In the final weeks of your pregnancy, it starts to set in that you will actually have to birth your baby. EEK!
Lots of emotions there!
So when your doctor drops a bomb saying that your baby is “measuring big”, it can really ramp up the anxiety and leave you doubting your ability to have the birth you’ve pictured.
Let’s sort through the myths and facts about Big Babies (aka fetal macrosomia) so you can have an informed and empowered birth experience!
Fetal macrosomia is a condition where the fetus weighs more than 8 pounds 13 ounces (4,000 grams) at birth.
Risk factors for fetal macrosomia include:
- gestational diabetes
- obesity in the mother
- family history of large babies
Diagnosis is usually made through ultrasounds or other prenatal tests, although they are often WRONG!
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Trish: [00:00:00] My name is Trish Ware and I am obsessed with all things pregnancy and birth and helping you to navigate with the practical and the magical seasons of this journey called motherhood. I'm an all day coffee sipping mama of seven. I've had the amazing privilege of delivering many babies in my 15 plus year career as a labor and delivery nurse and as a mama of seven.
I'm here to help you take the guesswork out of childbirth so you can make the choices that are right for you and your baby. Quick note, this podcast is for educational purposes only and does not replace your medical advice. Check out our full disclaimer at the bottom of the show notes. How
are you guys? Today we're going to talk about big babies. We're gonna talk [00:01:00] about small babies, we're gonna talk about what happens when you get news you don't want to hear, and how to handle that without letting it just tear apart your birth plans. And I know you guys know what I'm talking about.
Just when you hear something that... is surprising. But we're going to talk about the big things first because there's a lot of things that seem to be the norm here lately that providers like to use to get you to agree to an induction. But I first want to make sure that everyone knows that it's not Trish versus all providers because I absolutely adore a lot of providers.
Like some of my closest friends are obstetricians and midwives. [00:02:00] There are unbelievably incredible providers, but there's also this subset of providers who have like an agenda. And so I want you guys to be armed with knowledge, to be armed with power, and to remember no matter what, it's your experience, it's your pregnancy, it's your birth, and it's your baby, so you have every single right To make decisions.
Now, I was telling the girls in Fearless Birth Experience, and in particularly last night after the workshop, I hung out with my LNM mamas and my VIP mamas on a Zoom, and we were talking about refusal. And one of the things that I want you guys to know, that even though I'm talking about big babies and bullshit, I don't want you guys going into your birth and [00:03:00] refusing.
Everything just because you can so that's not what I'm saying here. Like you don't go in going. No. I don't want it No, no way. No. I don't want that. I don't want that. Nope. Nope. Never. You're not going into your birth saying no to everything just because you can. You can do that. But I want you to sit back and think, is that wisdom?
Is it smart to go into your birth and say, I will never do la. No, it's not because I can guarantee you if you are laboring and your baby's heart rate goes down into the 40s and we have tried everything, you damn well, you're gonna do whatever it is to save your baby. And that is why we're there. And that's why interventions are there.
They're not there. So someone can [00:04:00] go home or go to their child's soccer game or make more money. They're there for emergent reasons. They're there for necessary reasons. So that's what I'm passionate about. I'm passionate about arming you with the right information so that you understand when it's necessary.
So that You are the driver of that ship, so you know okay, I've taken Trish's birth class and I know that this is an absolute necessary time for that intervention to be used and I feel peace about accepting it. Or I feel peace about refusing it. I don't want you willy nilly refusing or accepting anything.
I don't want you accepting it just because you feel like you should. And you don't feel courage to say no. I don't want you accepting it because, Monday night on Fearless Birth we talked about [00:05:00] Being a people pleaser. This is not a time to be a people pleaser, hell no. You're not going to just accept things because you don't want to offend your labor nurse because you want to be that patient and everyone to like you.
No. This is your birth. You're not going to people please during your birth. You're going to stand up for what you want, because it's your birth. And five years from now, I want you to remember your birth and love it, not to remember it and feel dissatisfied or feel like, God, what if that random lady on Instagram was right?
