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Advice re vaginal birth, previous macrosomia

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#1 GreyhoundLover

Posted 13 November 2019 - 12:38 AM

My second baby was 5kg and I managed to have her vaginally (just) although there was shoulder dystocia requiring a McRoberts procedure and a grade 3a tear. Luckily baby was completely unharmed.

Recovery from tear was generally good, no incontinence except maybe a tiny bit when Im playing sport and have to sprint and lunge. I was really worried about what sex would be like post tear but it is actually still amazing and I want to keep it that way!!!!

Im pregnant again and OB was initially recommending a C/S but now he seems to have changed his mind and is leaning towards vaginal birth, provided successive growth scans dont indicate baby is over 4kg. My first baby was a 34 weeker weighing 2.27 so i dont know if she wouldve been massive and I just grow big babies, or whether my second daughter's size is just a random occurrence.

I guess what im wondering is am I mad to attempt a VB with my history? Can i trust the growth scans? Am I likely to just wreck myself and wish Id gone for a caesarean? Im really torn!! (Excuse the pun...)

#2 Expelliarmus

Posted 13 November 2019 - 01:03 AM

My first weighed 5kg and I had #2 (4.5kg) and #3 (4kg) vaginally as well.

I regret doing so and if I could do it again I would have caesareans.

I'm wrecked and it ain't pretty. For the first few years afterwards I was fine but the prolapse of everything a decade and more later is really quite depressing.

#3 ritten

Posted 13 November 2019 - 05:06 AM

I had a mcroberts procedure also with my over 5kg 3rd baby resulting in broken tailbone for me and prolapse and broken collarbone and badly bruised/dented skull for baby. We both had extensive bruising and just general body pain for weeks afterwards. Recovery for baby was long and uncomfortable

We were both extremely lucky however.

The last scan the night before I was induced estimated baby at 4kg...a whole kilo smaller.

I will not choose to have a vaginal birth again after that, and was recommended as much by doctors on discharge and post birth follow ups.

My other babies were around 3.8 kilos so over 5 kilos was a shock.

I would ask your doctor to explain their reasoning for you to make sure you are fully comfortable with whichever decision you make.

#4 Soontobegran

Posted 13 November 2019 - 06:14 AM

For me personally I would not be encouraged by scans showing a smaller baby as growth scans are +/- 500gms and it is very hard to determine shoulder size which of course is the determinant when it comes to dystocia.

Big babies deliver vaginally most of the time but with the history of one with large shoulders I just would not do it. Even average sized babies can have shoulders disproportionate to their body which means SD is very often a total surprise. With the knowledge at hand I would definitely be opting for an elective C/S.

I am so glad you had no negative effects from your previous delivery......I guess I am just a bit coloured by my experience as a midwife though.

Good luck, I understand your confusion here.

#5 blimkybill

Posted 13 November 2019 - 06:15 AM

My first two were 3.88 then 4.64 kg, vaginal but with forceps. When the third came along I was determined to have a vaginal delivery.  I did see an OB who recommended caesarean but also ordered growth scans at 34 or 36 weeks. These indicated a not too big baby. I chose to go ahead with vaginal. My baby was 4.84kg, had shoulder dystocia, and hhad a resulting nerve injury  (Erbs palsy) . Although her arm function partially recovered she has lifelong impacts. So I made the wrong choice.
I feel like the growth scans can't be trusted.

#6 GreyhoundLover

Posted 15 November 2019 - 09:56 AM

Thanks so much for all the advice and sharing your own stories, I really appreciate it because they have helped me make my mind up.

Reading those I think it is pretty conclusive that the safest option for me by far would be a caesarean, I think there is really no reason for me not to, apart from needing to stay longer in hospital and I won't get the experience of vaginal birth again (which does make me a little sad but the most important thing to me is that the baby comes out safely).

Thanks again for the advice - will be opting for a caesarean.

#7 panda eyes

Posted 15 November 2019 - 11:20 AM

My 3rd baby was induced at 37 weeks and was only 3.5kg, but he had a huge head. He's since been diagnosed with an overgrowth syndrome and has significant macrocephaly so it's lucky I didn't go to term because I wouldn't have been able to deliver him vaginally.

As it was, I found the delivery really really hard. My first two babies literally popped out in under 10 minutes so the extensive pushing to get him to descend (and then feeling all the tearing) was so disheartening. I also had a mcroberts and 4 extra staff running into the room at the last minute to get him out safely and the last few minutes were pretty scary for me despite being off my face on gas and air.

Despite having 3 successful vaginal births and fairly good recoveries I wouldn't do it again if there was clear macrosomia or macrocephaly. I have some lingering bladder issues and it just wouldn't be worth risking exacerbating those if I could have a nice controlled Caesar at 38 weeks instead!

#8 littlepickle

Posted 15 November 2019 - 11:36 AM

I had a 3.5 kg baby vaginally first time at 38 weeks and 4.1 kg at 41 weeks with Mild shoulder dystocia (Required McRoberts ). His head circumference was 36.5 cm completely unmoulded (so despite being small I must have descent pelvic structure) but a wide shoulder diameter which is much harder to predict.
If I had a third I would have considered elective induction at 38 weeks (I also have GDM)
A good obstetrician should be able to ‘feel’ the approximate size on abdominal palpation - noting that anything over 4.3kg becomes really difficult to ‘gestimate’
Discuss the risks with your doctor in relation to elective induction at 38 weeks verses C/s at 39 weeks.
Good luck

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