The Ultrasound Revealed My Baby is Big – What Now?

If I sympathize with any aspect of late pregnancy most, it is hearing the news that your baby is “big” or “too big”.  Our family grows big babies.  I was born a bit over 9lbs. (my mother’s first child) and my husband was born 10lbs. 13oz. (his mother’s first child).  So, when I became pregnant for the first time, I didn’t expect a tiny bundle at all. 🙂

My sweet baby was born on the day I turned 38 weeks weighing 8lbs. 13oz..  She was 20.5in. long.  This is her picture on the day after she was born.  You may read a version of her birth story here

My second baby daughter was born at 41 weeks 6 days.  She was quite a bit bigger.  She outweighed all the other babies born at the hospital that day by at least 3lbs.

My Mommy Received Prenatal and Birthing Care from a CPM!

She was born 11lbs. and 22in. long.  Her birth became complicated for several reasons, the main one being that she was not in the optimal position for birth.  My daughter settled in occiput posterior position at around 8 months into my pregnancy, and did not or could not move.  Neither of us were “in danger” during labor, but labor wasn’t going to progress because she was having a hard time fitting into my pelvis to help my cervix properly dilate.

Am I having a big baby?  Should I expect complications?

It is my firm belief that a healthy, active pregnant body will not grow a baby it can’t birth.  No matter if you believe we were created or we evolved, it would not make sense for a species to not be able to give birth to their offspring without medical or surgical procedures putting them at risk for permanent or fatal damage every time a baby was to be born.

In 2000, ACOG (American College of Obstetrics and Gynecology) released a statement regarding the management of fetal macrosomia (“big baby”).  This statement is no longer available to view online, but the American Academy of Family Physicians has their explanations of the ACOG statement online for public reading. 

As I experienced with my first pregnancy, depending on how your care provider views a baby of larger proportions, you may be faced with the decision of inducing labor early or elective cesarean section for fear of a complicated vaginal delivery.  When making this decision there are two things to keep in mind, both recommendations from organizations who set medical standards for maternity care.

A study comparing fetal weight estimates of clinicians, multiparous patients and ultrasonography found that ultrasound was the least accurate of the three methods.13 Limitations in the sensitivity and specificity of ultrasound have been observed in other studies.15 Despite these limitations, clinicians continue to incorrectly believe that ultrasound is an accurate way of predicting macrosomia.17

-AAFP – Am Fam Physician. 2001 Jan 15;63(2):302-307.

This is saying that both maternity care providers and mothers who have experienced pregnancy before are more accurate at predicting the weight of  babies with their hands and feelings than is the technology of ultrasound.  Ultrasound technology is more accurate in determining size during the first trimester of pregnancy when it is often used to determine fetal age. 

The second recommendation is disregarded often in modern maternity care often with a long list of reasons to accompany suggested medical procedures for birth.

Labor and vaginal delivery are not contraindicated for women with estimated fetal weights up to 5,000 g (11lbs.) in the absence of maternal diabetes. – AAFP – Am Fam Physician. 2001 Jul 1;64(1):169-170.

Why do we grow “big babies?”

The biggest determining factor in whether or not your baby will be above the average weight at birth is the presence of gestational diabetes, but what about genetics?  The following information from an abstract on a study of genetics and the determination of fetal size suggests that while size is largely an inherited trait, when the uterine environment (conditions inside the womb and mother’s health) are compromised in some way (or in subsequent pregnancies) the mother’s genes which restrain fetal growth are not as effective.

Size at birth is said to be a highly heritable trait, with an estimated 30-70% of the variability a result of genetics. Data from family studies may be confounded, however, by potential interactions between fetal genes and the maternal uterine environment…. This suggests that fetal genes, and in particular paternally expressed genes, may have significant effects on fetal growth during pregnancies where maternal restraint of fetal growth is less evident. 

So, where a father’s genes encourage growth, the maternal genes put a “check” on growth when in the optimal situation can have the potential to keep babies at a more average size.

So, if it is genetic, there is nothing we should do or worry about… right?

Worry never does much good for anyone, but I am of the opinion there are important things to consider when trying to conceive or while pregnant if the potential for growing a larger than average size babe is present.  I don’t say this because I don’t believe that we can give birth to large babies.  My great grandmother gave birth to my 12lb. grandfather at home with no complications.  She stood only about 5’4″.  She is not the only woman whom I’ve heard or known of birthing a large baby with no trouble at all.  But, I would be wrong not to admit that a larger baby has the possibility of leading to a more difficult birth.

This possibility is important to discuss because for some of us it is the reality.  Most Americans in general do not eat a diet of healthy foods, even if they feel that they might.  Our commercialized food culture has us eating more and more processed foods.  Even many of the foods advertised to us as “health foods” are not in their “whole” form.  Processed foods are not nearly as nutrient dense as whole foods.  This can leave even the “healthiest” of individuals nutrient deficient.  Our intake of refined white flours and sugars is immense with detrimental effects on our hormone production and our ability to metabolize food properly.  Because of this (along with other factors) we are seeing a rise in obesity and diabetes.  Combine this with a culture who leads a far more sedentary lifestyle than our ancestors and we see women entering into pregnancy in an unhealthy state. 

