Monday, October 7, 2013

Attack of the Giant Babies


They're coming to get you...  

What is a big baby to you?  
I've noticed a trend among parents lately but I'm guessing it's something that's been around for a while.  This idea that their newborn baby is so unusually big.  Is that just me?  I look at these very average babies and I think that baby looks completely normal.  Sure, some are bigger and more adorably roly polier than others but you would think some of these babies are Jabba the Hut freaks of nature the way their weights are gasped at.  So many of my clients are so afraid that their baby is going to be "big."  I have been shocked to find out that some of these parents think anything over eight pounds is big!  You should have seen the wide eyes when I told a couple that my last baby was eight pounds three ounces.  To me, that's not even close to big.  That's pretty darn normal.  (In fact, that "huge" baby while he was my biggest was also my easiest and if his weight had anything to do with it, I would take that any day over a smaller but fussier baby.)  If I had to say, I think I would place anything maybe nine and a half or ten pounds and over on the bigger end of normal.  Still, so many women I've known have birthed ten and eleven pound babies naturally.  My own aunt birthed my cousin at eleven pounds au natural.  And then there's this woman.  (Okay, okay, that is a big baby.)  Is it harder?  Sure, sometimes it is.  But it's not as weird or abnormal or dangerous as many medical professionals would like us to believe.  

Some statisticians say that any baby at 39 weeks or later that is above eight pounds fifteen ounces is a big baby while others raise that number to nine pounds fifteen ounces.  It's pretty hard to determine a normal natural weight range for a healthy baby since so many births are now augmented through induction or planned cesarean and it's near impossible to factor in things like heredity, ancestry, diet, and other circumstances.  Taking those things into account, maybe a baby that is nine, ten, or eleven pounds is normal and healthy when heredity and genetics and previous children are taken into account.  Now obviously, if a baby is large because the mother's diet is poor (which is a real and common cause for concern) or because of gestational diabetes, then that needs to be addressed because a baby who is made big rather than just naturally big can have issues immediately after birth and longterm but even then, it still doesn't mean that mom can't birth that child vaginally.

So why are so many women and dads nervous about a not really that big baby?  Sometimes it's fed into by hearing other mothers gush over their own baby's weights but more often than not, the fear is planted or at the very least fed into by doctors and midwives who intentionally or not, make guesses and shocked exclamations over any baby that is not exactly seven pounds, even though we know how notoriously wrong ultrasounds are at estimating weight.  (In fact, this study found that the woman's estimate of weight was more accurate than either an ultrasound or the clinician's estimate!)  A father recently told me that after their son weighed in at eight pounds seven ounces after the cesarean, the doctor told them that there was "no way" mom ever would have been able to push such a huge baby through.  Just like when it comes to due dates and those silly growth charts at the pediatrician's office, the mean has become to be considered the perfect ideal rather than simply the average.

If you're thinking I'm saying that we should completely ignore the size of the baby when making choices about birth or afterwards, I'm not.  It is a reality that there are issues that can arise when a child is above average weight.  Just like there are issues when a child is below average weight.  However, I'd just like to suggest and encourage that we need to rethink and expand our definition of normal and relax a bit with the whole big baby thing.  For some families, that "outside the average" weight is completely normal and healthy for them.  For some, perhaps we could say that not being allowed to reach their normal weight is more dangerous than the possible risks of being "too big."  I would love to see birth professionals take a more individual approach to the size of each baby and focus much more during the early months of pregnancy on the mother's overall nutrition.  I also think it would serve mothers and babies greatly if there were a more comprehensive understanding of how the bones of the pelvis move during labor and how birth position completely changes how much room the baby has to come out, "big" or not.  I would love to see a more rational approach taken towards those "big" babies after they are born, letting them just be carefully observed for any signs of a problem rather than routinely shuttled off to the NICU and separated from their mother for being a few ounces above normal even if every indication says that they are doing just fine.

So what does a woman do who is worried for valid reason or has been frightened into thinking that her unborn baby is huge?  
Some tips:


•Know that the evidence shows that risks of induction or planned cesarean can far outweigh those from a suspected big baby.  Educate yourself on all your options.

•Read good birth stories.  Some great ones are here.  Other ones here (this site contains all sorts of stories, though, so read with caution).  Ina May's Guide to Childbirth has some great ones, too, even if the book is "hippieish" according to one of my clients.  (It is.)  Ask other mothers what their estimates were versus what their baby's weight actually was.

