One of the most common reasons I've heard for induction of labor is that the baby will be too big. We know that induced labor is more painful than natural labor, and "medicalized" so to speak. We know that induction can raise the chances of cesarean.
There is evidence that the pelvis expands during childbirth. We know that ultrasounds are not 100% reliable on predicting a baby's size. [From ACOG, referenced below:
Weighing the newborn after delivery is the only way to accurately diagnose macrosomia, because the prenatal diagnostic methods (assessment of maternal risk factors, clinical examination and ultrasonographic measurement of the fetus) remain imprecise.]
Still, women routinely are induced based on a baby's size.

I am very curious if women are truly being given a choice. If this is the reason given for induction - why not believe a doctor who tells you that your baby is probably too big to be born vaginally? If this is what a woman is made to believe, why would she choose to let nature take its course?
I believe in informed choice. I also believe this is an example of choice not truly being given to a patient.

Here is my personal interest in this issue.
Ten years ago, my cousin was induced because of her baby's size. The induction was managed horribly, her baby was stuck in the birth canal for 3 hours and finally, a c-section was done. He weighed around 8 lbs. He now suffers from cerebral palsy due to lack of oxygen. His head was twice its natural size and purple at birth.
I am not blaming the induction - exactly - she should have received labor support beyond uncaring nurses and yelling doctors. But I do wonder how the outcome would have been if nature had been allowed to take its course - natural labor, freedom to move, all the things that facilitate successful birth.
I wonder how different Kendra Wilkinson's story would be also - though thankfully, her baby is 100% healthy.

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Many of my friends have been told their babies are too big and are induced early or given csections. One of my friends wanted a vbac (her first baby was "too big" as well) but was told she could only have one if she went into labor on her own TWO WEEKS before her due date (hello!). After that, she "had" to do a repeat csection. Another friend was told that the baby broke her tail bone because it was too big (less than 8lbs though) instead of the fact that she was on her back during birth. Now she's going to be induced early and is terrified of having a big baby. I don't think there really is a choice given to women. I think women put too much trust in their care givers who often don't understand why it is a big deal. I also feel that women don't understand 1) the risk of csection and repeat csection 2) the battle for a vbac 3) that in the case of having 2 csections, some doctors won't do any more and you could be told you can't have any more children. I just feel that so many of the woman I know having babies are told that their babies are too big or just big - like a scare tactic. I believe in NY state you can no longer induce before 1 week over due unless there is a cause... maybe this is the new "cause".
Like I said in another thread the best birth I have been to as a doula, was the all natural birth of a 10lb 7oz baby, who was 23+ inches long and had a 15.75 head and chest. It was the birth of one of my closest friend's son, and she has said to share the story to help inspire others. The mom is a small lady, when not pg she is 120-130lbs and 5'3" with a smaller frame. She was in early labor when she woke up the morning of 40w3d. She brushed it off as nothing and went about her day. By the afternoon she knew that this was most likely it and went shopping to get stuff for her other kids. Later in the day she helped her husband cook and took care of their two year old. When things go closer together she would spend her contractions on the ball or up and swaying while trying to keep herself occupied with the kids. After dinner she got their little one ready for bed and laid down with her and caught some choppy sleep. After that she showered and made sure things were in order and left for the hospital.

We got to the hospital around 12:30am and when she was checked she was 7-8cm well thinned. She refused the IV, pain meds and the BP cuff. She did however agree to 30min on/30min off of monitoring. She spent the next hour or so on the ball chatting and breathing through contractions. Her OB came in and she asked him to break her water, which got her to 9cm and almost fully thinned. Her OB kept commenting on how great she was doing, and how this is what labor should look like and that she should do this for a living and so on, which made her laugh. After her water broke things started to get a little more intense and she got up off the ball. She did a lot of rocking while holding on to the chair/me. I did some counter pressure and back massages, as well as encouraging her(and her husband).

At 3:30 AM she said she was feeling more pressure and wanted to be checked. She was 10cm and 100%. She told everyone she was tired and wanted to rest and did not want to push. We got her in a sitting position in bed, and had her use the stirrups as a leg rest to help open stuff up. Her OB got suited up, but said it was just as a precaution in case things went fast. He asked her if she wanted to push and she tried once and said no, she didn't want to. At that point we put the squat bar up and put a bed sheet around it to use as a pull. At every contraction she would pull on the fabric and breath over the contraction and then take a little nap, letting her body pushing the baby down. The OB just sat all suited up waiting for her go ahead. His only request was having the monitor on, which she didn't mind.

At 4:30ish am she asked me if I could see a decent amount of his head and I said yes, pretty much the whole top. After that she reached down and agreed she was willing to push. The OB offered to let dad do the catching, but he declined(he doesn't do blood well). She pushed at her own pace, deciding when she wanted to push and for how long. After 5 or 6 pushes baby Nolan was born at 4:59am and put right on mom's chest. She had very little vaginal trauma(almost no swelling) and a very small tear that only needed 2 or 3 stitches. Her OB said she only tore because of the 4th degree tear she received after a huge episiotomy with her first baby. He said if she hadn't been cut like that the first time she most likely would have been tear free.