If we look again at the earlier quote from the study of genetics and my earlier statement that a… healthy, active body will not grow a baby it cannot birth, then it becomes clear, that while not always the case there is a chance that because of less than the most favorable environment in the womb due to a mother’s lack of proper nutrition and inactivity (with nutrition being the biggest factor of the two) our body can grow a baby that is larger than it would have under better conditions.

Take also into consideration the birthing environment the majority of mothers will experience.  In general, is there access to freedom of movement?  Are women birthing in the all fours position?  Squatting?  These are often the best positions for giving birth to large babies.  Are women given continuous, experienced support?  Are they given time to work with their body and change positions as they feel the need to help the baby move through the pelvis and into the birth canal?  Can women feel their body and baby and respond to the sensations they feel?  All three of these things are helpful for any birthing woman and especially so for those of us who will birth larger babies. 

If you know you have the make-up to grow an above average babe, be mindful throughout your pregnancy and make healthy choices.  Eat a diet that consists of most whole foods with plenty of protein.  Look into pregnancy diets (not dieting) like The Brewer’s Diet and Real Food for Mother and Baby by Nina Planck.  Follow the basic recommendations for pregnancy eating set out by the March of Dimes if this seems to overwhelming.

Stay active while being responsive to the needs and demands on your pregnant body.  Rest when you need to, but also exercise.  There are so many benefits to regular exercise in pregnancy.  A recent study determined that exercise in pregnancy can result in a more average sized babies than those of mothers who do not exercise.

Choose a birthing environment/care provider that will be supportive of you moving throughout your labor and birthing in an upright or all fours position.  Movement does tremendous things for the progression of labor.  Follow the recommendtions on Spinningbabies.com to help ensure your baby is positioned well for birth.  Also, know that many of the complications that can result from “big baby” are determined by more factors than baby size.  For example, shoulder dystocia (the most serious complication) occurs in only 1.4% of births and including births of babies of normal size. 

A big baby does not mean automatic early induction or cesarean is the safe option for your birth.  That is simply counter to the medical standards for the managing of care in suspected fetal macrosomia (big baby).  I write this article as the mother of two “big babies”.  Someone who has a personal invested interest in this topic.  Also, from someone who trusts that in most cases birth will go normally when a mother is healthy and baby is healthy.  I hope this post is helpful to those of you looking for information.

What has been your experience with “big babies”?

Many happy days to you and yours,

Kelli

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About Kelli

I am Kelli B. Haywood, LCCE, a childbirth educator certified through Lamaze, a birth doula, and prenatal yoga instructor. My two little girls light my life. I am the wife of artist, musician, and teacher - John Haywood.
This entry was posted in Babies, Birth Topics, Healthy Pregnancy and tagged , , , , , , , , , , , . Bookmark the permalink.

13 Responses to The Ultrasound Revealed My Baby is Big – What Now?

  1. Feona says:

    Very informative post. Thanks for sharing.

    Take the test ABC’s of Pregnancy and find out your knowledge of things you are supposed to do and more importantly, what you are not supposed to do during your pregnancy.

  2. Teresa says:

    I am not quite 5′ 2″ and weighed 120 pounds when I became pregnant with my second child. My husband was 6′ and not a thin man, was around 1o pounds when he was born and was the smallest of his siblings at birth. I took Bradley childbirth classes and followed The Brewer Diet to the letter. My daughter was 9 lb 12 oz at birth, I was nearly 42 weeks along. She was healthy, alert, and I had NO difficulties birthing her. We were in a hospital but I spent most of my time avoiding nurses so I remained upright and active throughout labor. As a doula I get SO frustrated when I see/hear an OB or worse, a midwife, talk about how they think the baby is huge and automatically assume the woman will have troubles during labor and birth. How about trusting in her body’s ability?

    • Hannah says:

      Wow! Teresa, I know exactly where you’re coming from. I’m 5′ nothin’ with a small frame(although weighing more than I should have lol), my husband is 5’11 and was 9lbs 11oz at birth. His 2 siblings were both no less than 8lbs 13 oz. However, I was 4lbs 15oz at birth, and full term. So I had hopes that our baby would follow in my footsteps. No such luck. Sure enough, I had an 8lb 1oz baby who measured 21″ long. I was in labor for 41 hours while on Pitocin. I got an epidural around 35hrs once they maxed out the Pit dosage. I ended up needing a c-section because I stopped dilating at 5cm. I was devastated. I kept worrying that I would have the same problem with my future children. But after reading your post, along with some other research I’ve been doing, I fell so much better! So thank you much for sharing your story!