What if I had listened to that labor nurse? What was her name? The one that said that I shouldn't have been induced because the baby was big and the baby came out and she was only six pounds. Like God, I should have listened to that labor nurse because here's the deal about big babies. Here's the truth about big babies.
They are most often wrong. And if you look at some of my [00:06:00] posts on Instagram where I ask how big was baby, that's one of my most popular posts. You guys, when I say how big was your baby? What was baby's weight? Because this is something that touches everyone's soul, because I can't tell you how many times I have been the circulator for a primary cesarean for a big baby that turns out to be a not big baby, to be a little baby.
To be a six pound baby or a seven pound baby, or maybe even an eight pound baby, which isn't a big baby. I'm five, six. I tell my husband I'm five, seven. I'm five, seven y'all. But my son was eight pounds. That is not a big baby. I pushed him out just fine. Here's the thing. I have done primary cesareans.
Which means a first time mama cesarean for a suspected big baby That comes out to be a small baby and [00:07:00] then guess what the provider says this baby wouldn't have come out of your vagina. Anyway, this baby wouldn't have come out your pelvis. Your pelvis is small Do you know what that is? That's making excuses because they realize right when they see that six pound baby, Oh crap, don't call me out on this one.
Because it's not a big baby and they just did a freaking major abdominal surgery on a oopsie. So that is why I'm so passionate about you guys. Not falling into the big baby trap. You do not have to have an induction or a c section for a suspected big baby. And in fact, ACOG, who governs this stuff, says that suspected macrosomia, which is big baby, management according to ACOG is.[00:08:00]
vaginal delivery. Okay. So suspected macrosomia alone, which means if you have diabetes or you have something else going on, then you may have to, you may, there may be a different option. You may need to be induced. But if it's just suspected macrosomia or suspected big baby, you need to give your body a chance.
Your provider needs to give your stinking body a chance because your body needs to tell you, I can't do it. And guess what the chances of your body telling you that it can't do it. It's slim. I get so passionate about it. And here is the next thing I want to say to you guys. If you take a birth class, and obviously I want you to take mine, this is why I do what I do, and I know what I know.
I [00:09:00] know that I am passionate about what I teach. I know that I'm going to walk hand in hand with you, and my students will tell you that when you join our birth classes, you get us intimately. So I obviously want you to take my classes, but I know you need to take a class. Do not take a hospital class.
They're going to teach you according to their policies. And here's. The thing that is going to damn you if you do actually, in fact, have a big baby. Here's the number one thing that's going to shoot you into the O. R. Here's gonna put you on the fast track to the O. R. to get you right in line with all the other mommies walking to the O.
R. Laying in the bed, not moving, being strapped to the monitor and not moving, that's going to put you on the fast track. Because the number one thing you can do if you do have a big baby or even if you don't have a big baby, the number one thing you can do is work with your beautiful body. Because our bodies are incredible and our bodies are not meant to be like [00:10:00] this during labor.
Our bodies aren't meant to be like that at any time. Our bodies are meant to be fluid and in movement and rhythm. Everything we do in life is meant to be in rhythm. If you think about it, if you're nervous and you're sitting at your desk when you're in school or you're at work, what do you do? You start finding a rhythm if you're nervous, right?
It's a rhythm. If you're holding a baby who's crying. You find a rhythm. When you're in labor, find your rhythm. And I'm going to be teaching that tomorrow night, how to find your rhythm. That's part of your labor coping tools. When you are pregnant and in labor, when you're laboring, finding your movement and your rhythm is the key to bringing your baby through.
through your pelvis. So if you have a suspected big baby, and I say suspected because chances are equally as slim because ultrasounds are notoriously wrong either way. So you might be [00:11:00] thinking you have a normal size baby and end up with a big baby. So no matter how you look at it, you need to be moving in labor.
When you get up, and use gravity, you can open your pelvis by 28 to 30 percent. 28 to 30 percent you guys. So if you get up and you're moving and you open your pelvis by 28 to 30 percent, you can help your baby move down and through your pelvis. On the flip side, what do they want us to do when we're in labor?
Where do they put us? What's the first thing that happens when you walk into your labor room, or you walk into triage? What do they do? They have us put on a gown and lie down. Stupid. It's stupid, right? Yes. Knees in, ankles out, 100%. We need to stay up. So one of the things that I coach my students and my L and M mamas to do [00:12:00] is to stay up.