When I tell most people this story they say she was only able to do it because it was her 4th baby, but her, I and her OB all agree she was able to do it because of how she approached labor and her support team. Her other births which i will describe in a second were nothing like the last, which she says was her easiest by far, even though he was so large.

L&D-1: Age 18
She was induced at 42weeks with pit because that was policy. She asked to get out of bed, as she wanted to walk and move about, but the nurses said no. After 22 hours of pit induced labor trapped in bed she decided to get the epidural around 6cm, which pleased the nurses. After another 10 hours she was at 10cm and was told she had to push even though she didn't want to. She pushed for 3 hours with little success. The OB resident proceed to cut a VERY large episiotomy and inserted the vacuum to try and pull the baby out. When that didn't work they used forceps. The baby was 8lbs on the dot and mom was left with a massive tear. She was so traumatized she didn't even want to see the baby(who had been whisked away to be cleaned).

L&D 2-Age 21
Because of the first experience she refused to be induced unless there was a concrete reason and spent a lot of timing finding an OB who would agree. Finally she found one who would listen. She went into labor the early am of 43w3d. Around 8am she woke her mom up and told her she was in labor, but wanted to stay home still. her mom refused and off they went to the hospital. She was 4cm when they arrived at 10:30am. The contractions completely stopped though upon entering the hospital, mainly from the free of the last experience. She was encouraged to walk around and try to relax. By the afternoon things picked up again and labor was in full force. She labor around the room free to do what she wanted. She was 10cm by 7ish pm. She was told by the nurses she had to start pushing and on her back she went. She pushed for over an hour before the OB arrived. When the OB got there she helped her change positioning and had her start pushing again. Still she felt nothing. Finally after 2 hours of forced pushing she finally got the urge and her little girl was born a little before 10pm weighing 8lbs 2oz. The nurse went on to tell her if the baby had been any bigger she never would have been able to deliver her, which mom thought was BS. She had a decent amount of swelling from all the pushing, but only needed a few stitches and felt amazing compared to her first birth. However she still felt like she had not been listened too and things could have been a lot better.

L&D-3 Age:31
When she got pregnant with the 3rd she decide she wanted a MW when she was in her 3rd trimester. Things were going well till her water broke at 38w2d. She waited for 5 hours for labor to start. She did walking, spicy foods, nipple stim and so on, but not a single contraction. Her husband started to get really nervous and pretty much forced her to go to the hospital(this was his 1st baby). At the hospital a MW she had never met was on call and after the exam yielded that mom was only a finger tip along she ordered pit to be started. The new midwife came on call and was very annoyed pit had been started and said a balloon induction would have been much better, which was upsetting for mom. Too much time had passed though to change. After 14 hours of pit, mom was exhausted and got the epidural at 5cm. She slept from there on out and was 10cm when she woke up 6 hours later. She told the MW she wanted to push at her own pace and she agreed. Her little girl was born around 1am after an hour of pushing and over 25 hours of labor weighing 7lbs 14oz. She had a 2nd degree tear again, which she attributed to the epidural. She felt like she had been listened to by the 2nd midwife, but wanted that high for the natural birth again.

So while she had given birth to other babies in the past, they were all 2+ lbs smaller and were somewhat traumatic births. She 100% agrees if she had gotten an epidural or been induced that her birth with the 10.7lb baby would not have been enjoyable and could very well have ended up in a c/s. She knew her body could do what it was made to do, if she was allowed to let it. I think this is true for most mom and if we walked away from this induction and epidural obsession, and allowed birth to do what it is designed to do, that many more women could have the experience she had.
I have had so many friends who have been told that their babies are too large, and then "forced" to induce or have a c-section. I say "forced" because while they technically have a choice, once they were caught up in the hospital system they didn't really understand what their rights or other options were. All off these friends (about 5, a small sample) ended up having babies less than 9 lbs.

There is definitely a culture in the U.S. of smaller babies and feeling that any baby of 8 lbs is large, or even too large. I had my first son in a birth center, and at exactly 37 weeks he was 6 lbs, 13oz, and the smallest baby I have seen on the board there ever. Most babies born there are in the mid-8 to mid-10lb range. The largest baby born there was over 12lbs. I think it goes to show that healthy women with healthy pregnancies can absolutely safely deliver larger babies without interventions if they are given the chance and allowed to go to term.

The only way to change our culture is to continue to be advocates for midwifery, home birth, and malpractice lawsuit reform. Hope this was helpful!

I actually think liability plays a big part in this scenario. My bet is that most doctors recommend this due to the fear of malpractice.



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