"Management" Of Large Babies: obstetric versus midwifery approaches

Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448. Link

The obstetric approach to "managing" a suspected large baby:

The management of pregnant women carrying large babies needs a holistic approach and regular assessment during labour ...

Managing the delivery of large babies is challenging for clinicians and there is no consensus on this. Sonographic assessment of fetal weight is frequently inaccurate ... the fundal height [must be] adjusted for maternal variables such as age, weight, height, ethnicity and birthweight in previous pregnancies. A holistic approach is required taking into account all the different variables.

During labour regular assessment of progress is required, continuous electronic monitoring of the fetal heart rate should also be performed because of the increased oxygen requirement of the fetus. Rates of shoulder dystocia are also heightened the larger the baby. Prompt assessment and management of this are critical during labour.

... induction of labour for suspected macrosomia in non-diabetic women has not been shown to reduce the risk of caesarean section, instrumental delivery of perinatal morbidity ...

The midwifery approach is not focussed on blowing out of proportion what *might* go wrong, but rather taking an awareness of what *might* go wrong and then supporting the natural process of birth to assist what can go *right* to happen. This will include such things as upright positions for labour and birth, encouragement for natural methods of managing the senastions of labour such as water immersion in a deep bath, hot packs, showers, massage, mobility and being supported by trusted and caring family and a midwife. Other things are also improtant if the midwife suspects a large baby. The midwife will share her concerns with the woman, enabling the woman to make informed decisions about how she wishes her labour to proceed. Many women will opt to await spontaneous labour, because labours that start by themselves more than likely end up as spontaneous births with no intervention. It's impotant in labour that the baby is given time to descend and rotate. This is assisted by position changes and upright positions. Walking, lunges, deep squats and all-fours / kneeling positions are helpful. Midwifery is very much about being aware of what might happen (not blindly disrgarding risks) and then supporting the natural physiology of the birthing woman to provide the optimal chance of birthing normally.

Melissa Maimann, Essential Birth Consulting 0400 418 448