•Find out what your birth weight was.  Your husband's.  Your parents, siblings, and cousins.  Take all that into account when determining what your normal may look like.

Learn what birth positions give the most room for the baby to emerge.  Some of them increase the circumference of the pelvic opening by 30%!  Also, learn how to help your baby get into the optimal position for birth.

•Find out your care provider's induction and cesarean rate.  Factor that into their approach to birth.  (The World Health Organization says that a healthy cesarean rate is ten percent.  Above fifteen percent means that cesareans are being performed unnecessarily and creating risk for patients and babies.)  If you don't trust them, find a new provider.  It's never too late.  

•Eat a healthy protein-rich diet and cut out on the processed sugars and carbs.  Even if you've slacked for most of the pregnancy, start now.  You can do it.


So now you tell me, what is a big baby to you?  What are your "big baby" stories or thoughts?  Share 'em here!

My giant blurry baby

**In case it wasn't incredibly obvious from the post above, I'm not an expert on the subject of macrosomia and I'm not trying to be.  Nor do I want to make your birth choices for you.  I'm just a mom, with a little bit of education on the matter, some doula and life experience, and thoughts to share.**




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24 comments:

  1. Everyone is so scared of a big baby, and it's because some doctors are making them that way! They are inducing women early and then ending up in C-sections because of their "big babies" that end up being not so big after all. It's terrible. My biggest was 8 lbs 14 oz. and his labor was the most painful for me, especially the pushing part. I do think it was because he was big, but I wouldn't have allowed any medical intervention (not that my midwife would suggest it) to have gotten him out sooner and smaller.

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    1. It took an extra push or two with Luke as well and I'm thinking it was because he was over a pound more than his brothers. Longer but most definitely doable!

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  2. My "macrosomia" baby was a mere 7lbs 4oz...thanks for the induction and resulting c-section....not a fan of "too large"

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    1. I'm so sorry that happened to you and to so many other women! Hopefully you can at least use your story to help other mothers in the future. Thank you so much for sharing here.

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  3. My first child born at 42 weeks was 8 lbs. 6 oz. I had to be induced, and they discovered at some point he was posterior and never descended into the birth canal, even after 48 hrs. of hard labor. Finally, he started to go into distress and they performed an emergency C. I was told that he probably couldn't descend, despite the hard labor because I am small (5' 2") and he was so big. I was absolutely scared to death to experience this again when I was pregnant 9 months later. I went to a midwife practice and they completely assured me that they would check for the size of the baby via ultrasound prior to delivery just for my peace of mind. When the time came, they adamantly refused the ultra sound and said by my measurements it was a small baby (he weighed the exact same as my first.) It was a horrifically frightening, long, painful labor (over 24 hrs.) and they were finally forced to use a suction machine on the top of his head to bring him through the birth canal. Again, they told me it was because of my size in comparison with the baby's size.

    Funny though, my next labor lasted a mere 20 hrs, maybe 15 minutes of pushing, and the little guy weighed 9lbs 3oz!

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    1. Hey, we're height twins! I'm 5' 2" as well! I'm so sorry the first two happened like that for you. Looks like you proved that diagnosis wrong with that last guy! A friend I know is smaller and more petite than I am and birthed her ten pounder naturally without even a tear so I'm thinking that the height and stature thing isn't always the best predictor. So many other factors to consider!

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  4. Mary
    We're expecting our 10th in Dec, and I'm assuming another 'big' baby;) My first was only 6lb9 but the majority of the others have been over 9lb (with the exception of 2 who were just under 9lb) our largest was 10lb5 all born naturally.
    so heartening to read this post to not feel so unusual:) Do you think some of this 'big' mentality is due the the increase of premies?

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    1. Congratulations on your tenth! That is awesome. Interesting about the preemies. I know the stats they take are for full term babies but I do wonder if because more and more babies are being taken earlier that if people are seeing these tinier babies and thinking that is the norm. I'll say some prayers for your upcoming birth!

