Delivering a Bigger Baby Boy with Mother with Gestational Diabetes.

Hi N. - Hang in there and don't rush to c-section. My second baby was also quite large -she was 10 days late and ultrasound predicted she'd be about 9 lbs. My doctor mentioned the possibility of shoulders getting stuck, but she ended up being 8 lbs, 14 oz and I delivered her just fine vaginally. Just because the baby is large does not mean that you automatically need a c-section. Best of luck for a healthy delivery!
J.

I second calling a mid-wife about natural methods for turnign a baby.. there is a lot of yoga poses that can encourage this... also, you might consider seeing a chiropractor who specializes in pregnancy and fetal positioning. it might be worth a try since you still have a week or two.

It sounds like you'd rather go natural with this one too (and I understand that... did with my first too.. hoping to do it again with second) but also remember that it is about surrendering to the "event", if a c-section is part of that plan, then so be it. try what you can to get the baby to move, try and relax and let go of control too... the prize at the end is the same wonderful bundle of joy.
:)

Hello there,
I too had agestational diabetes and a breech baby. My doctor said he cold try turning him but that generaly it doesn't work and the baby will flip right back to the breech position. I was scared to death of having a C-section but had to do it. In the end everything went smoothly. The c-section wasn't nearly as bad as i thought it would be with a surprisingly quick healing time. Do what you feel is right and everything will be fine. Good luck and congrat on baby#2 :)

You might find the info at www.spinningbabies.com useful. It has some ideas for how to encourage a breech baby to turn to an AOL position before birth. I was trying to avoid a posterior presentation with my second, because it made my first labor so long, so I crawled around on my hands and knees cleaning my floors while I nested. We had the cleanest floors ever, and i am sure this helped him rotate into position--it was my easiest birth by far.
I also suggest reading "Ina May's Guide to Childbirth," since you are natural-childbirth-oriented and this book has many positive birth stories, including one about a mom who was worried about not being "big enough" to have her baby naturally--her fears were unfounded and her baby came beautifully.
This is your second baby, so, as my midwife says, "the road has been paved." If you are not using energy feeling stressed or worried, you can let your body do its work and let your baby out. I just had my third, and while I did not have gestational diabetes, this baby (at 9 pounds, 5 ounces)was a full pound heavier than my second, who was a full pound heavier than my first. I have a friend who had a baby who was 11 pounds at birth, which seems *enormous* to me, but she had a comfortable, unmedicated birth and all went smoothly.
I would hesitate to put all your faith in ultrasound. . . weight estimations can be off by quite a bit and I'm not convinced that an ultrasound-based weight estimate is a good enough reason to undergo major abdominal surgery. Your body can probably accomodate your baby if you're allowed to shift around and walk while in labor, and planning for normalcy has a lot more benefits for everyone than planning for a cesarean. Of course you have to trust your care provider, but I would want to know the odds he is thinking about when he suggests there might be problems, since my personal bet is on the well-supported mother every time. Have you considered using a doula to help you during labor?
P.S. I second the idea of contacting a midwife skilled in turning breeches. I have heard there is a birth center near Boise--is that near you? Those midwives could be useful for their opinions and help. Many midwifes and even some obstetrician will catch a baby who comes breech without doing a cesarean, so the breech position is not always a definite cesarean. It depends on your care provider's lawyers, frankly. best wishes!

I had a 9lb 3oz baby with shoulder dystocia (huge shoulders) and I had a perfectly natural wonderful birth. My whole labor was 3 hours and pushing, even with the dystocia, was 8 minutes. I had to have an episiotmy, but I still birthed him naturally. I suggest switching doctors to someone who is willing to catch a vaginal breech.

Try a chiropractor to turn the baby--they have an adjustment that will turn the baby 90% of the time :-)

My first reaction is that the fear of big babies is overexaggerated in the medical community. Not that it's not riskier, but it's not as risky if you are in good positions during pushing. On your back in stirrups like the standard hospital birth is the worst position. My mom had a few 10 lb babies at home with no other problems than a longer pushing stage.

At this point in your pregnancy, ultrasound is not very accurate. Drapplebaum.com has a booklet about ultrasound. He says that a due date determined by ultrasound between 29-40 weeks can be 3 weeks off. I teach Bradley classes; in my folder of studies & articles, one study found that because of the risks of c-sections, it would be better to improve pushing techniques so the baby doesn't get stuck than to c-section for a big baby. One thing that can help are squatting, which makes the pelvic opening the biggest it can be. Also, a traditional technique that is even being taught in med schools today is the Gaskin technique. The Gaskin technique is turning the woman on her hands and knees if the shoulders do get stuck. It's named after the midwife Ina May Gaskin, who says in every case of shoulder dystocia she saw, hands and knees worked.