  3. Birth True says:

    Thanks for commenting. I think this is a perfect example of a healthy woman growing an “above average” baby that her body could and did birth. 🙂 I too do not understand how (especially given there are no medical standards or scientific research out there that justify this) doctors or midwives can automatically expect complications. I think it just admits insecurity either in their ability to handle complications and/or the issue of high malpractice insurance rates. It seems like it would work the opposite too. In my case with my second birth, there were several other complications that arose that were only exacerbated by my daughter’s size. I don’t believe my daughter’s size was the determining factor in her birth outcome. Though I do believe I could have been healthier in my approach to eating during my pregnancy. I believe if I were to be pregnant again, I would grow a big baby and most likely birth vaginally with no complications. In general I am a much healthier person now, than I was then.

  4. Carrie says:

    It’s funny that I’m reading this! I’m 36 weeks this week and at our 32 ultrasound three weeks ago, the doctor told me the baby was already 5lbs. If I make it to 40 wks, we’re looking at 9lbs! You can IMAGINE my response after a 7lb, and a 7lb 6oz baby! This was a 3D ultrasound since I am hypothyroid (supposedly has small babies…ha!) and the doctor is very conservative so I kind of believe him. I have another ultrasound in 2 weeks I guess just to see how its going. I can’t wait to see if he was right but I am worried about them trying to push an induction. They’re known for that. But I’ve resisted twice now. 😀

    • Birth True says:

      Carrie, if you feel healthy, I would say there is nothing to worry about. As the link here mentions late pregnancy ultrasounds are not very accurate at predicting size. So, even if it tells your doctor 5lbs., it could be wrong. You’d only be looking at 9lbs. if your baby gained a pound a week for the rest of your pregnancy. Assuming you carry to 40 weeks. WebMD says your right on track. That site says baby should weigh about 5.5lbs. at 35 weeks, and as you look further through the weeks, it assumes baby will gain about 1/2 pound a week.
      Try not to let it make you nervous. Even if your baby were 9lbs. it wouldn’t be a problem. If you are healthy, and your baby is positioned well for birth – you are able to be up and moving through labor, it should be fine. Trust your body and go with your intuition. Sending you peace for your third birth!!! 🙂

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  7. Tonia says:

    I had a problem with shoulder dystocia with my second child. I am 5’3 120lbs prepregnancy and gained maybe 40 lbs. She was 10 lbs. I am pregnant again and I am really scared that this could happen again. I am gaining at the same rate as with her and I am wondering if I already had this problem once, if I should push for an induction. Am I more likely to find myself in the same situation again?

    • Kelli says:

      (((HUGS))) Tonia. Try not to be afraid. Shoulder dystocia is not as common as we might think. Simply because you had it one time, it does not guarantee it will happen again. All maternity care providers should be trained to resolve a shoulder dystocia with relative quickness. Check out this site, and share it with your car provider. http://www.spinningbabies.com/spinning-babies-and/resolving-shoulder-dystocia There is also information there about preventing it.
      It is my opinion that pushing for induction would not be your best option. Induction is hard on both mom and baby and it comes with too many risks without a real medical emergency justifying its use. Here is what the spinningbabies site says… “Inducing labor to prevent the baby having time to grow big is not statistically found to reduce the incidence of shoulder dystocia. That may be because the powerful effect of Pitocin, the artificial hormone to make strong uterine contractions to induce labor, moves the baby down fast enough that a few of these babies, though smaller, don’t have time to rotate their shoulders for birth. Meanwhile, inducing to force the birth before baby finishes growing is a common, and risky, occurrence.”
      Think about lots of movement in labor. Mamas birthing chunkier babes need freedom of movement and position changes in labor. Squatting is a good position to push in because it widens the pelvis, or standing, all-fours positions.
      It would be good to have a doula with you during your labor and birth. She might be able to offer some suggestions that will help things move along in an optimal way.
      I hope this helps some. Sorry I was long in replying. Things have been hectic. Let me know if I can be of anymore help.

  8. Shandy says:

    I was afraid when I found out that my baby is around 8.5lbs. in the 8 month, imagine I am around 5’4 in height and my child is huge, I am so afraid then but I was able to make it on normal delivery. I found out that fear is non-sense in time of delivery, and what you must do is talk to your child and let your child know that you love him so much and you are excited to see him. What I did was I asked my baby to help me and we can both make it. What happened was in 5 minutes after talking to him he came out.

    baby ultrasounds

  9. I am 6 weeks pregnant and I am doing a lot of research about me not gaining weight as well as my baby. Is there any diets that I can do? Because in my case I am already a chubby person and am afraid in gaining more weight as well my child. Thanks!
    fetus ultrasounds

  10. Layla says:

    I’m confident that the fact that I had an active home birth saved my baby. After a peaceful first stage and a productive empowering start to the pushing stage, he got stuck after his head was born. After seven minutes, of trying various positions, he was born. After a few seconds, he started to breathe and had no issues. He was 10lbs 5oz (I’m 5’4″,). If I’d had an epidural or any sort of inactive labour, I think the outcome would have been far worse for both of us.

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