to be big, the outcomes are poorer than when the
baby really *is* big but no one expects it to be and nature is allowed to
take its course.
> However, your last paragraph seems to have hit it on the head...
>
> I would note, however, that when I started this post (which was shortly
> after our last visit to the hospital), I was'nt even aware that the option
> of no C, no intervention was even viable.
>
> The docs words ere something like - Its a large baby so we won't let u go
> over term. No mention of doing nothing...
>
And that's why many of us have been pointing you to the research on this
subject. Your doctor is NOT practicing evidence-based medicine--he (she?) is
practicing convention-based medicine.
*Conventionally*, the obstetrical approach to potential fetal macrosomia is
to intervene, typically by inducing labor prior to the due date. This
practice developed because doctors *assumed* that large babies were a
problem and that inducing labor before the baby got *really* big would be
better, leading to fewer c-sections, shoulder dystocias, and other
complications. The problem is that when you look at actual outcomes, you
discover that inducing due to suspected fetal macrosomia *doesn't* do any of
the things doctors thought it would. It doesn't decrease c-sections, it
increases them. It doesn't decrease shoulder dystocias (though I don't
believe it increases them, either). It doesn't, in fact, appear to decrease
complications or improve outcomes in any way.
Now, all of this might reasonably cause you to wonder why doctors continue
to recommend induction for suspected fetal macrosomia. And the simple answer
is that this is what they've LEARNED they're supposed to do. It's what
EVERYONE does. It's become standard of care, even though the evidence
doesn't support it, and that means they're afraid that if you experience a
problem because the baby IS big and they didn't do the STANDARD thing,
they'll be in trouble. The irony is that people rarely sue or raise
malpractice concerns when a doctor DOES something, even if that something
was actually ill-advised and brought on iatrogenic complications. People
tend to assume that things would have been WORSE had the doctor NOT
intervened and are, ironically, GRATEFUL to have been subjected to the
interventions that led to a C-section and a baby in respiratory distress in
the NICU because they assume the outcome would have been less favorable had
the doctor done nothing.
--
Be well, Barbara
(Julian [6], Aurora [4], and Vernon's [18mo] mom)
This week's special at the English Language Butcher Shop:
"She rose her eyebrows at Toby" -- from "O' Artful Death", by Sarah Stewart
Taylor
Daddy: You're up with the chickens this morning.
Aurora: No, I'm up with my dolls!
All opinions expressed in this post are well-reasoned and insightful.
Needless to say, they are not those of my Internet Service Provider, its
other subscribers or lackeys. Anyone who says otherwise is itchin' for a
fight. -- with apologies to Michael Feldman
Chotii
But many of us have. Some of us have had this experience repeatedly.
When my 4th baby was born vaginally after 2 cesareans (1 singleton, 1 set of
twins), I kept asking the nurses if I could do things. Like have the baby in
the bed with me at night, and pick her up by myself, and have her in the
room when nobody was there with me. The answer was always "Yes, of course"
as if I was asking silly questions. But I wasn't. I was going by my previous
experiences, when I was *not* allowed to have the babies in bed with me, or
pick them up by myself (ha, I could hardly walk), or have the baby in the
room with me when I was alone. I wasn't out of pain with my first cesarean
for something like 6 weeks - I mean, I was still taking pain medications. I
was still taking them 2 weeks after the second cesarean...and having to take
care of my firstborn also. And I was lucky - I didn't get an infection in my
incision either time. Many women are not so fortunate.
I haven't seen an answer yet in this thread to a couple of questions:
1. What is it about a "large baby" that frightens you and your wife so
badly? If you can express your fears, perhaps they can be addressed with
further cites from peer-reviewed medical journals.
2. On what do you base your aversion to the use of venteuse or forceps? I
will assume that it is not because of pain for the woman, since you say your
wife intends to have an epidural (and I can tell you that if the epidural
works, pain is not an issue with the venteuse).
3. Do you consider the risks (immediate and long-term) from surgery to be
preferable for mother and/or child than the risks from venteuse or forceps?
If so, why? (Yes, I do know that venteuse and forceps can cause birth
injuries.)
3. What coping methods for labor have you researched and practiced using in
the event that an epidural doesn't work, doesn't work completely, or cannot
be administered for some reason? (They don't always work. I have even met
one woman whose cesarean was performed with an epidural that failed, and
this is not as rare as you may think.)
I agree with your assessment that birth is an "inexact science". Actually,
no, I don't agree. It isn't a science. It's a natural function of the female
body. Like other natural functions, it may sometimes need help, but that
doesn't make it less *natural*. I'm concerned when people approach it as a
science, because often when nature doesn't fit into science's "box", science
*makes* it fit. And since I've been there twice, and didn't like the
experience either time, I hope others may avoid going through what I went
through.
--angela
Nikki
>
> I would note, however, that when I started this post (which was
> shortly after our last visit to the hospital), I was'nt even aware
> that the option of no C, no intervention was even viable.
>
> The docs words ere something like - Its a large baby so we won't let
> u go over term. No mention of doing nothing...
Have you thought of getting a second opinion? When my OB and I disagreed on
an induction date I asked for a second opinion. The second high risk doc,
my OB, and myself were all in the room together discussing the issue. After
that consult we all were able to agree on a course of action. I felt much
better and I think my primary doc felt like she was off the hook if the sky
fell in since there was a second opinion.
