Wednesday, August 1, 2012

My Take on Big Babies, or, Don't Get Your Knickers in a Twist

Every time I start writing a post like this, a post that deals with issues over which well-meaning midwives and obstetricians disagree, I end up opening more Google tabs on my Safari browser than I have time to read, and fretting that I have missed something and someone is going to berate me for it. But alas, I think at this point it's safe to say that my readership is small enough that no one who hates me for saying this will ever see it.

Besides, what I'm really trying to grapple with is the buzz I hear from women and doctors about babies that are too big, and why everyone is freaked out but no one seems to have a good answer that doesn't involve doing c-sections on thousands of women who don't need them. And I hear it all the time!

"Oh, they said my baby was too big, so they scheduled me for a c-section at 38 weeks."
"My baby was 10 pounds when he was born and my doctor said I must have had gestational diabetes and we just didn't know about it."
"My baby was 8 pounds and everyone comments on how huge he is."

Some anecdotal evidence on the reaction (overreaction?) to big babies:
  • I vaginally delivered a healthy 9lb 8oz baby boy a little less than two years ago with no problem. My endocrinologist's reaction? "That's a little bigger than we like to see." I'm not sure why it's any concern of yours since *I* was the one to push him out *and* I did it in less than 20 minutes, but whatever.
  • A friend of mine delivered a baby boy at 9lbs 2oz so fast that an ambulance picked her up off the sidewalk and he was breastfeeding 15 minutes after arriving at the hospital. Simply on the basis of his weight, they told her that she probably had insulin issues, despite the fact that she passed the glucose tolerance test.  
  • Another friend of mine has six children. She does not have any form of diabetes. All but one of her children have been 9lbs or more, including one baby who was close to 11lbs, all but one of her children have been delivered vaginally, and she has never failed a glucose tolerance test. Her one c-section birth was not related to the size of the baby.
  • My sister-in-law gave birth to a 10lb 6oz baby vaginally with no complications.
  • I asked the nurse who delivered the Statesman what she thought about the average size of babies at birth, and I questioned her about the 7 1/2 pound average. Her response? "I don't know. I see an awful lot of 9-pound babies born in this hospital." 
  • I heard of a woman who was told that she needed to be scheduled for a c-section prior to the birth of her child because he was anticipated to be more than 9 pounds. His true weight at birth? 7 pounds 12 ounces.

So now that I have done it three times, watched a bunch of other Type I diabetic mamas do it, heard stories from countless women who were told their babies were "too big," heard doctors fret about it, and spent an embarrassing amount of waking time thinking about it, I'm proposing that we all just chill out about big babies and take a look at the real problems (and the real benefits!) of growing them large.

First of all, no one seems to know just how to classify a baby that's "too big." The average is 7 1/2 pounds (give or take a few ounces). My endocrinologist thought 9 1/2 pounds was too big (again, I'm not sure why it's bothering him). If you read my links, you'll notice that some say 8 pounds 8 ounces is too big and some say 8 pounds 8 ounces is optimal (whaaaaat...?), and some put the cut-off at 9 pounds 15 ounces. I had people tell me my first son, 8 pounds 2 ounces, was "massive" and "huge." I wrote some things about this 2 years ago, when I was pregnant with my 9-1/2-pounder, and I think they are all still true. "Too big" is not very well-defined, nor is it easy to measure, and nor can it always be chalked up to diabetes.

So what are the problems with having a big baby anyway? Well, one thing you've probably heard is that having a large birthweight is linked with obesity later in life, but please, people. Correlation does not equal causation.

So as far as I can tell, the worst problem with having a big baby is shoulder dystocia. Frightening, to be sure, life-threatening, and not predictable by clinical symptoms alone. Ultrasound is not always reliable to detect baby weights, and neither are palpations. You don't really know it's happening until the baby's head comes out and...the rest of the baby won't. Women who avoid an epidural have more options if it happens.

In fact, women who avoid an epidural seem to have one of the most excellent options available to women whose babies get stuck: the "all-fours" maneuver. In a 1998 study, shoulder dystocia treated with the all-fours maneuver alone resulted in the live birth of the child 82% of the time. There is unfortunately no information on the long-term outcomes of these births (most notably, no information on brain damage), but I'd say getting the baby out alive is a pretty big deal when you're talking about a complication that cannot be reliably predicted or prevented beforehand. Some other techniques here, by Spinning Babies and here, by the Thinking Midwife.

So in addition to my thoughts here, avoiding an epidural may actually help save your baby's life, should he or she get stuck in transit. Hooray for natural childbirth! I knew there was another reason I thought it was a good idea, and especially so for diabetics whose risk of having a baby with shoulder dystocia is a bit higher.

And here's what else I know about big babies: pediatricians LOVE them. March of Dimes wants you to  wait as long as possible before inducing labor, partly because big babies do better. My big babies had APGARs of 8 and 9, both of them. I heard a 70-year-old woman in the grocery store tell me, "babies these days are so alert, so smart, and so strong. Much stronger than when I had my daughter." My mother-in-law is convinced that my husband slept through the night at an early age because he was so big when he was born (9 pounds 13 ounces). I'm convinced he sleeps through the night because he's secretly trying to shove all middle-of-the-night child-care duties onto me, but that's a different story.

Anyway, I acknowledge that it is possible to have a baby "too big." There's clearly an optimal birthweight somewhere between 5 pounds and 16 pounds, and I'm no expert, but I'm still not sure why everyone seems to think that having a baby with birth weight in the double digits means you must be really fat. Maybe some women just grow their babies big, and maybe some women can blame their husbands for being big at birth (ahem). Maybe it's just evidence that women are eating well, and nourishing their babies well prior to birth.

As one midwife puts it, "I think people get their knickers in a twist about big babies. If the labour progesses, then the baby will be born safely. After all, you can get problems with six-pounders. You need vigilance."

Yeah. What she said.


  1. I see too many moms being pushed into inductions because the baby is "measuring big," only to have a perfectly normal baby born. As we say in hypnobirthing, there is only one way to measure a baby: have the baby, and then measure him. (and, I agree with the big, happy baby idea: each of my babies has been bigger, and as a result, happier than the previous one... and not really any more difficult to deliver!)

    1. "Have the baby, and then measure him." I love it!

  2. I never would have guessed I'd have a 9lbs 10oz baby, but I'm thankful that I was confident because of all of your "educating" me, Beth, that my body was meant to deliver my babies :) When my contractions stopped during pushing after a position change (to lying on my back from all fours) I knew instantly that I had one big ole baby about to come out. After a bit of rest for my body and after irritating the doc, I said, I have to squat to get her out... up into the lowest squat I could manage and two pushes later that big ole' baby came right out. I felt so guilty, like my diabetes had something to do with her weight for a long time. However, my A1cs were the best they have been among my three pregnancies with this, the largest baby. I went into her birth thinking that with an a1c of 5.7 she would be my smallest baby by far and the ultrasound estimate was predicting the same thing, about an 8lbs baby. Surprise! :) Loved this post, and love the new look!! jenn

    1. Jenn - I'm so glad you just knew what your baby needed on the way out. I definitely could not have taught you that intuition, but I'm glad I helped you trust it! My A1Cs were the best this time around, too, and the little man still only came out with one kidney. So some things in pregnancy and birth just can't be helped, I suppose. We'd love to hear your birth story when you're ready to share!