This is my first pregnancy and two days ago I had my 37th week exam. My chosen midwife is currently on vacation so I had to see a different midwife. I have had absolutely no issues during this pregnancy - it has been a dream. However, this substitute midwife was very alarmed by how much weight I had gained and how large I was measuring at this point. He suspects the baby may weigh as much as 9 pounds currently and is worried about me going to my due-date or later and having to deal with shoulder dystocia. He decided to schedule an ultrasound for my 38th week check-up and if he is right, he wants to induce right away. My chosen midwife is not back from her vacation until after this ultrasound and I am not quite sure how to handle the situation from here. I have been planning on having a completely natural childbirth and really want to avoid induction with any sort of pitocin or other drug. Any ideas?

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I am a grad student finishing up my nurse-midwifery education and we learned about induction based on estimated fetal weight...this is the upshot...IT IS NOT EVIDENCE-BASED. Ultrasounds in the last month of pregnancy are known to be unreliable and have a range of accuracy from 1 to 2 pounds, or some say 10-20%. Therefore, no matter how "large" someone thinks your baby is, it is always somewhat of a guess. Most shoulder dystocias are unpredictable, and inducing everyone who might have a big baby is thought to have an unfavorable risk/benefit ratio. That means that the risks involved with induction outweigh the benefits when you look at the actual well-designed studies. Granted, having an ultrasound if you are measuring large for your dates is a totally fine, recommended thing to do. You might have extra fluid, or you might carry your baby in a way that makes your measure bigger. We can't look inside an accurately tell the baby's size no matter how much we want recommendation is find a midwife-friendly OB/GYN who has a good track record for non-intervention unless necessary, and have your second opinion with her or him after your ultrasound. If the doctor recommends waiting and thinks you are fine, that opinion will override the recommendation of your substitute midwife. OK, I just noticed that you posted in July, not yesterday. That means you already had your baby Kayla! Tell us how it went! I hope you had a great birth regardless. Thanks for the discussion.
I totally forgot to let everyone know how things went! I consented to have the gel at 40 weeks and 5 days. It did not kick start my labor as hoped so I left the hospital. 4 days later, I started having contractions at 5 am. They weren't very strong or very regular so I went about my daily business - getting last minute preparations taken care of. Around 2 am, I called my doula/sister to come help me with contractions while my husband caught up on his sleep since he was coming down with a cold. We went for walks outside, bounced on a yoga ball, ran up and down stairs and I even tried hanging in trees to get my labor to intensify. Around 7 am, we decided my contractions were regular enough to go into the hospital. Around 10 am, my midwife broke my water in hopes of getting my baby to drop into the birth canal.
This really intensified my contractions. I was hoping that meant that they were actually going to settle in and regulate themselves and help open my pevis. I labored in the shower, on a yoga ball, walking around, on all fours, every position imagineable. By 2:00, I was still only at 4 cm, my contractions were incredibly intense and still irregular in timing. Around 4:00 I had a contraction that lasted 25 minutes. This is when I began to panic. I couldn't imagine going through labor for 6 more cm and then pushing this baby out. I could also feel that the toes had beome lodged under my ribs. After 2 more hours of these incredibly long and intense contractions and no more progress in the dilation, we decided that the best thing would be to try an epidural and pitocin to try and regulate my contrations so that they were of more use. I knew that this meant I had a good hance that I would require a c-section. I received the epidural at 9:00, it only got me to 7 cm and my contractions never regulated. At midnight we decided that it was time to move to a c-section as the heart rate was starting to fluxuate.
The c-section ended up being extremely difficult. The doctor thought that it would only take about 20 minutes after they made the firt cut. It turns out that they cut me open, had to use both the vacuum and forceps and it took over 30 minutes to get the baby out. He really was lodged up under my ribs and would not have come out if I had tried to push.
Thankfully, I had a great surgeon. After 44 hours of labor, she delivered my 9lb and 9oz, 21 3/4" baby boy, Elias James.
Wow! Good job! I think moms who have these kinds of births are have to deal with so much uncertainty. I admire your desire to do things the best you could and in making informed decisions. I'm glad everything turned out ok.
The baby's position helps explain why your contraction pattern was so strange. It sounds like his head probably wasn't pressing down on the cervix properly for you to contract and dilate effectively. Amazing story! Congratulations on the birth of your little boy!
this issue is probably over for you now.I hope it went well. to anyone else reading this: I just delivered by natural birth an 11 lb 2 oz baby at home. the labour lasted 1 1/2 hours and he was delivered on the toilet! (not in!) with a midwife in attendance. Lucky for me we didn't know ahead of time he would be so big. Everything went fine, it was a beautiful birth.
That's awesome Kristin! Congrats!!!!
My second baby was born 41 weeks 6 days. 42 weeks I think it is like the cut off right? I was scheduled to induce but finally she decided to come on her own. So I say wait. She was a big baby too ... 2 ounces shy of being a 9 pounder.

The baby comes the baby comes on his or her time when she is ready. What is this data on shoulder dystocia? Are you a smaller size woman with narrow pelvic? I am 5 feet 4 inches tall and my pre pregnancy weight was 145 lbs. and at about 40 weeks marked I was 160 lbs. I also had gestational diabetes.

It is better to think of the pros and cons about this induction. If the baby is in grave danger then yes do it now do not wait, but I will want real hard data on this fear of shoulder dystocia.
I wouldn't worry about ultrasounds, how much is your fundus measuring? It is normal to be 2.5cm either way of how many weeks you are but if it is over that then still worth to have a look but still one or two centimetres than that shouldn't be too much to worry about.

I would just wait until your normal midwife comes back and chat with her. There is no way that the ultrasound can be completley accurate for weight so the ultrasound cannot really "make sure" that the doctor is right. So say no to the induction if the ultrasound is saying bub is big and say you would like to wait until your midwife comes back to discuss any major interventions that may need to be done.

Here are a few links that may help you....

It is better to have a trial a spontanious labour even if you are measuring big with no other problems rather than being induced or having a csection WHICH a csection is more likley with a pitocin induced labour as you already probably know



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