Big Babies – Birthing a Macrosomic Infant – Part 2.
This is part 2 of a two part blog on ‘big babies’ please CLICK HERE for part 1.
So What are Your Birth Options with a Big Baby?
Having birthed four big babies myself and through my involvement in the birthing scene ever since, I have come to conclude that if you are carrying a suspected large baby then you need to put a bit of extra planning into planning the birth. I like to use the acronym ACE IT to help plan a big baby’s birth.
Remaining active throughout labour is important for all mums, but even moreso for mums expecting a big baby. Why is this? it’s a well known fact that being in a recumbant or semi recumbant (laying down/sitting back) position can reduce the pelvic capacity by up to 30% by preventing the sacrum from moving properly – that 30% is especially valuable when you have a larger than average sized baby on board. If a woman is left to birth actively, free from monitors keeping her confined to the bed, free from drips in her hands and free from an epidural leaving her confined to her back in bed, then she will instinctively move into positions that help her pelvis to open up and help her baby to rotate into the perfect position for birth. Many mums of larger babies will instinctively birth in a squatting or all fours position, also known as the Gaskin Maneuver - named after the inspirational American Midwife Ina May Gaskin.
Also consider using water to labour and/or birth in. Relaxing in a birthing pool can help you move into amazing positions that you may not ordinarily be able to remain in on dry land, the water helps you to relax, helps labour to progress more quickly and importantly helps you to remain active and keep your pelvis open.
This is all about what happens during labour if you are anxious. The major hormone released during labour, oxytocin, is incredibly fragile. If a woman feels scared during labour she will release catecholamines, the most well known of these being adrenaline. The release of adrenaline during labour causes two things to happen, firstly it inhibits the release of oxytocin, this causes the uterus to stop contracting effectively and can cause the labour to become erratic and slow, secondly when we release adrenaline we cannot release beta endorphins, nature’s own natural anaesthesia and feel good chemical. The contracting uterus also becomes starved of oxygenated blood which leads to a build up of lactic acid and thus pain (ever experienced severe muscle cramp?) and combined with the lack of release of our own natural pain killers labour becomes harder, longer and more painful (often known as “failure to progress”). By ensuring that the birthing mother releases as little adrenaline as possible we can help the birth to progress easily, safely and comfortably. By ensuring that she is confident about her body’s ability we can help her to experience the easiest birth possible.
One way to feel confident again is to read lots of inspirational books such as Ina May Gaskin’s “Spiritual Midwifery” . Marie Mongan’s “HypnoBirthing – A Celebration of Life” and Michel Odent’s “Birth Reborn” or by reading positive birth stories of women who have had easy births with larger than average babies. Perhaps your local NCT branch has a “big baby” mum on its experience register who may be happy to talk to you or perhaps you could consider classes such as http://www.hypnobirthing.co.uk/.
It may also be worthwhile looking into hiring a Doula. Doulas are non- medically qualified women who have experienced the ease and joys of natural childbirth. They view childbirth as normal, not a disease or sickness or something that a woman needs artificial help to achieve. A doula believes in a woman’s own innate ability to birth her own baby, she doesn’t so much support the birthing mother (as that would indicate that a woman needs more than her own wonderful body to birth her baby) rather she ensures that the woman can feel as at ease and undisturbed as possible so that the amazing act of childbirth can be, free from outside influences and therefore as easy and as safe as possible, she also helps antenatally by ensuring that the mother and father to be feel as confident as possible. You can find a qualified doula in your area by visiting http://www.doula.org.uk/.
All birthing women should think about the environment they will give birth in, often it’s a decision made very lightly without proper research. For mothers of big babies it is even more important that you choose the right environment for you – one where you feel safe, secure and above all else – relaxed. For some the close proximity of medical equipment in the hospital makes them feel at ease, for others they chose to remain in the safe environment they have nested in for so many months – their own home. In fact one could argue that if you are expecting a large baby, then the safest place for you to deliver is the place where you are least likely to be induced, constantly monitored, prodded and poked by registrars, timed and stuck on the bed with an epidural and also the place where you feel most comfortable of all – where would that place be? you guessed it – HOME!
I always swear that if my third baby (who weighed 11lb 3oz and had “sticky shoulders”) had been born in hospital, his birth would have resulted in a C-Section. I firmly believe choosing to birth at home with him (against my consultant’s wishes) gave me – and him – the best chance of a normal – and safe! – birth.
So, think about things that help you to relax and imagine the most relaxing environment you could be in to give birth, what is the lighting like? what noises can you hear? who is with you? what smells are there? what comfort measures do you have with you? Really work with the enviroment and on the day your work planning will pay off! You’ll find lots of tips in THIS ARTICLE.
As mentioned in previous pages, an induction for *just* a big baby is ill advised, it is not in line with statistical data and is not based on evidence based practice. When a pregnant mother is induced it opens the door to a whole cascade of interventions, it is often more painful and thus the chance of having an instinctive natural birth – so important for smooth & easy progress and no limiting pelvic capacity – is dramatically diminished.
If an induction is being suggested to you – question it!! if it is only for a “suspected
big baby” just say no!!
Another useful acronym for helping you out in this situation is remembering to use your “brains“:
Benefits - e.g: “what are the benefits of an induction?”
Risks - e.g:: “what are the risks of an induction?”
Alternatives – e.g: “what are the alternatives to an induction?”
Instinct - e.g: “what does your instinct tell you?”
Nothing - e.g: “what happens if we do nothing and let nature take its course?”
Smile - e.g: Remeber to be polite – be confident & assertive not rude & aggresive!
Chances are, if you’re reading this you’ve probably been subjected to extra tests “just in case”, things such as growth scans and Glucose Tolerance Tests (GTT). These tests have not been shown to increase the survival rate of mother or baby, they have not been shown to increase the health of newly born mother and baby and they have not been shown to decrease birth trauma. One must ask then what is the point of them? what exactly *do* they do? If you have no other risk factors, if you just have a perfectly happy and healthy baby, ask your midwife or consultant exactly what these tests will add to the wellbeing of you and your baby? how will they use the results? what will it mean for you to be under consultant led care? and more importantly how will you feel? your pregnancy and birth is rapidly spiralling from the “normal” camp to “abnormal” and “high risk” - I refer you back to the “CONFIDENCE” point above. Don’t just agree to a test – question what it’s for, what the results will be used for and question if it is really needed or is just a matter of protocol and policy.
I’ll leave you here with a picture of my son, who was born at home in a birthing pool after am easy 4 hour labour. I had no intervention at all and no need for any pain relief either. I enjoyed every moment of his birth. He weighed 11lb 3.5oz.
…and here is his sister who was born in a labour lasting less than an hour, again at home in a birthing pool, again no intervention, no pain relief and no perineal damage. She weighed 11lb 1oz.
Oh and by the way, I’m 5ft 1inches and wear a size 4-5 shoe.
Who said birthing big babies was hard?!
Posted on November 4, 2012, in Birth and tagged big baby, big for dates, Birth weight, Caesarean section, Childbirth, doula, Gestational Diabetes, Home birth, induction of labour, large baby, Large for gestational age, macrosomia, Michel Odent, Pregnancy and Birth. Bookmark the permalink. 1 Comment.