However, a breech baby is also another issue. Doctors who deliver breech are getting fewer and fewer. Delivering breech vaginally does not increase infant mortality, but a earlier poorly-done study does show an increase. So doctors don't know the hands-on skills to deliver breech anymore. I do know a doctor in Salt Lake that would deliver breech, or I know home-birth midwives would be more likely to deliver breech. The best thing would be to get the baby to turn. There are several options to consider besides external version (that your doctor said he'd do). Moxibustion by an acupuncturist(burning incense near the foot), the Webster technique by a chiropractor, and the froggy position (knees and chest together while on the ground) can encourage the baby to turn. This website has more details:
http://www.birth.com.au/Info.asp?class=603&page=15

Good luck!

Hi N.-

I would recommend that you do seek further opinions from both midwives and doctors. U/s are quite inaccurate for estimating size, so that may not be accurate. Also just because the baby is larger than your first doesn't mean that you can't deliver it vaginally.
Second not all doctors are equally skilled at external versions. Another poster said that versions are not safe, which isn't true, they have very low risk. (and I have seen one done using hypnosis relaxation techniques that was not uncomfortable for the mother) It is important to keep in mind that all the studies about breech birth show that it is higher risk, even if the birth is done by c-section, so if you can turn the baby it is better no matter which manner of birth you end up with.
There are benefits to having a scheduled c-section, but there are also downsides. It is important to be certain that your babies lungs are mature, c-section babies have more breathing problems so it is even more important that your baby reaches term. That being said it may be worthwhile to wait until labor comes, seeing then if baby is vertex or not. There are also risks and benefits to having labored before you had your cesarean so that could be a factor as well, especially if you plan more children and would want the opportunity to have a VBAC next time (especially if you are planning a large family as the risks for each c-section and subsequent pregnancies get higher with each operation).
I'd suggest you visit the International Cesarean Awareness Network website www.ican-online.org - familiarize yourself with some of the numbers, risks and benefits. Talk to some other providers in your area and then follow your instincts.

-H. (birth doula and student midwife)

Hi N.,

I completely understand your worries. My first born was breech, late and ended up being 10lbs 2oz (I am a small framed person) and so it was a tough delivery. Luckily,I had a doctor that was willing to work with me. We were able to delever him and he was fine, beautiful and thriving and now 10 years old. I would talk candidly to your doctor and if let them know your concerns. This is your body and your baby and while I am sure your doctor is only doing what s/he thinks is safe you need to speak up and let them know what it is you really want. Good Luck!!

N.,
I have read all of the responses to this point, and want to put my two cents in. I am an ICU nurse, who put in my years in Labor & Delivery. This is only my opinion...from what I've tended to, seen, and experienced myself.

You have several issue to think about. #1, the size of the baby, #2 your gestational diabetes and #3 his current breech position. This puts you in a diffucult spot. Any of these issues would be something to deal with alone, let alone all three together. I understand your desire to go natural, however I would also urge you to consider the other points of a C-Section. I know that it's scary, and to be totally honest with you, external version (manually trying to turn him before birth) is quite painful for many women...and not always sucessful. Also, shoulder dystocia is a very real concern...not just for the risk of permenant limb/arm injury, but for the baby's travel through the birth canal and his sucessful/healthy delivery.

I may be playing "devil's advocate" here. However, I would never want for you and your son to experience a traumatic birth. Being prepared and educated is SO important, and brave of you...BRAVO! Best of luck to you and your family!

U/S can be wrong by up to 30% in determining baby's size...the closer to the due date the more wildly inaccurate they are. So don't go by an U/S for size. Find a competent midwife, they are generally more accurate.

My DS was breech and had him via Cesarean. Not my first choice, but in the end that's what worked for all of us. C's are not ideal, but not as bad as people (including me!) can make them out to be. They do have advantages: scheduling, quick birth, little pain, quick recovery, etc.

I am a huge proponent of non medicated, non intervention births. But after having two babies that would have resulted in a bad outcome for me, I have finally realized modern medicine has its place. Breech births are one of them.

My oldest sister had an unusally large (11 lbs. 14 oz.)gestational diabetes baby and if she had to do it again she would have demanded a C-section. Due to being stuck and being pulled out with forceps at the last minute when it was too late to do the C-section her son had a pinched nerve and was born with a dead arm. He has always been on disability, did therapy and had surgery. Now his arm is still shorter and doesn't have a range of motion. He would have been born perfect if she had insisted on the C-section.
Communicate with your doctor what your wishes are and make a birth plan that fits your perfect scenario but you will also feel good about if you need to go C-section.