You can do your admission process standing by the bed. No thank you. I'm going to stand up. You can answer questions standing up. You can get an IV squatting by the bed. You can sit on a birth ball by the bed while they're doing your admission questions, while they're starting your IV. I've started a mini IVs sitting next to a patient squatting next to a bed.
A good labor nurse can start an IV upside down on her head next to a bed. A good labor nurse can check your cervix no matter what position you're in. If your nurse can't, she can get one who can. They can monitor your baby next to the bed. I want you guys to be ready when you get to your labor room to say no.
One of the things that I've said every night this week at the end of my free classes, is if you don't know your options, You don't have any. So if you went into your birth tonight [00:13:00] and you didn't know that bringing your knees in, ankles out, opened up your pelvis and you're pushing and they're telling you that your baby is not coming down into the pelvis and they say something like this, which is said all the time.
Mom baby's doing okay right now, but we ought to consider going back for a c section because nobody wants a, a baby in a bad situation. And they say this all the time, right? So if you don't know your options, you don't have any. So this is why we dedicate all of our time to educating, because we want you to know your options.
Because if you say, hey, let's try this, because to try that, your team might not try that. Just because they are birth professionals doesn't mean they know all these things. things. I can 100% tell you that part of my career, I didn't know all these things before I started taking classes outside of what the hospital [00:14:00] taught me till I started doing spinning babies classes and all the education I did outside of what the hospital taught me.
And I stopped doing the hospital policies. So now let's talk a little bit about. Small babies. I wasn't going to talk about small babies, but I really want to talk about that as well because I've had a lot of that lately. So if you've been told that you're having a small baby, I want to go to that side as well as big baby because it's the same thing, but Obviously opposite.
A lot of you guys get told that you need to be induced because your baby's small. And that one is near and dear to my heart because I was told the same with my daughter. So my daughter is small because Her birth father is small and I was small. She is a small girl. She's 17 and she's small. Her body is small.
She's not [00:15:00] disproportionate, right? So there is a difference between a small person and A I U G R which is intrauterine growth restriction. So I want you to know the difference. So you need to get clarification if your provider is saying that your baby is not growing or could it be possible that mama is small or daddy is small and baby is going to be small.
So I would definitely I would definitely get clarification on that for sure because you want to know The difference like if your baby is not getting nutrients and not growing, that's a big difference between, Hey, I just make a small baby. My family is small. My baby is going to be small. There's a big.
big difference. So you want to have clarification because again, we don't want you doing anything unsafe. There are really [00:16:00] good reasons for inductions if baby's going to be safer outside of you. So when it comes to small baby, you have to get a clarification. Is my baby getting the nutrients my baby needs to grow?
And if so, is my baby just going to be a small person like my Lainey because she is just small? Or is my baby not getting what it needs to grow? And is maybe one part of my baby growing okay, but the other part not growing? As well. So that's the clarification. So if your baby has been diagnosed with IUGR, that's much different than just SGA, which is small for gestational age.
One of the conversations we've had with our LNM mommies lately is about GDM. And if I'm GDM, do I need to be induced? If you are GDM or gestational diabetic and you're on insulin or your blood sugars are not [00:17:00] controlled, Then, chances are high that you need to be induced or something untoward is going on.
Then, again, there might be a medical reason that you and baby need to be separated sooner than later. So that's where it gets a little gray. However, if you are gestational diabetes and your diet controlled and your numbers are in the good range and you're doing good and baby's doing good. What's the difference between you and someone who doesn't have diabetes?
If your blood sugar is controlled, you're doing good and baby's doing good. What's the difference? My rationale is nothing. You're both healthy and you're doing good. Diet controlled, you've done your job. They've taught you how to handle it and you're handling it. So in that case, what Linnea and Taylor and I do inside the labor bat signal with that mommy is [00:18:00] we will help them navigate a dialogue with their provider.