It seems the doctor has scared the dickens out of your wife and that is to
bad :-( She should be making this decision by knowing the facts and
following her heart, not out of fear.
Are you familiar with a doula? If your wife decides to try for a vaginal
delivery I would really recommend a doula or midwife. She is going to need
a lot of support. Not because the labor will be hard or because the baby is
big, but because she is going to be scared and the seeds of doudt have been
firmly planted at this point.
--
Nikki
Mama to Hunter (4) and Luke (2)
Kereru
> Kereru wrote:
>
>
> > Mind if I ask why you say that? I ask because I am having a large baby
> > (looking to be 10-11lb by 40 weeks) and the midwife isn't keen to let me
go
> > too far past term so induction may come into the picture.
>
>
> Be really cautious here--as so many have posted, estimates
> can be really off, there is no good evidence that induction or
> elective c-section for suspected large baby improves outcomes,
> and larger babies are not necessarily more difficult to birth.
It's probably a pretty good estimate. My first was 10lb 8oz and consistently
measured smaller than this on by both fundal height scan and just the sheer
size of me!The hospital OB agrees with you on the last bit. Induction is
unlikely unless he's looking really really huge and not before term and
c-section without a trial of labor isn't an option they (or I) will
consider.
>
>
> > So do you mean that induction is worse then c-section in general or do
you
> > just mean that in the case of this woman who's scared of a vaginal
birth?
>
>
> I interpreted her to mean that if you don't want a vaginal
> birth anyway, an induction is a waste of time and energy for all
> involved ;-) Also, since induction (particularly if done in a
> less favorable situation) can increase the odds of a more painful
> labor and instrumental or surgical delivery, it's not necessarily
> a nice option for someone already afraid of vaginal birth.
That's what I thought she meant but I wasn't sure
>
>
> > I REALLY want another vaginal birth, I'm pretty much terrified of having
> > surgery.
>
>
> If you really want it and plan for it and have a good team
> to support it, odds are you *will* have another vaginal birth,
> even with a large baby. Also, all inductions are not created
> equal. If somehow you find yourself in a situation where an
> induction really is the best thing, you may be able to get by
> with a much more gentle approach than cervical ripening followed
> by loads of pitocin.
My midwife thinks that as my second baby a bit of cervical ripening at term
should do the trick. I've also had some accupuncture. I hope I don't get to
induction but thankfully my midwife and the Dr she is consulting with both
want to avoid intervention as much as possible.
Thanks for your input
Judy
>
> Best wishes,
> Ericka
>
Mary W.
Nikki wrote:
> Paul W wrote:
> >
> > I would note, however, that when I started this post (which was
> > shortly after our last visit to the hospital), I was'nt even aware
> > that the option of no C, no intervention was even viable.
> >
> > The docs words ere something like - Its a large baby so we won't let
> > u go over term. No mention of doing nothing...
>
> Have you thought of getting a second opinion? When my OB and I disagreed on
> an induction date I asked for a second opinion. The second high risk doc,
> my OB, and myself were all in the room together discussing the issue. After
> that consult we all were able to agree on a course of action. I felt much
> better and I think my primary doc felt like she was off the hook if the sky
> fell in since there was a second opinion.
Good idea Nikki. We did this, when we had our big baby scare. It bought
us an extra weekend to think about it. Turns out I went into labor that
weekend before getting the second opinion.
> It seems the doctor has scared the dickens out of your wife and that is to
> bad :-( She should be making this decision by knowing the facts and
> following her heart, not out of fear.
Yup. Same thing my doctor did to me....
> Are you familiar with a doula? If your wife decides to try for a vaginal
> delivery I would really recommend a doula or midwife. She is going to need
> a lot of support. Not because the labor will be hard or because the baby is
> big, but because she is going to be scared and the seeds of doudt have been
> firmly planted at this point.
I so wish I had done this. If I had a doula, or midwife, I may have been
more likely to stick out my labor longer, and may have gotten some
constructive ideas on how to get baby to descend. As it went, we opted
for the c-section after 12 hours of labor, with no progress. It turned out
OK, but my big regret is not giving a vaginal birth more of a chance, and
not having a more supportive environment for that. I do not regret going
into labor at all, it was good for me and good for baby. I am very glad
I declined the elective c-section (without trial of labor) in favor of a second
opinion.
Mary
Ericka Kammerer
> You seem to come up with some great stuff. If you don't mind me asking - are
> you a healthcare professional ?
Thanks for saying so ;-) I'm not really a healthcare
professional, though I have done health care research in the
past. Most of my information I get from Medline, which anyone
can search (and occasionally I stop by the library to check
the full text of the study if I can't get it online). There
are also some books that I find very handy and believe to be
very well researched, like Henci Goer's book and Enkins et al.'s
_Guide to Effective Care in Pregnancy and Childbirth_. I
do have a background in research, which makes interpreting
the results a bit easier.
Best wishes,
Ericka
Daye
<paulfoel_rem...@hotmail.com> wrote:
>> Then why are you asking for opinions and arguing? If she wants a
>> c-section, let her have one. You said that she is a nurse. She is
>> medically with it enough to figure out the risks etc.
>>
>> Just let it go...
>
>And is there any harm in finding out as much as you can before the final
>decision needs to be made?
But you are not that keen to find out that much information. You are
just arguing your side. We have given you tons of good information
about why the whole idea of induction and/or c-section for a
*suspected* large baby is a bad, bad, bad idea, and you are still
arguing your side.