Big Babies: The Medical System's Paradigm vs The Reality

Balancing Intuition with Knowledge After Providers Recommend Induction

Recently, I have seen a rash of women lamenting that their birth plans seem to be going out the window due to size prediction via ultrasound or even fundal height. While this can feel intimidating and scary, the reality is that there are several factors to consider before tossing your birth plan, and medical providers will often neglect to inform you about them. The kicker is that most women feel that the recommendation of an induction for a “big baby” is not what they want, but they lack the understanding and the embodiment to be able to decline or question their provider. While reading, keep an open mind: this article is not meant to shame, but to empower.

Most induction recommendations are not evidence based; modern maternity care is based on about 10% good quality evidence. That means 90% of recommendations

are based on conjecture or opinion. Ultrasounds are notoriously inaccurate. Typically, the prediction is within about 15% of the baby’s actual weight - plus or minus. Fundal height can also be tricky - if baby has moved, or is engaged in the pelvis later on in the pregnancy, it is very possible that the measurement may be off (this will typically indicate baby is smaller than expected, but shouldn’t be the only diagnostic tool). Any provider that recommends induction for results based on an ultrasound or fundal height alone is typically pushing for a controllable situation - they may be ignorant of normal, physiological birth due to overseeing only medicalized births, and may have no confidence in women’s bodies. They may be looking for an excuse for more interventions and/or are projecting their fear of birth onto the pregnant woman.

Outside of certain medical conditions like uncontrolled gestational diabetes or pelvic injury, a woman’s body will not make a baby too big for her to birth. The most commonly cited concern for birthing a “big baby” vaginally is shoulder dystocia - an exceedingly rare condition whose chance only increases in such cases as mentioned above (uncontrolled GD or structural pelvic issues). To mitigate this risk in women with these conditions and even in healthy pregnancies, being able to move freely in labor is invaluable. Using tools such as a birth ball, a rebozo, Miles Circuit, and moving intuitively are a few strategies to ensure proper positioning. Giving birth in a position that the woman feels is right - upright, squatting, on all fours, etc will usually contribute to baby’s proper positioning, open the pelvis and reduce the risk of a “stuck baby”, episiotomy, vacuums, forceps, and more. Additionally, a skilled provider should be able to work with you to adjust positioning and should know various techniques (such as the Gaskin maneuver) to dislodge a true shoulder dystocia.

In short, a “big baby” is not a medical diagnosis, nor is it a valid reason for induction in most cases. If you feel that you do not want to induce, and decide to trust your body, remember that you are the one in charge. It is your body, and your baby; you are the only one that can and will birth this baby, and the people providing you care have been hired by you. You are within your rights to say no, ask questions, or find another provider. Remember to consider B.R.A.I.N with any intervention that is offered - benefits, risks, alternatives, intuition, and doing nothing.

One of the best strategies to mitigate coercion and give you confidence in your maternity care and birth is to have a supportive birth team on your side. From your partner, a mother, a friend, or a doula, it is crucial to ensure that you are being supported on this journey and you have someone to hold space with you as you give birth. Additionally, doula care is associated with more vaginal births after cesarean, improved breastfeeding rates, and fewer preterm deliveries.

If you would like to work with me, you can find me and more about me and the services I offer on my website https://primalbirthdoula.wixsite.com/primalbirth or you can send me an email at primalbirthdoula@proton.me

Happy birthing!