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    2. Still on the subject of premies, when I had my son (10lb5) all the other babies were premies and I have to admit he was quite big, he filled the 'crib' at the hospital, end to end. oh and thought you'd be interested to know baby 2 & 3 were home-births. but we were transferred after no 3 to hospital, quite a tale, and hence hospital births since. But my hospital is so good, totally ask me what I want and we have shared care with the midwives:) and midwives deliver (all going well)

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  5. My first was 8 lbs 6 oz and everyone talked about how "big" he was... But he lost a ton of weight after birth, probably because his weight was SERIOUSLY inflated because of the amount of fluids I received during labor! I think it was the 15-inch head that made him seem a lot bigger than he was! The next 3 were smaller, but still with fairly large heads. And I was actually really impressed with our ultrasound technician with the twins - she was absolutely correct on their weights! I had an ultrasound at my appointment the day they were born and she was right on! But normally I know that's not the case :)

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    1. Those heads are important :) My babies' heads never did much moulding since I push so crazy fast (which caused other issues...) Interesting point about the fluids, too. I wonder how much he would have weighed without that? And how many other babies have inflated weights for the same reason?? I had a friend with a similar experience except that the staff freaked out because baby lost weight and they pulled some crappy stuff. She knew it was all just water weight but they were completely unreasonable. So sad.

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  6. My third was 8 pounds, 13 ounces. My first was 6 pounds, 13 ounces. I'd take the third over the first if I had a choice, because the third gained weight well, while by little 6 pounder struggled to gain any weight at all. My third is now 23 pounds at 9 months, while my first was a mere 15 pounds at 9 months. I find that ladies over 70 years old tell me how healthy my third looks, while younger women note how big he is (and not in a flattering way). I found with my first, younger women noted how tiny and cute she was, while older ladies offered us pity. I think it's perception and life experience. I think baby size follows what's popular in mommy size (ie skinny mommy's are in, and so are skinny babies). Ladies who remember struggling to feed their babies (ie in the depression, during the war) feel comforted at the size of my third, and fear at the size of my first. Like many things, comments say more about those making them then those receiving them sometimes. Those are my two cents...

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    1. That is super insightful! I never thought about it that way! Thanks, Melanie.

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  7. Three of our four babies weighed between seven and eight pounds. One weighed 8 lbs. 12 oz. That one was by far the fastest to deliver, slept the best, and had the sunniest disposition as a baby. And all were vaginal births with no medication. This leads me to prefer big babies, but I'm fond of all the babies to whom I'm related. :-)

    (Oh, and Rosie [see earlier comment] was #3, weighing 7 lb. 3.5 oz., taking about six hours start to finish. Easy birth, good nurser. Nice work, Rosie!)

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    1. I think that way about our youngest even though it was a harder birth in some ways, it's totally worth it for a more content baby!

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  8. My biggest was 8'1" so still not very big. He was by far my hardest and longest labor and most difficult to push out, but I don't think that is related to size. He had a short umbilical cord and I think was in a less than ideal position.

    I think there are a lot of factors going on that has to do with a particular mother can birth a baby of a particular size. I think in times past, people generally married people of the same ethnic group...so generally people of similar build and bone structure...but now you can have a mother with a very petite bone structure marrying someone with a very wide/stocky bone structure and it could possibly cause difficulties during birth. But there is really no way of knowing that before trying labor, so I really, really hate it when doctors do an automatic c-section for a big baby. That's just ridiculous. I have a friend who birthed 10 and 11 lb babies "easily" but she is very tall, big bone structure and was a big baby herself (like 12 pounds) while I have other friends who needed c-sections, and tend to be more petite women who married someone with a stockier, broader build. So, I think there a lot of factors involved.and actual baby weight isn't so much of a factor. Plus, even baby weight is misleading, because two babies can weight the same, but one may be longer and leaner while another is shorter and has broader shoulders, bigger head, etc.

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    1. All great points. I really am so tired of women being told in their first or second trimester while their lying lithotomy on a doctor's table that their pelvis is probably too small. It's such a load of garbage. At the very least look at her when she's full term, the relaxin has kicked in, examine her while she's squatting, etc. It all changes and those bones move so much!

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  9. I've never had a little one.... but someday! My concern about "big babies" is due to the difference between my husband and I! I was a seven pound baby who grew up to a whopping 5'0", 110 pound little wife, while my hubby was a ten pound baby who grew up to be 5' tall in the third grade, only to become the 6'6", 375 pound man he is today. Yeah, a bit of a difference there.

    I'm hoping the mama's size is more determinant of a baby's size than daddy's size is... otherwise I might be in trouble! Of course, my youngest two sisters were 8.5 lbs and 9.7 lbs at birth, and my mom's pretty little, so there's hope!