I don't have the exact situation, but was almost diagnosed with gestational diabetes. I consistently measured 2-3 weeks larger than I should. At 38 weeks I was measuring 41 wks pregnant - haha right??? No way, I wanted that baby out. The Dr was nervous about the baby's size as well and scheduled to be induced a few days before my due date so I wouldn't go overdue for the baby to get bigger. I ended up going by myself and he was 8 lbs 6 oz, so a good size, but not huge. My old boss delivered her baby boy naturally at 11 lbs - yikes!! I would do what your Dr recommends. Maybe inducing you early and see how you progress and if the baby doesn't descend down to the birth canal then - csection. Although you wouldn't want the shoulders to get stuck because then that's a scary case when the baby is right there and wont' come out. Normally the head is the largest part of the body and the rest follows. Ultimately, I would go with what your Dr recommends.

Hi N.,

You also have to consider YOU!!

My first was 10 pounds and 22 1/2 inches longs. I did not have gestational diabetes, just a really big baby. My experience...my doctor tried using the forceps and that is not work. So I had to have an episiotmy and my baby was still stuck so we used the sucken cup. Still did not help. Had to have an emergency C-section.

So I had to recover from natural birth and a c-section. My husband had to help me off the toilet at the hospital because the pain was so intense. And I have a high pain tolerance. At home it was take me about 5-10 minutes to sit down or to stand up. But I had to have help standing up for the first four days. I had to have my baby handed to me to feed him. I really felt helpless for that first week. I was also on a high dose of pain meds too.

My second was a premature and she was 6 pd 8 oz. Had her a emergency c-section too. But I recovered much quicker. When I got home I cleaned the house, nothing like the last deliverly. And the scar you cannot really see. It looks like the edge of a paper.

So if I were you...consider a C-section. For you and your baby.

I am a mother of almost 3, 3 years, 18 months and due any minute :0). Both my girls measured big for my due dates, and both were on the larger size. My 3 year old was 8lb 10oz and my 18 month old was 10lb 8oz. The weight for my 18 month old wasn't so much the issue as the size of her head and shoulders. Her head was acenclitic (spelling),cocked to the side, so she had to be pushed back up in order to straighten her head. After that she progresses well until we got to her shoulders, she had shoulder dystocia (spelling), her shoulders literally stuck and they had to be pulled out by my mid-wife. Her head was 14 1/4 inches and her shoulders were about the same. That having been said, she was delivered vaginally and at home, with no tears. It was by no means an easy birth, but it was doable and both she and I were happy and healthy at the end. We were both exhausted at the end to say the least.

I think the biggest concern would be the fact that your little one is breach. If they can get him to say head down, then I wouldn't worry too much.

In the end even if the labor is hard (which is inevitable with larger babies) and you tear, you will recover more quickly and with less complications even if he gets stuck than you will with a C-section. If you plan to breast feed and you have a C-section, you will be delayed in being able to get started and this will complicate the process or even make it impossible to breast feed at all. Just food for thought.

Hope this helps. Just breath, it is possible to birth BIG babies. It never ceases to amaze me how the female body can stretch the way it does :o).

-M.

I'm not a doctor. . .but as others have said, the medical community is often very eager to overestimate the size of babies to encourage cesarian births to cover their own butts. I have had two babies, both 12 days late, both 10 pounds, both without pain meds. It can be done!

As for breech - investigate how late babies can turn on their own, I've also heard that external inversion is very painful and not always successful. But trust yourself. Your body is an amazing thing. Cesarian births are not the end of the world but don't be motivated by fear.

My first was big 9lbs 4oz with a 16 3/4 solid shoulder and 15 3/4 head. There was no way I would be able to deliver him. Unfortunately I went to a midwife and she didn't catch that he was going to be big. So she decided to induce me because he was late and it ended up that I was in labor for a long time and he became in distress. I had to be rushed to the operating room and have an emergency c-section. With an emergency c-section you don't get to see your baby right away. He went to the nursery and I went to recovery for a couple of hours. If your doctor doesn't think your baby won't fit and that he suggests a c-section I would take it instead of trying to deliver and end up with an emergency one. The twins were a planned c-section and I was able to see them and they went to recovery with me and we all went up to my room together.

There are so many of pros and cons for both . The best is for you to trust your gut. Call a midwife to ask how to turn a breech baby naturally not maually. I think the goal is a safe baby and a safe mommy. Manually turning a baby is not safe in my opinion. A breech baby is natures way of telling you to have a c-section . Good luck and god bless