Childbirth

“Large” baby (macrosomia): Induction of labor or caesarean section?

The medical term for big baby is macrosomia , which literally means “big head.” A child weighing more than 4 kg at birth is considered large, while we speak of severe macrosomia when the weight is greater than 4.5 kg.
A baby is also called “large for gestational age” if his weight is greater than the 90th percentile at birth, in other words if he is 90% larger than all other babies born in the same gestational age.

Macrosomia or growth above 90% is often associated with gestational diabetes. Researchers have found that the higher your blood sugar, the more likely you are to have a large-for-gestational-age baby. However, women who manage and then compensate for their gestational diabetes through diet, exercise or medication reduce their chances of having a large baby. Cause of macrosomia are also: excessive maternal weight gain during pregnancy, multiparity.

Hospital assistance, for these women, provides for the induction of labor with drugs (there is a 67%), and the rest of the women try to self-induce labor, before the term, with natural methods (37%) . If induction fails, a caesarean section is planned (often caesarean section is presented as the only solution).

Why is the approach, in the case of macrosomia, so medicalised?

  1. Older children are at greater risk for shoulder dystocia . Shoulder dystocia is defined as any situation that requires the intervention of the obstetrician and gynecologist to help expel the shoulders.
  2. Induction before term prevents the baby from continuing to grow and therefore reduces the risk of having a caesarean. According to a recent study, inducing delivery at or near term when a macrosomal fetus is suspected would reduce fractures and birth weight.
  3. Laceration of the perineum . It is possible that women who deliver large babies are more likely to have severe (3rd or 4th degree) perineal tears. However, there are conflicting studies! For example, there are 3rd and 4th degree lacerations even with normal sized children. Although a large baby may be a risk factor for severe lacerations, movement in labor, free positions at delivery, and unguided pushing may reduce this risk.
  4. Postpartum hemorrhage. Women who give birth to large babies may be at increased risk of postpartum hemorrhage. In a large study, researchers found that women who gave birth to babies weighing more than 4.5 kg were more likely to have postpartum hemorrhage (1.7%) than women who had normal-sized babies. . But on this point, it’s not clear whether this higher postpartum hemorrhage rate is due to the size of the baby or whether it was a medicalized delivery (inductions, cesarean), since both of these procedures can increase the risk of postpartum hemorrhage.
  5. Neonatal complications. One study compared 2,766 macrosomic babies and found they were more likely to have low blood sugar after birth, “wet lung,” fever and birth trauma.

In summary for physiological pregnant women

If your gynecologist says your baby is big, based on ultrasound use or your size, know that they’re wrong about half the time.

About 7-15% of older children have difficulty with shoulder birth, which is known as shoulder dystocia . This is why healthcare professionals get regular training in the treatment of shoulder dystocia.
Although very early induction (37 to 38 weeks) may prevent the onset of shoulder dystocia, very early induction may carry other risks for mother and baby.
Having an elective C-section for older babies is harmful. Simply because, going back to the first point, in half of the cases the child has a normal weight. Then a free caesarean will have been done.

For mothers with diabetes or gestational diabetes

Management of gestational diabetes (diet, exercise, or drug therapy) reduces the chance of having shoulder dystocia.

Dr Kathryn Barlow

Kathryn Barlow is an OB/GYN doctor, which is the medical specialty that deals with the care of women's reproductive health, including pregnancy and childbirth.

Obstetricians provide care to women during pregnancy, labor, and delivery, while gynecologists focus on the health of the female reproductive system, including the ovaries, uterus, vagina, and breasts. OB/GYN doctors are trained to provide medical and surgical care for a wide range of conditions related to women's reproductive health.

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