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    1. Definitely hope! That is a big size difference but I think often a mom's body and the baby will know when the baby is getting big and labor will be triggered by that. Trust that if your body grew that baby your body will be able to get him or her out. The best thing I think you could do in your situation is to find a midwife or doctor who doesn't routinely section for "big" babies. Ask them lots of questions in the early months about their protocol, whether you can move around in labor, positions for pushing, etc. If that freaks them out, then find another one. Thanks so much for stopping by and if and when you are expecting, feel free to email me whenever for any tips or encouragement!

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  10. I have had four children and my easiest ones were the bigger two- 8.14 and 10.4- the biggest was the quickest!

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  11. Thank you for having this conversation! When I grew 3 cm in one week with my second baby, my doc sent me to another office to get an ultrasound. The baby had grown that much and the ultrasound doc told me that I shouldn't be a "martyr" when it came time for delivery and ask for a C-section if I needed one. My son was born 2.5 hours after labor started at 9 lbs. 13 oz. He was posterior; I squatted to deliver him; the nurses almost had to deliver him because I had only been in the hospital for 29 minutes and my doc wasn't there yet; and I didn't tear. (I am 5' 9".) I hadn't planned to squat, it just felt right. The article that you mentioned indicated that squatting can open up the pelvis 30 percent. Fascinating! I've never heard that statistic. I could have used it when an on-call doc had to deliver my 3rd. My sweet doctor who knew my plan was on vacation and I met the man who delivered my third when he walked in during transition. I calmly told him that I planned to squat and he told me that it would tear me to shreds and that he had never delivered with a mom squatting. I am usually tactful, but I informed him that I would stick with my plan and it would be fine. He didn't say much else, but the delivery went well (again 2.5 hours from start to finish) and I had a much smaller son at 8 lbs. (I did apologize the next day for being rude and he did too for assuming that I couldn't do it.) I'm pregnant with number four and am planning to squat though I wouldn't mind if this kid stays below 9 lbs. It was really nice to not have to push after the head. My big boy's shoulders got stuck. Needless to say, he was meant to be big. He's four and a half now and still off the height and weight charts.

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    1. Good for you! So many women are scared into unnecessary and more risky interventions because of this. And it's kind of shocking that doctors don't realize that the pelvic opening can grow depending on position. I've known women who were told in their first or second trimester that their pelvis was just too small to deliver naturally! Never mind that the ligaments loosen at the end of pregnancy and that they were lying flat on their back for an exam for the measurement which is the smallest it can get! I've never squatted during but it definitely helps a lot of women. I always say I'll try it but in the moment I just am in whatever position feels right to me at the time…maybe this next time it'll be squatting :) Thank you so much for sharing your encouragement for other moms!

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  12. Mary, this is old but I hope you will get a notification. My #3 was only 8'5, but her shoulders became stuck on the way out. All was fine, but it was quite stressful and now I'm 31 weeks with #4 and experiencing some anxiety. In your experience, is this something that happens in subsequent births or is it an isolated event? I do suspect this Baby will be larger than my last. I know its silly to worry so, but alas, here I am...

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    1. Hi Holly, I'm so sorry you went through that! It must've been scary. While shoulder dystocia can be serious and the rates do go up for bigger babies, it's pretty rare and it's very hard to predict when it will happen. Having a previous one does seem to increase the rates but the bigger factor is the size of baby. When it does happen there are definitely things that can be done IF a midwife or doctor is skilled in it and often it's not a huge emergency if the midwife or doctor know some simple techniques. This link is a GREAT resource for learning more about it and maybe allaying some of the fears. http://midwifethinking.com/2010/12/03/shoulder-dystocia-the-real-story/
      It seems the best things to prevent a shoulder dystocia in the first place is to prevent gestational diabetes and keep mom free to move in whatever way she naturally does in labor so her body and baby get themselves lined up correctly and not rushing labor or pushing. Chiropractic care at the end of pregnancy can be helpful, too, as well as practicing some of the moves shown in that link at the end of your pregnancy to help you know what you can do if it happens again. It would be pretty unlikely for it to happen again but that might give you some peace knowing that you have a plan of action.. A doula might be helpful, too, in talking these things through and I would definitely recommend talking it through with your provider to know what their approach is.

      I hope this helps! I'll be praying for you!

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