So say the provider's we want to induce you at 37 weeks because you have gestational diabetes and studies show that you should be induced, blah, blah, blah, or whatever. Then we have them ask for the study. Print the study, and then take it home, non emotionally, walk through it at home with their partner, walk through it, come back and say, hey, I've read it, my diet, I've diet controlled, baby looks good, how about...
I come in, I agree to testing. We do some NSTs, some BPPs, and we go to 39 weeks with testing, and then we revisit the conversation at 39 weeks. Come back at 39 weeks and then push it to 40 weeks. At 40 weeks, push it to 41 weeks. And you take baby steps and push it to where you want to go.
And where you're comfortable with [00:19:00] going instead of just, Oh no, I'm not being induced and just leave it willy nilly. You take baby steps to where you actually want to go. And that's how we work it with our LNM mamas. And one of our GDM VBAC mamas had her baby almost in the car yesterday.
So go Jessica, we love it. And they were really pushing her in all sides. to have a C section and she did it and we're so proud of her. So another one would be gestational hypertension. Hypertension is another one. If it's controlled, if you are having no issues with it, you can have a conversation.
Now with hypertension, this is a little, this is one where even though, someone said the other day that I'm crunchy with the side of medical, I am. I am crunchy with a side of medical and hypertension gets me a little bit. I get a little uncomfortable. So I would definitely, you want to make sure that [00:20:00] you're watching it.
We have a lot of our mamas who have white coat syndrome. If you tend to have good blood pressures at home and they spike at the office, I would have a conversation with your provider. Talk about it. Really talk about what's going on and see if you can work out different scenarios where maybe you can figure out how to calm down.
One of our mamas, we figured out between all of us, we figured out a way where she can have her blood pressure taken later in her office visit instead of right when she gets there so that she has time to de stress and to get past that white coat syndrome. You want to come up with different ways.
So if you find yourself that your blood pressure spikes every time you go to the doctor, but it's fine all the other times of the day, every time you take it at home, then let's come up with a plan. So that's another way that we help our students through [00:21:00] our virtual support. It's really important to think outside of the box.
Don't think narrow minded. A lot of times your providers think very narrow minded. Let's think about you as a whole person. And that's part of why I named this big babies and other BS because another one of the things is high BMI or advanced maternal age. I for one am really tired of a blanket diagnosis and them taking like every single mama over the age of 35 needs to have this, that, and that done.
All of us need to be induced after this. No, because one 42 year old who's pregnant. might be way healthier than some 25 year old who's pregnant. So does she really need to be induced? Or maybe this 25 year old who has gestational diabetes, who has high blood pressure, who has this, that, and the other, she might need to be [00:22:00] induced.
But this 42 year old who works out every day and goes running and eats healthy might not need to be. They need to look at each woman individually and make decisions based on her, not on a blanket statement. And I'm really passionate about that. When I'm talking about testing, when I said NST and BPP, so an NST is a non stress test.
So if you're a high risk or you have some diagnosis or. If you go past your due date or what have you, an NST is checking, how is the baby doing under no stress? So labor is considered stress. So we want to see how is your baby doing when you're not in labor. So we're going to hook you to the monitor and we're going to watch how the baby's doing when you're just chilling, right?
Non stress test. A biophysical [00:23:00] profile is where we're going to do an ultrasound and we want to see a score that is eight out of eight is perfect. And we're going to do different, there's different scoring mechanisms of the biophysical profile so that we can see that baby is doing good on the inside.
And that's how we see. So if your baby is passing the NST, passing the BPP, then there's no reason the baby can't stay inside of mama. So that's why I say compromise if they want to induce you for big baby or other BS and do a, an NST, do a BPP so that you can just compromise with them and stay pregnant instead of being induced.
Because ultimately being induced, there's more risk and you have a higher chance of going back for a cesarean. Spontaneous labor is going to win when it comes to vaginal delivery by far. Anyway, hopefully that was beneficial for you [00:24:00] guys. All right. Have a great day. See you guys later.
I hope you enjoyed this Instagram live all about big babies and other BS. You have to be educated to understand your options so that you can make informed decisions. This is so important. Our birth classes are going to educate you. We do not beat around the bush. Okay, hit subscribe. We'll see you again next Friday.
Bye for now.